Introduction. Over The Last Two Decades, Growing Number

Supplementary and independent nurse prescribing has taken some years to materialise; this movement was facilitated by Department of Health (DoH), nursing regulators, nursing professional bodies, and general practice (GP) supporters (RCN, 2012). Following the Medicines Act (1992) where only Health Visitors and District Nurses were allowed to prescribe from a limited formulary, over time legislations were subsequently amended allowing non community nurses to prescribe from an extended formulary. In 2003, supplementary prescribing was being recognised and by 2012 The Misuse of Drugs Regulations allowed the nursing formulary to access all of the British National Formulary including controlled drugs. In line with these changes and to ensure that

It should be made mandatory for the nurses to read back the documented prescription to the doctor. It should be signed by the doctor for confirmation after been reviewed by the druggist.

Nurse prescribing was first suggested by the Royal Collage of nursing (RCN) in 1980, it was to take another six years for it to become part of the government’s agenda with the Cumberlege Report in 1986 (Department of Health and Social Security (DHSS)(1986). These two report

Nurse prescribing has an important contribution to make in improving the service to patient’s clients within the primary health care setting, its benefits was highlighted in the crown

Although the largest profession in the health care industry is nursing, a larger number of people are getting older and living longer. This means that more people will need nursing care, whether it’s in a hospital, a long-term care facility or at home. It is projected that long-term care facilities will need 66% more RNs by 2020 (Addressing the Nursing). The increase in life expectancy has amplified the complexity of health care because more people are living with chronic conditions. The American Nurses Association reported that “a large cross-sectional study of over 1,000,000 adults revealed that 82% had one or more chronic conditions” and we are seeing an increase of those age 65 and older living with multiple chronic conditions (Mion). Now, more than ever, there is a high demand for the best delivery of medical care.

In the United States, health care accessibility, quality, and affordability continue to be ongoing topics of discussion that effect many Americans on a regular basis. The need for affordable, quality healthcare continues to grow, not only due to a growing elderly population, but also as a result of the Affordable Care Act which has allowed millions of previously uninsured Americans access to health insurance and therefor better access to healthcare services (Patient Protection and Affordable Care Act, 2010). According to the Institute of Medicine (IOM) the projected demand increased for healthcare have led to a call for expansion of primary care services by policy makers (Institute of Medicine, 2010; National Governors Association, 2012). Since Advanced Practice Nurses or Nurse Practitioners (APNs or NPs will be used interchangeably for the purpose of this paper) are one of the fastest growing groups of healthcare providers, and continue to practice and provide care in a range of settings including primary care, it is important to investigate and address any potential barriers to practice. This author believes that allowing APNs to write prescriptions for commonly used controlled substances will help improve timeliness and flexibility in health care delivery; studies have shown that there is a positive impact on high

For nurses extending their role to include prescribing there is much to consider. Revelay (1999) states that, accountability involves an individual giving an account of their actions with the rationale and explanation given for these actions. The decisions regarding boundaries of practice are firmly placed in the hands of the individual practitioner (Carlisle 1992). Accountability means being able to justify any actions and accepting responsibility for them, and is an integral part of nursing practice (Rowe 2000) The NMC Code of Professional Conduct (2004) states that a nurse is personally accountable for her practice, has a duty of care to patients and must work within the laws of the country.

Every health professional has a legal obligation to patients. Nurses as part of the health care team share an important role in the quality and safe delivery of patient care. They have the major responsibility for the development, implementation and continuous practice of policies and procedures of an organisation. It is therefore essential that every organization offer unwavering encouragement and resources to support their staff to perform their duty of care in every patient. On the other hand, high incidences of risk in the health care settings have created great concerns for healthcare organizations. Not only they have effects on patients, but also they project threat to the socioeconomic status. For this reason, it is expected that all health care professionals will engage with all elements of risk management to ensure quality and safe patient delivery. This paper will critically discuss three (3) episodes of care from the case study Health Care Complaints Commission [HCCC] v Jarrett [2013] Nursing and Midwifery Professional Standards Committee of New South Wales [NSWNMPSC] 3 in relation to Registered Nurse’s [RN] role as a leader in the health care team, application of clinical risk management [CRM] in health care domains, accountability in relation to clinical governance [CG], quality improvement and change management practices and the importance of continuing professional development in preparation for transition to the role of RN.

