From September 2020, the Nursing and Midwifery Council expects all education programmes, including those relating to prescribing, to operate under new standards.
penny franklin prescribing opinion piece
This will mean nurses can begin to train for community practitioner nurse prescribing qualifications (through a V150 programme) immediately after receiving their PIN – instead of waiting two years.
This change looks set to increase the number of nurse prescribers and has the potential to improve patient care. (Though for this to really take off the formulary used by community practitioner nurse prescribers needs looking at as it is over 20 years old and requires updating.)
Another change the NMC is introducing means nurses in all settings will be allowed to train as more advanced independent and supplementary prescribers at an earlier point in their careers.
They will be able to gain a qualification that allows them to use the full British National Formulary - within their scope of practice - by going on a course after just one year of experience, instead of waiting for three years after registering.
Community nursing teams take on high levels of responsibility and must be able to prescribe for the conditions they manage. It is therefore desirable for more community nurses to have these advanced practice skills.
“Nurses may feel pressurised by employers to go on prescribing courses when they do not feel ready”
If deemed appropriate, and after demonstrating competency, following their first year in practice hospital nurses will also be able to train as independent and supplementary prescribers.
However, this type of prescribing is not for everyone. For example, many community staff nurses focus on wound care, continence, and skin care – and so for them remaining as a community practitioner nurse prescriber (with a V150 qualification) might be more appropriate.
In addition, nurses may feel pressurised by employers to go on prescribing courses when they do not feel ready. To stop this from happening, practice-based governance measures may need to be tightened.
Employers must put adequate checks in place ensuring that staff are ready to undertake prescribing programmes.
If they are not ready, nurses should be encouraged to develop the necessary knowledge and skills to bring them up to speed. These include consultation, history-taking and assessment. Nurses will also need clinical knowledge of the conditions for which they are likely to prescribe and knowledge of the drugs and medicinal products that they may be prescribing.
“Experienced nurse prescribers will need to act as role models for newly-qualified staff”
To support nurses to prescribe, healthcare organisations must have up-to-date medicines management and non-medical prescribing governance procedures in place.
This is also in the context of the NMC withdrawing its medicines management standards – though it is unlikely this move will compromise patient safety, as some have suggested, due to the strengthening of pharmacology and drugs management teaching at undergraduate level.
Alongside employers providing support, experienced nurse prescribers will need to act as role models for newly-qualified staff and offer up mentoring.
This would also provide an excellent way of enabling existing nurse prescribers to keep up to date.
It will help those who have been prescribing for a while to challenge and advance their own prescribing practice and to further develop mentoring skills. In this way, the regulatory changes will contribute in a positive way to the development of experienced and novice prescribers.
Penny Franklin is prescribing advisor for Unite’s Community Practitioner and Health Visitors Association and executive committee member at the Association for Prescribers