Independent Nurse: Practical Prescribing

February 20, 2008 by admin 

I was asked by a consultant to prescribe a medicine for a patient I had not assessed, and for a condition outside of my area of competence. I did not prescribe but don’t want this situation to arise again. Can you advise?

It is important to understand why you have been asked to prescribe outside of your area of competence. Amongst some member of the medical profession there is a lack of understanding about nurse prescribing. This has led to doctors feeling concerned about nurses encroaching on medical territory, nurses’ clinical skill base, and the possibility that nurses will prescribe outside of their area of competence. The rapid expansion of nurse prescribing in the UK has done nothing to allay these anxieties. However, if nurse prescribing is to be successful, the support of doctors is crucial. A lack of support by doctors has been identified as a barrier to nurse prescribing! The support of a medical prescriber is a necessary pre-requisite for prescribing training; they provide essential and invaluable support during the prescribing course and essential supervision post qualifying.

It seems that the consultant in question does not fully comprehend nurse prescribing. I have heard stories of unconfident House Officers almost being coerced into prescribing by their Consultant colleagues. In nursing, this situation would never occur. A nurse runs the risk of losing their registration if they prescribe outside of their area of competence. You need to educate your Consultant colleague about the professional limitations of nurse prescribing and, promote and publicise the NMC Standards of Proficiency for nurse and midwife prescribers (NMC 2006). This should provide the necessary reassurance that nurses (perhaps unlike the medical profession) won’t prescribe outside of their area of competence. Once this is understood, the situation you have described will not arise again.

Reference
NMC (2006). Standards of Proficiency for nurse and midwife prescribers. London: NMC

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