The scope of practice for non-medical prescribers (NMP) has expanded greatly over the last 2 decades, with legislation now allowing NMP’s to prescribe from the whole BNF (with the exception of treatment in addiction and within the prescribers competency). Since the introduction of the Medicines Act in 1986 there have been over 15 different governmental reports and legislative changes (see Appendix 1 timeline) that have allowed for the development and growth of the NMP role. Initiated by The Cumberledge report of 1986 and followed by advisory group report in 1989 legislation was introduced with the Medicinal products: Prescription by nurses act of 1992 which allowed primary care nurses to prescribe from a limited formulary (V100 & V200). This advancement in legislation recognised previous recommendations and placed the improvement of patient care and effective use of resources at the core of its practice. However these acts did not reflect on other areas like secondary care or pharmacist and it wasn’t until 1998 The Crown Report and its second report published a year later that led to supplementary and independent prescribing (V300). In 2003 legislation was passed allowing some prescribing of controlled drugs in palliative care with restricted circumstances (amendment to Misuse of drugs Act 1971). In May 2006 nurses were empowered to prescribe from the whole BNF with the exception of some controlled drugs, and in 2009 further legislative changes were made to include the

Easy access to the drugs is another important factor contributing to nurses who substance abuse. As stated by Serghis (1999) the availability of medications in the workplace has been linked to substance abuse among nurses (as cited in Talbert, 2009, p.17). Part of the nurse’s duty every day is to give medication to their patients, which exposes them to have easy access to drugs. Nurses who take medication from their patients for their own personal use are "always using the maximum PRN dosage when other nurses use less" (DeClerk, 2008, p. 12). The healthcare field accepts the use of medication and so nurses may perceive the wrong idea by making use of patients drugs themselves. "Medications are easily accessible to nurses, who may believe erroneously that they have the ability to control their own medications use because of their experience with administering medication to patients" (Talbert, 2009, p. 17). In the case

Nurse prescribing was first recommended, by the RCN, in 1980 and became part of the government’s policy agenda in 1986 with the Cumberlege Report (DH 1986). Further, the Crown Report (DH 1989) advocated prescribing by trained community nurses from a limited formulary. Legislation was introduced in 1992 -The Medicinal Products: Prescription By Nurses Act, 1992 followed by secondary legislation,

In the UK, nurse prescribing was born out of the need to increase efficiency in the NHS by making best use of its resources. Nurse-led services are one means of improving healthcare provision and a string of legislative change has gradually broadened the scope of nurse prescribing in the UK. (Courtenay et al 2007).

In order to meet the growing demand for primary care, nurse practitioners need prescriptive authority to provide quality, safe, and cost-effective healthcare to patients. The development of nurse practitioners, plus physician shortages in primary care, leads to an increasing need for nurse practitioners and access to health care. However, nurse practitioners currently face prescription regulations for controlled substances, which limits their scope of practice. The regulation of nurse practitioners prescribing controlled substances diminishes comprehensive health care services by increasing the wait time for patients and liability claims for physicians. The number of nurse

This critique will analyse a principal policy institutionalised within the Nelson Marlborough District Health Board (NMDHB). Tilted 'Self or Nominated Person Home Administration of Intravenous (IV) Medication for Adults’ - Appendix A, the policy has been established by the NMDHB to ensure the safe management and administration of IV medication by a Self or Nominated person within the home environment. The critique will focus on using current literature to reassess its relevance, effectiveness, and usefulness to my area of clinical practice. This policy is integral to our service because as Registered Nurses (RN) within the District Nursing Service (DNS), we are responsible for the supervision and administration of IV therapy within the community.

Key message: “Nurses should practice to the full extent of their education and training. The IOM definition of primary care”. The provision of integrated accessible health care. Services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, practicing in the context of family and community”. (IOM 1998) The challenges mainly are management of chronic conditions, care co-ordination, prevention and wellness, prevention of adverse events ,provision of mental health services, school health services , long term and palliative care. Recommendation put forward by IOM to work collectively to improve through integration of primary care and public health. Advanced Practice Registered Nurses in 16 states and District of Colombia can diagnose and prescribe medications. These states have granted autonomy and significantly reduced the barriers to practicing independently, allowing patients greater access to quality care. The ARPNs work throughout from health promotion and disease