Extension
of Nurse Prescribing Roadshows– Question and Answers
Preparation
For Extended Nurse Prescribing
Q:
What would be the requirements for a nurse to apply to become
an extended nurse prescriber?
A:
All first level nurses of ‘E’ grade or above can access
the extended nurse prescriber course, if all the following
criteria are met:
-
Able to
study at level 3 (degree level)
-
At least
three years post-registration clinical nursing experience
-
A medical
prescriber willing to contribute and supervise the
nurse’s 12 day learning in practice element
-
Supported
by their employer
Q:
Can the training requirement for current independent nurse
prescribers be clarified and why has it been left to HEIs
to decide this?
A:
Training requirements were set out by the UKCC, see NHS
Education of Scotland website: www.nes.scot.nhs.uk.
Each Higher Education Institution then had to incorporate
this into their course descriptors.
Q:
Do you have to apply for the course through the Director
of Nursing’s office? Will nurses get back up information
letting them know the number of hours required for study,
etc?
A:
As with any development of practice, a nurse who wishes
to become an extended nurse prescriber would have to identify
a need that would improve patient care/outcomes. Nurses
must be supported by their line manager, Director of Nursing
and a medical practitioner who is willing to support them
during the duration of the course. They must also have access
to a prescribing budget e.g. GP budget , hospital budget.
Q:
Should Directors of Nursing be informed that Practice Nurses
are interested in applying?
A:
Most definitely, it is essential that all nurses who feel
that being an extended nurse prescriber would be beneficial
to their patients and colleagues should present themselves
as being interested parties.
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Q:
Will choices to extend not be limited due to requirements
of individual posts?
A:
Yes, this is a matter for each Trust and will be based on
local needs of both patients and service delivery.
Q:
Do individuals get the choice of University they want to
attend or is it up to the Health Board/PCT area?
A:
Trusts are working closely with Higher Education Institutions
(HEI) who are developing the extended nurse prescribers
course. Therefore nurses who are being supported by their
employer will be requested to attend the HEI that the Trust
is working in partnership with.
Q:
Will there be any encouragement for GPs to allow Nurse Prescribers
access to the budget? Will there be any solutions suggested
if GPs resist this due to the budget growing? Will the Scottish
Executive encourage GPs to participate in the Extension
of Nurse Prescribing?
A:
It is likely that nurse prescribers will be prescribing
items that the GP would otherwise have to prescribe themselves.
It is unlikely that this will have an impact on prescribing
budgets. The Scottish Executive are encouraging GP practices
to participate and medical staff have been involved in the
consultation process for the extension of nurse prescribing
and have been supportive of this development.
Q:
The Extension of Nurse Prescribing course is 25 days and
12 days supervision, over what time span will this happen?
A:
The NHS Education for Scotland (previously the NBS) stated
that the course should last a minimum of 3 months and a
maximum of 6 months.
Q:
Is there any central funding available to allow staff to
be released for education/training?
A:
Central funding is available from the Scottish Executive
Health Department to cover the costs of the extended nurse
prescribers course provided by the Higher Education Institutions,
as well as a contribution to other costs, replacement costs
will have to be covered locally.
Q:
If nurses choose to do open learning/distance learning option,
will employers be informed that nurses have to have time
off for study, even though they are not travelling to another
location?
A:
This issue would have to be locally agreed with the nurse’s
manager.
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Q:
Has there been discussion with GPs and GP Professional Bodies
informing them that they will be required to be supervisors,
if so, are they willing to do it?
A:
Medical staff have been involved in all aspects of the development
of nurse prescribing and extended nurse prescribing. It
is the responsibility of the Higher Education Institutions
to liase with GPs’ and Medical Staff who have agreed to
be supervisors of the extended nurse prescribers.
Q:
Will there be training for GP Supervisors?
A:
There is no formal ‘training’ for GP who have agreed to
supervise nurse prescribers on the course, but support will
be available from the HEI.
Q:
Is there a financial award for the medical practitioner
who is taking on the supervisor role? Can they supervise
more than 1 person at a time?
A:
Funding available form the Scottish Executive is to cover
the cost of the course provided by the Higher Education
Institution. There is no reason why a medical prescribing
supervisor cannot supervise more that one nurse at a time.
