Prescribing is the future for nursing
With the right training and competencies, nurses could take on a much bigger role in medicine prescribing says Professor Lisa Nissen.
Speaking at the NSWNMA’s Professional Day, Professor Nissen, Head of the School of Clinical Sciences at Queensland University of Technology, said nurses and midwives are already handling and administrating medicines as part of their day-to-day practice and are in an excellent position to expand their practice to prescribing.
“You already touch medicines everywhere, you have roles in administration, you are already in prescribing [environments].” Nurses, she said, are “ethical, you’re excellent communicators, you work in collaborative teams with other people, you communicate across different boundaries”.
Currently prescription medicines cost the Pharmaceutical Benefits Scheme (PBS) 11 billion dollars a year. But not all of that money is well spent, she said: “In 10 to 20 per cent of cases [medicines] hurt people”.
One issue is that “the space around medicine is getting much more complex,” she said. In her own lifetime, assessment and care of patients “has gone from being one or two people to now being myriad different health practitioners”.
Nurses can play a central role in prescribing in an environment where care is increasingly fragmented, she said. And there are also growing issues around patient access to complex information.
Nurses have a particular strength in patient communication, and “I do think engaging patients in their care in this age of digital technology is going to be really important.
“Taking a history, working out whether medication is appropriate, communicating that to the people that are relevant, and making sure you review it where it is required,” are key skills nurses can bring to prescribing, she said.
Professor Nissen has been an expert adviser for the National Prescribing Service on prescribing competency standards, and she’s been closely involved in the training and development of nurse practitioners, who have been able to prescribe for more than 15 years. She spoke about the different prescribing models that could be used for professions such as nurses, pharmacists, podiatrists, physiotherapists and optometrists, from independent prescribing practitioners to those who are closely supervised.
Prescribing is not mysterious
What is needed though is an overarching “super model,” she said. “We want to have a consistent way we do this for people, making sure people are safe and have the right knowledge to work.”
There is nothing mysterious about prescribing, she told the conference. “We often think it is special, but prescribing is a tool like any other clinical tool, that you use and you teach at your universities to graduates.”
“We as pharmacists like to lay claim to medicines as being special, just because we spend four years doing it. Yes, there are things around the clinical decision making that involve drugs that you need to know about, but the rest is very generic.”
“We don’t spend enough time in the curriculum on confidence for prescribing. Most of our training programs prepare health practitioners to take excellent clinical histories. We learn lots about our patients, and we understand our patients. We have a reasonable understanding of treatments and we are really good at communicating with other people, but when we have particular decisions about prescribing, we are not so great [at teaching this].”
Research from Professor Nissen’s own university shows that when prescribing competencies are taught and assessed in programs that do involve medicine, not surprisingly graduates’ confidence in prescribing is very high.
Prescribing is the “future” for nurses, Professor Nissen said. “You don’t want to be in the situation where 10 years from now or 20 years from now you have three or five per cent of profession involved in prescribing.”
“We are trying to put prescribing on top of your core training, whether you are an NP or whether you are an eligible midwife. [And] I would say to you, when you are doing your next standards, please put prescribing in the undergraduate program for midwifery.”
Professor Nissen ended by encouraging nurses to take ownership of prescribing spaces. “We need to revolutionise health care … and to do that we need major system change. You’ve got to think about scope of practice, and it is about optimising the skills that you bring to the system.
“You can do more. I would say to you this opportunity is rare, but it is the right one now for nursing and midwifery going forward.”
Current nurse and midwife prescribing in Australia
Nurse prescribing was first introduced in Australia in 2000 with the creation of nurse practitioner (NP) roles. Now prescribing is established practice for midwives with an endorsement for scheduled medicines; other health professions in areas such as dentistry, podiatry, pharmacy, and optometry now hold varying authorisations to prescribe. Nurses and midwives who prescribe and manage medications are subject to Nursing and Midwifery Board of Australia (NMBA) regulatory requirements, and they must complete an approved post-graduate education program.
Since 1 November 2010, NPs and midwives with a scheduled medicines endorsement have been able to prescribe medicines subsidised by the Pharmaceutical Benefits Scheme (PBS). Medicines that NPs and midwives may prescribe independently within the PBS are listed and others are identified as medicines NPs may prescribe for ‘continuing therapy only’ after a medical officer makes the first prescription.
Listen to the podcast
You can listen to all of Prof Nissen’s presentation at http://www.nswnma.asn.au/podcast-dr-lisa-nissen-quality-use-of-medicines/
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