Nurse Prescribing

Extension of Nurse Prescribing

Supervised learning in practice

Institutions should have in place policies and procedures to ensure that their responsibilities for learning in practice are met and that learning opportunities during a placement are appropriate (QAA, 2000 and NBS, 2000).

Supervised learning will total 12 days. These days will be divided, so that they are interspersed between the theoretical components of the programme. The aim is to enable an on going process of reflection and consolidation where the student has the opportunity to relate theory and practice as they move between university and practice settings. It may consist of blocks of time, for example one day per week, or shorter sessions, depending on the nature of the learning experience, but the cumulative total will equate to 12 days. Time spent learning in practice will be recorded by the student in the portfolio and monitored by the HEI.

The student must have one designated and qualified prescribing practitioner who is responsible for facilitating appropriate learning opportunities and assessing the student’s prescribing practice. This will be a doctor at present. The prescribing practitioner should be willing and able to devote a sufficient part of their time during this period of supervision to provide appropriate guidance for the student. Other qualified prescribing practitioners may contribute to providing appropriate learning experience, but the responsibility for assessing prescribing competence rests with the designated prescribing practitioner.

The designated prescribing practitioner must be a registered medical practitioner who:

(i) has normally had at least 3 years medical, treatment and prescribing responsibility for a group of patients/clients in the relevant field of practice;

(ii) (a) is within a GP practice and is either vocationally trained or is in possession of a certificate of equivalent experience from the Joint Committee for Post-graduate Training in General Practice Certificate (JCPTGP), has "acquired rights", or is exempt.

or

(b) is a specialist registrar, non consultant career grade or a consultant within a NHS Trust or other NHS employer;

(iii) has the support of the employing organisation or GP practice to act as the designated medical practitioner who will provide supervision, support and opportunities to develop competence in prescribing practice.

(iv) has experience or training in teaching and \ or supervising in practice. In the case of specialist registrars, has obtained the Certificate of Completion of Specialist Training.

Prior to the period of supervision, the HEI will brief the designated prescribing practitioner on the programme, the learning outcomes to be achieved and their role in the support, supervision and assessment of the candidate. This may involve a member of HEI staff visiting the practitioner in the practice area or at least being available to clarify issues with the practitioner through telephone discussion. It is not suggested that the prescribing practitioner will need to attend the HEI for formal preparation for the role. It is also suggested that HEIs contact their local deanery of the Scottish Council for Post Graduate Medical and Dental Education (www. s h o w.scot.nhs.uk/scpmde/) to discuss arrangements for the preparation and support of prescribing practitioners.

HEIs should offer students appropriate guidance and support, including information about their responsibilities and rights, prior to commencement of learning in practice (QAA 2000). However, due to the integrated nature of the practice element of the programme, and the aim to achieve a cycle of reflection and consolidation, guidance and support must be ongoing. This will require designated staff within the HEI and the prescribing practitioner to work together to guide students and support them in achieving prescribing competence.

Dedicated time and opportunities for the nurse or midwife to observe how the prescribing practitioner conducts a "consultation/interview" with patients and/or their carers, and the development of a subsequent management plan.

Opportunities to allow in-depth discussion and analysis of clinical management using a structured case analysis approach, when patient care and prescribing behaviour can be examined further.

Facilitate student learning by encouraging critical thinking and reflection with the use of the student’s professional portfolio.

Allow opportunities for the student to carry out consultations and suggest clinical management and prescribing options, which are then discussed with the prescribing practitioner.

Learning in practice is likely to take place within the student’s work setting, that of their prescribing practitioner or a combination of the two. It will comprise a total of 12 days of the nurse’s time.

Learning in practice will be related to the medical conditions and circumstances in which a nurse is likely to use the extended formulary, though the learning process will also prepare the nurse for prescribing from other areas of the formulary.

The prescribing practitioner may be a doctor with whom the nurse or midwife normally works. However, arrangements can be agreed where another doctor acts as supervisor, provided the criteria above are met.

The nurse or midwife may gain prescribing experience from a group of prescribing practitioners, for example partners in a general practice or a medical team within an acute area. However, the designated prescribing practitioner is responsible for providing guidance for the student, ensuring that learning opportunities are made available and assessing prescribing competence.

Assessment of Practice

Practice will be assessed by the qualified prescribing practitioner. They must confirm that the student has completed the period of learning in practice and whether the required standards have been met. It is likely that the student’s portfolio, together with observation of the student’s practice, will provide the designated prescribing practitioner with the evidence to judge their competence to prescribe. They will be required to "sign-off" the assessment of

practice, which should be returned to the HEI as part of the assessment requirements. Any concerns regarding the achievement of competencies should be discussed with the link lecturer and student as soon as identified, to facilitate appropriate remedial action.