Q:
Will Nurse Prescribers eventually be able to undertake role
of supervisor, or will medical practitioners always do this?
A:
This point will be considered in the future and may be a
possibility in a few years time.
Q:
Can Pharmacists become supervisors or is it only doctors
who can do this role?
A:
Pharmacists are an excellent resource for nurse prescribers
to access for advice and support. As they are presently
not able to prescribe, it would not be appropriate for them
to be supervisors at present.
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Q:
Will the Scottish Executive consult with representatives
of pharmaceutical contractors about the impact of these
proposals?
A:
They were included in the consultation process and were
supportive of this development.
Q:
If anyone doing the Extension of Nurse Prescribing course
fails part of their exam, will they have to re-sit all of
it again or only the part that they failed?
A:
This would be at the discretion of the relevant Higher Education
Institution.
Q:
How many times a year will the course be run by the universities?
A:
Most Higher Education Institutions will have two intakes
a year.
Q:
Do you see the Extended Nurse Prescribing course being included
with the Community Nursing in the Home degree?
A:
The extended nurse prescribing course, at present, is a
stand alone course. The training for the DN/HV formulary
will continue to be core to nurses completing the District
Nursing or Health Practitioner course.
Q:
Why has nurse prescribing in acute hospital settings been
omitted, as there are many examples of where this would
be beneficial, especially in pain management? If nurses
are educated and developed in this role, why would certain
drugs be excluded, i.e. opiates?
A:
Access to the extension of nurse prescribing course is open
to all 1st level nurses of ‘E’ grade and above who meet
the inclusion criteria laid down by the Nursing and Midwifery
Council and NHS Education for Scotland. This can include
those working within hospital settings. Controlled drugs
remains outwith the scope of extended nurse prescribing.
Q:
Is it fair to put nurses through this extent of academic
and experiential preparation to prescribe off a limited
list of drugs, many of which can be bought over the counter?
A:
Professional organisations involved in the consultation
supported the course contents and length, to maintain patient
safety.
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Q:
Will people working in Community Hospitals be eligible to
do Extended Nurse Prescribing, i.e. we respond to symptomatic
relief for patients in the absence of GPs but this would
not necessarily be regular or frequent practice?
A:
Frequency of prescribing is essential to maintain competence,
therefore the appropriate identification of nurses to attend
the extended nurse prescribing course is essential; in theory,
individuals working in Community hospitals would be eligible.
Care
Settings
Q:
How much impact will the Extension of Nurse Prescribing
have on Acute Paediatric care, as this is a very specialised
area of prescribing?
A:
Nurses working within this speciality should look at how
the patient’s wellbeing/journey could be improved, if they
could prescribe from the extended formulary.
Q:
Which Nurse Prescribing course would be most appropriate
if we were redesigning the dermatology service and introducing
a nurse – led clinic?
A:
The extended nurse prescribing course would support both
these developments, the consultation process regarding supplementary
prescribing has been completed and a report is due autumn
2002.
Q:
Will there be provision for nurses to prescribe on the A/E
notes as doctors do, e.g. if they are Nurse Prescribers
and have completed the prescribing course?
A:
Hospital nurse prescribers should use approved documentation
to write a prescription.
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Q:
Are Generalist Community Children’s Nurses eligible to do
both courses, i.e. patients need dressings as well as supplementary
specialist paediatric prescribing?
A:
The consultation process regarding supplementary prescribing
has been completed. One of the points raised is around this
issue and whether to be a supplementary prescriber the nurse
must have completed the extended nurse prescriber course.
The report due out autumn 2002 will clarify this issue.
Q:
How does "extended prescribing" allow for the
homeless populations, who are not registered with General
Practitioners, to be cared for?
A:
This situation would have to be looked at locally to ensure
access to a central prescribing budget as well as patient
details on the prescription pad.
Prescribing
Issues
Q:
Previous Nurse Prescribing course did not use prescribing
powers as much as we would like in terms of computerised
prescribing, will you be looking at providing more computerised
prescribing for nurses through the Extension course?
