Non-medical prescribing offers nurses greater autonomy, and patients a shorter care pathway. Could a nurse prescriber be your next nursing role?
What is non-medical prescribing?
The term covers prescribing by healthcare professionals other than doctors. Alongside nurses, it includes pharmacists and allied health professionals.
Where nurse prescribing is now, and how we got here
There are almost 50,700 independent or supplementary nurse prescribers and 40,300 community practitioner nurse prescribers on the Nursing and Midwifery Council (NMC) register. Figures have risen steadily over the past five years, particularly for independent or supplementary prescribers, the number of whom has increased by 13,710 since 2017.
It was back in 1986 that Conservative peer Baroness Julia Cumberlege recommended community nurses be able to prescribe from a limited drug list. By the 1990s, community nurses were prescribing independently from a limited formulary, but it was not until May 2006 – after much lobbying and many incremental stages – that nurses could finally begin to prescribe from a full list of licensed medicines.
This has been followed by further legislative changes. In 2009, nurse and midwife independent prescribers were permitted to prescribe unlicensed medicines, while since April 2012 they have been able to prescribe virtually any controlled drug.
How do I become a prescriber?
There are two kinds of nurse prescriber:
- Community practitioner nurse prescribers (CPNPs) complete an NMC CPNP course, also known as a v100 or v150, before registering as a CPNP with the regulator. The majority are district, public health, community and school nurses, who can only prescribe from the Nurse Prescribers’ Formulary (NPF) for community practitioners, which is part of the British National Formulary (BNF)
- Independent prescribers (IPs) must complete an NMC IP course, also known as a v200 or v300, before registration as an IP with the NMC. IPs are able to prescribe any medicine within their competency
You need to prove to your approved education institution that you are capable of safe and effective practice at a level of proficiency appropriate to your programme and intended area of prescribing practice.
You will also need to show you have the necessary skills in clinical and health assessment, diagnostics, care management and care planning and evaluation.
Consideration may be given to previous learning, your revalidation portfolio and appraisal, and experience in the area of nursing care where you’re working and intend to practise.
Source: NMC – becoming a prescriber
Why do nurses want to become prescribers?
‘Nurses want to be able to open and close a patient episode,’ says Mr Lovatt. ‘They want to be able to use their competence to assess the patient and prescribe within their scope, so the patient moves through the system more quickly, efficiently and in a caring way.’
For many nurses, it can be fulfilling, although there is an over-riding sense of responsibility and accountability. ‘It’s still a big gig,’ says Mr Lovatt. ‘If you get blasé about prescribing, you should stop doing it.’
Since becoming a prescriber, Gavin Gorman’s career has been shaped by the qualification. ‘It’s changed my career immeasurably,’ he says. ‘For many years, it was based specifically around prescribing.’
Qualifying in 2000, Mr Gorman completed his prescribing course three years later at Southampton University, while working as a community psychiatric nurse in Hampshire. Shortly afterwards he moved to Scotland, where he led a project to develop a prescribing policy and strategy for NHS Borders, exploring how to take full advantage of the emerging non-medical prescribing roles in the organisation, eventually becoming the non-medical prescribing lead.
‘It set me on a career path that I never expected, focused on non-medical prescribing leadership and development,’ recalls Mr Gorman. ‘It mapped out my career for the next ten years. Back then, it was something different, innovative and novel that nurses hadn’t done before, which brought challenges that kept me interested and engaged.’
In his current role, as an advanced practitioner in a specialist multi-professional team for early psychosis in Devon, he is the clinical lead, a post that would traditionally have been held by a consultant psychiatrist.
In early intervention, there is clear prescribing guidance, with a hierarchy of antipsychotic medications, all of which may be prescribed by Mr Gorman and members of his team with the appropriate qualifications.
‘We try to use those with least side-effects as the first line, with a tiered structure of what we might need to move to afterwards,’ he says.
Selection is also dependent on patient choice, any co-morbidities and potential drug interactions. Part of his role involves regular monitoring of any impact on patients’ physical health.
Client feedback is positive. ‘They’re happier we have the time to sit and explain things to them that sometimes our medical colleagues don’t,’ he says.
Mr Gorman recently became a designated prescribing practitioner, mentoring non-medical prescriber trainees. ‘It’s the first time experienced non-medical prescribers have been able to take on this role. It’s an exciting development and long-awaited.’
Where can I find help to decide if prescribing is for me?
The University of Surrey has produced the Preparing to prescribe toolkit. Pulling together information, resources and research evidence, the toolkit provides a step-by-step guide for nurses and other healthcare professionals.
It also explores personal readiness to prescribe, including motivation, work-life balance, finance and study skills, alongside offering advice on choosing your programme.
By Lynne Pearce, health journalist
This is an abridged version of the article Becoming a nurse prescriber: how it could take your career in unexpected directions which was first published in Nursing Standard.
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