Nurse prescribing is about being a maxi-nurse, not a mini-doctor
In an overstretched NHS, prescribing enables nurses to be more efficient and autonomous
When I started my nursing career in 1989, nurses weren’t allowed to prescribe medicines, not even paracetamol.
This was frustrating for many of us, especially the senior nurses who advised junior doctors on prescribing medicines for patients within their specialties.
Not being able to prescribe was also a huge hurdle for community nurses, who often selected dressing products but then had to wait for a doctor to prescribe them, delaying patient care.
Something had to change, and thankfully it did.
Nurse prescribing is safe, cost effective and patients like it
After years of lobbying from nursing professionals and organisations, including the RCN, many UK nurses now have the same prescribing authority as their medical colleagues.
Credit must go to the district nurses and health visitors, the pioneers of the V100 community nurse prescribing course. Their careful management and implementation of the qualifications, including developing training packages, gave other professions and legislators the confidence to develop this extended role.
The V200 independent nurse prescribing course, which included stringent standards from the Nursing and Midwifery Council (NMC), paved the way for the V300 course, which allows supplementary prescribing by nurses from almost the entire British National Formulary, including some controlled drugs.
After extensive research demonstrated that nurse prescribers were prescribing safely, were clinically effective as well as cost effective, and that patient satisfaction was high, the controlled drugs most doctors were able to prescribe were made available to nurse prescribers.
Autonomy aids efficiency and helps ease the strain on the NHS
Given the severe staff shortages in the NHS, of both nursing and medical staff, ensuring nurses are fully autonomous and able to complete entire episodes of care is vital in preventing the service from collapsing under the strain.
Nurse prescribing is an essential part of this. It helps us to work more efficiently by increasing access to medicines, improves quality of care and helps us meet the demands of patients and the public.
The types of nurse prescriber
- Community Practitioner Nurse Prescribers (CPNP) Nurses who have successfully completed an NMC community practitioner nurse prescribing course (also known as a v100 or v150 course) and are registered as a CPNP with the NMC. Most nurses who have done this course are district nurses and public health nurses (previously known as health visitors), community nurses and school nurses. They are qualified to prescribe only from the Nurse Prescribers Formulary (NPF) for Community Practitioners, which contains appliances, dressings, pharmacy, general sales list and 13 prescription-only medicines
- Independent Prescribers (IP) Nurses who have successfully completed an NMC Independent Nurse Prescribing Course (also known as a v200 or v300 course) and are registered with the NMC as an IP. They can prescribe any medicine provided it is in their competency to do so, including medicines and products listed in the British National Formulary, unlicensed medicines and all controlled drugs in schedules 2-5
- Supplementary Those who have successfully completed the supplementary part of the prescribing course are also able to prescribe against a clinical management plan
Source: Non-medical prescribers (RCN)
Preparing nursing students to become future prescribers
Qualifying as a nurse prescriber is similar to passing your driving test. It doesn’t mean you are the finished article and can prescribe for anyone and any condition, but you are fit to start learning within this field.
In the new standards of proficiency for registered nurses, which came into effect in September 2019, the NMC acknowledged the importance of preparing nursing students to prescribe medicines.
At the point of registration, nurses are required to ‘apply knowledge of pharmacology to the care of people, demonstrating the ability to progress to a prescribing qualification following registration’.
The success of nurse prescribing has paved the way for other professions, with pharmacists, podiatrists, dieticians, radiographers and paramedics now training and working as non-medical prescribers.
This is a welcome ‘pat on the back’ for nurses, who should be proud of the work they have put in to develop themselves and the profession and help ease the pressure on overstretched NHS services.
Nurse prescribing: the challenges and opportunities ahead
Although we have come a long way, there are challenges still to be addressed if patient safety is to remain our number one priority. These include:
- Deprescribing: Reasons for stopping medicines for patients include lack of efficacy, patient safety and prevention or treatment of addiction, as well as cost savings. This requires a multidisciplinary approach to ensure that original prescribers and their rationale for starting specific medicines are considered.
- Antimicrobial stewardship: Antibiotic resistance is a major global threat. Unless we manage this problem by changing the way we prescribe and use antibiotics, there is a very real risk that people could die of relatively minor infections in the future.
- Training new prescribers: As we see more nurses becoming prescribers soon after qualification, and new professions training to become prescribers, nurses could play key roles in training and supporting new prescribers by sharing their knowledge and skills.
- Safe working environments: It is vital that the prescribing or deprescribing of medicines and medicines management takes place safely. We all have a part to play in reducing medication errors, including employers who need to act on issues such as poor staffing levels and unsafe working environments to help reduce the likelihood of errors occurring.
A nursing role suited to the changing health landscape
According to latest figures from the NMC, there are now more than 80,000 nurse prescribers in the UK. Prescribing is an integral part of modern nursing but is about being a maxi-nurse, not a mini-doctor.
I have received fantastic care from many nurse prescribers over the years, with efficient treatment, good quality information and guidance, and time to ask questions about my medications.
The NHS landscape has changed beyond all recognition from the health service I started working in more than 30 years ago. It seems fitting that in 2020, the International Year of the Nurse and Midwife, the UK continues to lead the world in the development of nurse prescribing.
Further information
Medicines Management: Professional resources (RCN)
Matt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University