A:
The Scottish Executive is currently working with relevant
parties to support this through the G-Pass system. In November
2002 an updated version of G-Pass will allow all nurse prescribers,
with access to this system, to generate prescription. The
nurse must of course have access to the relevant technology
(networked computer and printer).
Q:
Nurses can work with up to 15 different groups of GPs, for
example remote and rural areas, how will this be dealt with
so that nurses do not have to carry 15 different groups
of prescription pads? Is the Scottish Executive looking
at this?
A:
Yes, this issue has now been resolved. It has been agreed
that where a nurse prescribers for more that one GP practice
that they will be issued with a prescription pad that will
allow them to complete the GP practice code for the patient
they are prescribing for.
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Q:
I have passed the Nurse Prescribing course but I have not
received my prescription pad, what should I do and will
there be a quicker system put in place?
A:
Your Trust will have a local supply of prescription pads
for nurses for distribution on request from either the nurse
or practice manager. Presently the Scottish Executive and
the Common Services Agency are working toward the issuing
of pre-printed prescription pads for each nurse prescriber.
There will be a minimum order of 10 per nurse and again
these will be stored centrally with Trusts for distribution
to individuals on request.
Q:
Will the IT be advanced to replace hand written prescriptions,
multiple stamps and pads?
A:
Pre-printed prescription pads will be available for all
nurse prescribers by January 2003. Computer generated prescriptions
are also being addressed, but nurse prescribers require
access to a computer and nurse prescribing flat prescription
sheets.
Q:
Which budget will night/evening District Nurses prescribe
from?
A:
Nurses who prescribe for more that one practice like night
and evening district nurses, will be supplied pre-printed
prescription pads that would require them to complete the
relevant practice code of patients they are prescribing
for.
Q:
How will Community Pharmacists know who is authorised to
prescribe? This is already causing Community Pharmacists
a lot of problems, especially dealing with new prescriptions.
A:
The Scottish Executive is addressing this issue in partnership
with the Nursing and Midwifery Council. This will allow
a community pharmacist to phone the NMC and check the nurses
qualification to prescribe.
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Q:
In many remote and rural areas, dispensing practices can’t
go to pharmacies to get the required medication, therefore
are dependent on the GPs stock, will this issue be looked
at and is there away around it?
A:
As stated the by the Nursing and Midwifery Council, nurse
may dispense in ‘exceptional circumstance’. If nurse prescribers
find that they are required to dispense, then they should
discuss issues around stock items locally with the GP practice
for their area.
Q:
Prescribers in hospitals do not use pads, Will they be able
to prescribe on an emergency sheet as doctors do at the
moment?
A:
Hospital based nurse prescribers will be issued with relevant
prescription pads.
Q:
Will the supply of BNFs to nurses be improved, i.e. the
same as GPs?
A:
The Scottish Executive is currently reviewing the distribution
of the BNF, NPF and Scottish Drug Tariff to ensure Nurse
Prescribers will receive a copy of each as detailed in the
‘Extending Independent Nurse Prescribing within NHSScotland:
A Guide for Implementation’. Although numbers per Trust
can be noted, there has to be a local system in place to
support their distribution.
Q:
Do the 170 items on the limited list include the present
nurses’ formulary?
A:
The items identified for the extended nurse prescribing
formulary is over and above that prescribed by District
Nurses and Health Visitors.
Q:
What will nurses who have already completed nurse prescribing
under HV/DN do?
A:
They can continue to prescribe for the limited formulary
and if applicable may all apply to attend the extended nurse
prescribers course. Institutions may offer assessment of
prior experiential learning (APEL) to current nurse prescribers.
Q:
How will the list be reviewed to include additional drugs,
i.e. lignocaine for local anaesthetic in A/E Departments?
A:
The contents of the both the limited and extended nurse
prescribing formulary are reviewed and any necessary changes
require the support of certain organisations. There is a
Nurse Prescribers’ Formulary Subcommittee that comments
may be submitted to, contact details are included in the
Nurse Prescribing Formulary.
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Q:
It is important to ensure a complete medication record is
held on computer for paperless practices. How will this
be achieved if nurse prescribers have to hand write prescriptions?
