VOL: 102, ISSUE: 13, PAGE NO: 52
Ann ShuttleworthTraining to become an independent prescriber is a significant undertaking. While nurses can rely on their own effor...
Training to become an independent prescriber is a significant undertaking. While nurses can rely on their own efforts to fulfil their academic and clinical learning needs, they need support in developing their prescribing competence and confidence. This is provided by designated medical practitioners (DMPs) - often called mentors - who supervise and assess students in the 12 days' learning in practice.
The National Prescribing Centre (NPC, 2005) has defined criteria for DMPs (see Box 1), and the NMC has incorporated these into its prescribing standards. However, the relationship between DMP and student is also crucial. So what makes it work?
Cheryl McKay, non-medical prescribing facilitator, Kent and Medway Strategic Health Authority, believes DMPs need the right personal qualities. 'They need to be patient and good at time management so they can make time to be with the student, and able to look at the student's learning outcomes, assess whether these are being met and give constant feedback on this in a constructive way,' she says.
If the relationship is to work, students need to agree its practicalities with their DMP before starting the course. For example, they need to be clear about how and when the DMP will monitor and assess their practice (see box below opposite).
'There is no single model for a DMP-student relationship, because some nurses have an awful lot of experience by the time they get on to the prescribing course and others may have slightly less,' says Trudy Granby, assistant director, National Prescribing Centre Plus programme. 'DMPs need to be able to assess their students' learning needs and ensure they get exposure to the right learning opportunities and breadth of experience needed to meet the learning outcomes.'
The lack of an approved model enables students and DMPs to structure the learning in practice in a way that works best for them.
While 12 days' learning in practice may seem like a heavy time commitment for DMPs, they are not expected to spend the whole time with the student, as Molly Courtenay, reader in prescribing and medicines management, University of Reading and RCN joint prescribing adviser, points out. 'Students do need to spend quite a bit of time with their mentor, sitting in on consultations, developing assessment and diagnostic skills and looking at case examples. However, they don't need to be glued to the mentor's side for the whole 12 days. They are also likely to spend time with a pharmacist and even other qualified nurses prescribers, who can teach them about different aspects of prescribing.'
Ms Granby says there is also a general expectation that DMPs continue to support and contribute to their students' CPD after they qualify as prescribers. However, there is no obligation for them to do this.
'In fact it may not always be appropriate,' she says. 'Nurse prescribers need to identify their own ongoing learning needs in order to maintain competency in this role, and they should choose the most appropriate person to help them with these. For example, they may be confident about making clinical decisions but less so about monitoring their prescribing activity, so they should choose the best person to meet their needs at that time.'
But Ms McKay believes that continuity is important. 'The relationship should definitely continue after students have qualified, because they are still a novice immediately after the course and need to develop their prescribing skills,' she says. 'Mentors need to be able to share their prescribing experience and develop the new prescriber's confidence and competence.'
Given the commitment involved in the role, there are concerns that it may become difficult to recruit enough DMPs, as the number of nurses and pharmacists studying to become prescribers increases. There have been suggestions that nurse prescribers might fill this gap - indeed the RCN is to debate the issue at its congress in April this year.
Nurses themselves seem ready to do so. Researchers from Reading University found that three-quarters of 868 extended/supplementary prescribers surveyed would be happy to act as mentors (Courtenay and Carey, 2006). Ms Courtenay believes the development is likely once nurses have gained enough experience of prescribing practice.
However, some people are wary of such a development, including Fiona Peniston-Bird, non-medical prescribing facilitator at Surrey and Sussex Strategic Health Authority. 'I think it would be foolish,' she says. 'Doctors should continue to fulfil this role because it builds relationships between professions and increases their understanding of other professional roles.'
Ms Peniston-Bird questions whether concerns about a shortage of DMPs are justified, pointing out that for many GPs there is a long-term pay-off in that the nurse they work with can take on more responsibilities - potentially increasing the money paid to their practice.
Although she also disagrees with the idea of nurse mentors, Ms McKay does see nurses taking increasingly active roles with students.
'If a 'buddying' system is developed this may be a role experienced nurse prescribers could take on', she says. 'While it is something doctors could certainly do, a nurse working in the new prescriber's specialty may be equally helpful.'
Whether or not the supervision and assessment of nurses studying to become prescribers remains a medical-only responsibility, the key to its success is the relationship between student and mentor. This requires commitment from both parties to make it flexible enough to meet the student's learning needs while enabling both to meet the demands of clinical practice.