Training

Nurse prescribing requires commitment and resources from employers as well as support and leadership for nurse prescribers. It is essential that all nurses who wish to undertake training to become independent or supplementary pre-scribers must be registered with the Nursing and Midwifery Council (NMC).

The NMC has now determined a new standard in respect of Independent Prescribing (for the Extended Formulary) and Supplementary Prescribing, and will only validate new recordable courses against this standard. To enable modification of existing Extended Formulary nurse prescribing courses, additional training and preparation has been incorporated to form the new NMC standard for Independent and Supplementary Prescribing at academic level 3.

The Department of Health believes that preparation for supplementary prescribing will take between one and two additional days, together with the course on Extended Formulary nurse prescribing. It was therefore decided that the length of a combined course covering both the Nurse Prescribers' Extended Formulary and Supplementary Prescribing should be at least 26 days, plus learning in practice. Of the 26 days' taught element, a substantial proportion should be face-to-face contact time. However, other ways of learning, such as open- and distance-learning formats, are also being considered for future development.

The NMC has requirements for validation of extended independent nurse prescribing and supplementary prescribing courses. The standard of the programme should be at a level no less than first degree, and a variety of assessment strategies should be used that should focus upon the principles and practice of prescribing, professional accountability and responsibility of the practitioners on the council's register.

The principal areas, knowledge and competencies are in the following table taken from the NMC (NMC 2004b):

Table 22

Principal areas Knowledge

Competence

Principles Legislation that underpins prescribing

• Works within the legislative framework relevant to the area of practice and locality.

• Understands the principles behind supplementary prescribing and how they are applied to practice.

• Able to use adverse reaction reporting mechanisms.

Team working principles and practice

• Aware of the impact of prescribing in the wider delivery of care.

• Able to work and communicate as part of a multidisciplinary prescribing workforce.

• Reviews diagnosis and generates treatment options within the clinical treatment management plan.

Philosophy and psychology of prescribing

• Understands the complexity of the external demands and influences on prescribing.

Table 22 Continued

Principal areas

Knowledge

Competence

Practice

Accountability

Up-to-date clinical and pharmaceutical knowledge

Principles of drug dosage, side-effects, reactions and interactions Communication, consent and concordance

Relationship of public health to prescribing

The code of professional conduct

The lines of accountability at all levels for prescribing

Drug abuse and the potential for misuse

Requirements of record-keeping

Lines of communication

Responsibility Leadership skills

Roles of other prescribers

Makes an accurate assessment and diagnosis and generates treatment options. Relevant to own area of expertise. Able to prescribe safely, appropriately and cost-effectively. Understands how medicines are licensed.

Able to work with patients and clients as partners in treatment. Proactively develops dynamic clinical management plans. Able to assess when to prescribe and when to make appropriate referral.

Able to refer back to medical practitioner when appropriate. Aware of policies that have an impact on public health and influence prescribing practice. Able to articulate the boundaries of prescribing practice in relation to the duty of care to patients and society.

Able to apply the principles of accountability to prescribing practice.

Able to account for the costs and effects of prescribing practice. Regularly reviews evidence behind therapeutic strategies. Able to assess risk to the public of inappropriate use of prescribed substances.

Understands where and how to access and use patient/client record.

Able to write and maintain coherent records of prescribing practice.

Able to communicate effectively with patients, clients and professional colleagues.

Able to advise and guide peers in the practice of prescribing. Able to articulate and understand the roles of other key stakeholders in prescribing practice.

Table 22 Continued

Principal areas Knowledge Competence

Principal areas Knowledge Competence

Table 22 Continued

Relationship of

• Understands the requirements of

prescribers to

pharmacists in the prescribing

pharmacists

and supply process.

Clinical governance

• Links prescribing practice with

requirements in

evidence base, employer

prescribing practice

requirements and local

formularies.

Audit trails to inform

• Demonstrates ability to audit

prescribing practice

practice, undertake reflective

practice and identify continuing

professional development needs.

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