A:
Record keeping is essential good practice. If all patient
records are held on computer then local access must be agreed
for each nurse prescriber to access a computer to keep patient’s
records up-to-date.
Q:
How will it be possible to prove Extended Nurse Prescribing
has benefited the patient, i.e. the patient will not see
who has written the prescription if the local pharmacist
receives it and a van delivers it?
A:
There are a few ways to measure patient benefits with extended
nurse prescribing – patient waiting times to see General
Practitioner, patient satisfaction surveys.
Professional
Issues
Q:
If professionals in General Practice (i.e. Midwives, Health
Promotion, minor ailments, etc) do the Extension of Nurse
Prescribing course, do they become a Nurse Practitioner
without doing the Nurse Practitioner training?
A:
The Nursing and Midwifery Council will update the nurses’
professional register with an annotation signifying that
they have successfully completed the specific programme.
This does not affect their job title.
Q:
How will nurses with Extended Nurse Prescribing be identified
on the register and how will this differ from those with
original nurse prescribing?
A:
This has been agreed with the NMC and will also be identified
on the prescription pad. They will be identified by either
of the following: DN/HV or Extended Prescriber.
Q:
Will "E" grade nurses be financially rewarded
for their extended role?
A:
There is no link between this qualification and pay structure.
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Q:
Will there be any information produced on patient management,
i.e. if more than one prescriber is involved in the patient’s
care, there must be communication between the prescribers?
A:
Best practice will always identify communication skills
as essential in the management of a patient’s care.
Q:
Will the ENB/NBS qualification programme be mutually recognised?
A:
Yes, on the successful completion of the nurse prescribing
course, the nurse’s qualification will be recorded within
their NMC registration.
Q:
Will nurses, due to professional workload, be assured that
they are not discriminated against in the job market if
they decide not to do the Nurse Prescribing course/training?
A:
The Extended Nurse Prescribing course is optional not compulsory.
But all nurses have a responsibility for ongoing professional
development to support their practice.
Continuous
Professional Development
Q:
How will the adequacy of training for prescribing be measured,
in comparison to number of hours of pharmacology in pharmacy
undergraduate course and in terms of knowledge base for
safe practice?
A:
Nurse’s who are supported to become extended nurse prescribers
will require to have at least 3 years post-registration
clinical nursing experience and usually be at ‘E’ grade
or above. This will ensure that nurse’s nominated to attend
the course will possess an excellent foundation relating
to understanding their limitations and competency. In addition
to their professional accountability and responsibility
regarding their clinical care and decision making processes.
Ongoing professional development is also essential for all
nurses. The national prescribing centre has produced a tool
to facilitate this, see
www.npc.co.uk
Q:
Will there be any ongoing assessment or refresher courses
for the Extended Nurse Prescriber?
A:
All nurses have a professional responsibility to maintain
their competence to practice. Nurse Prescribing is no different.
Training and education needs should be identified within
the nurse’s personal development plan and their employer
should ensure that the nurse has access to relevant education
and training.
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Supplementary
Prescribing
Q:
Which course should nurses who are interested in both Supplementary
prescribing and Extended Nurse Prescribing complete?
A:
Supplementary prescribing consultation has now been completed
and the final report will be published in autumn 2002. One
of the key questions is around the qualification to become
a supplementary prescriber. This may be that if the nurse
has successfully completed the extended nurse prescribers
course then they may also be supplementary prescribers.
Patient
Group Directions
Q:
Can you give more information on Patient Group Directions,
especially on immunisation and cover legally?
A:
Patient Group Directions relate to the supply and administration
of named medication to groups of patients who may not be
individually identified before presentation for treatment.
Immunisations are an excellent example of how a PGD can
be put into place to support practice. PGD must meet a set
criteria and be signed of by the both a doctor or dentist,
as appropriate and a pharmacist. Only named individuals
(nurse) may work within the PGD and will be legally supported
by the Trust, on condition they work within the PGD at all
times.
Miscellaneous
Q:
Has there been any further discussion with the medicines
committee regarding midwives and the diamorphine issue?
A:
Watch this space, the Medicines Control Agency is just about
to start a public consultation around Patient Group Directions
being used for controlled medicines.
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