Non medical prescribing in Scotland: implementation guide

Educational Preparation for Nurse Independent Prescribing

43. The NMC has set out standards for the educational preparation of nurses for prescribing ¹⁶ and will only approve programmes in Approved Education Institutions ( AEIs) which meet these standards (see www.nmc-uk.org). Currently, NES undertakes all aspects of quality assurance on behalf of the NMC in Scotland.

44. Eligibility to prescribe requires successful completion of an NMC approved programme of preparation at no less than degree level ( SCQF, level 9). The education programme includes nurse independent and supplementary prescribing and consequently all successful candidates will qualify as nurse independent/supplementary prescribers. The programme comprises a minimum of 26 days of theoretical learning plus 12 days 'learning in practice'. A designated medical practitioner will provide the student with supervision, support and opportunities to develop competence in prescribing practice during the learning in practice element of the programme. Programmes will be no longer than one academic year.

45. For distance learning programmes, there must be a minimum of 8 face-to-face taught days (excluding assessment) plus 10 days protected learning time. In exceptional circumstances, where this is not practical, video-conferencing in which interaction between all participants is possible, will be acceptable.

46. The education programmes include an assessment of theory and practice which must be successfully completed before the student's entry on the NMC register is annotated, to indicate that s/he holds a qualification for prescribing.

47. Individual Higher Education Institutions, where appropriate, may use approved prior learning ( APL), to give credit for a nurse's previous learning, and improve courses based on research findings.

Supervising and the Designated Medical Practitioner ( DMP)

48. Guidance entitled 'Training non-medical prescribers in practice - A guide to help doctors prepare for and carry out the role of designated medical practitioner' is available on the National Prescribing Centre website at: www.npc.co.uk and should inform the selection of Designated Medical Practitioners ( DMPs) (see Appendix 13).

49. The period of learning in practice (see above, paragraphs 44 and 45) is to be directed by a DMP, who will also be responsible for assessing whether the learning outcomes have been met and whether the trainee has acquired all competencies. These outcomes and competencies will be identified by the Higher Education Institution ( HEI), running individual courses.

50. The DMP has a critical and highly responsible role in educating and assessing the non-medical prescriber and assuring competence in prescribing.

51. Before taking on the role of DMP, the doctor and the HEI should consider the implications of undertaking this role safely and effectively. It is then important that the DMP and the HEI running the prescribing programme should work closely together.

52. Preparing new prescribers will undoubtedly take up some time. The approach to teaching and learning should be developed on an individual basis, so it is difficult to predict how much time this will involve. It is unlikely that the student prescriber will need to spend all of the period of learning in practice with the DMPs, as other clinicians may be better placed to provide some of the learning opportunities.

53. Registrants undertaking educational preparation to prescribe as nurse independent/supplementary prescribers must successfully complete a range of assessment strategies to demonstrate that they have met the required learning outcomes relevant to the scope of their prescribing responsibilities. Competence will be demonstrated through an assessment of theory and practice, and a range of assessment strategies will be employed to test knowledge, decision-making and the application of theory to practice.

54. The assessment of practice is the responsibility of the DMP who remains responsible for assessing whether all the learning outcomes have been met, and verifying by the end of the course that the student is competent to assume the prescribing role.

Continuing Professional Development ( CPD)

55. All nurses have a professional responsibility to keep themselves abreast of clinical and professional developments. This is no less true for prescribing. All nurse prescribers including nurse independent prescribers will be expected to keep up to date with evidence and best practice in the management of the conditions for which they prescribe, and in the use of the relevant medicines. See NMC (2006) Practice Standard 13 ¹⁷ on evidence-based prescribing. It is for each nurse independent prescriber to remain up-to-date with knowledge and skills to prescribe competently and safely. Also see NMC (2006) Practice Standard 15 ¹⁸ on continuing professional development.

56. Nurses may use the learning from this activity as part of their Post Registration Education and Practice ( PREP- CPD) activity. The employer should ensure that the practitioner has access to relevant education and training provision. It is good practice for employers to support these prescribers in pursuing self-directed study. Details of additional training and updating will need to be incorporated by the individual into their personal professional profile, in order to renew their registration with the NMC.

57. NES¹⁹ has developed a CPD competency framework for all qualified prescribers to support individual practitioners to maintain their skills and competencies. Individual teams or organisations can also use this template to record and identify learning.

58. In addition to the time spent on the formal programme, it is important that employers of nurses undertaking the programme should recognise the demands of private study and provide support where necessary. Employers may also consider providing mentoring opportunities and clinical supervision for these nurses (see paragraph 74).

59. Continuing Professional Development is an important element of clinical governance, crucial to ensure quality care and patient safety (see paragraph 104 also).

Buddying and mentorship

60. Support from other professional colleagues is invaluable to non-medical prescribers, especially to those who are newly qualified. Many non-medical prescribers already have a buddy/mentor after qualifying: this could be a doctor, nurse or pharmacist. Opportunities for experienced (nurse) prescribers to mentor nurses will increase, over time, as the number of nurse independent prescribers increases.

61. Supplementary prescribing is also a useful mechanism to enable new non-medical prescribers to develop expertise and confidence. Core personal formularies/local formularies may be a system that nurse independent prescribers would wish to develop in agreement with local management and the prescribing budget holder.