The Scope Of Practice For Non Medical Prescribers

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

The Medicines Acts 1968 and various amendments cover the legal management of medication. While care staff are not expected to have detailed knowledge of the legislation, they do need to be aware of the legal difference between types of drugs and the legal framework that allows them to handle medicines on behalf of the service user.

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

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.

I feel it is important for the purpose of my scenario to acknowledge the new skills which I have acquired whilst undertaking the V150 and explain the background to Nurse Prescribing. The Cumberledge Report (DHSS, 1986) made the initial recommendations for nurses to

“Non-medical prescribing is prescribing which is taken by a health professional who is not a doctor” (Non-medical prescribing 2012).To become a non-medical prescriber the relevant training must be undertaken to ensure the patients’ safety is most important. The health care professional who is the non-medical prescribers is only legally allowed to prescribe within their area of expertise and they must remain competent within that area, through maintenance of various continuing education and training programmes.

There are several current legislation, guidelines, policies and protocols relevant to the administration of medication. These are The medicines Act (1968), Misuse of Drugs Act (1971), Misuse of Drugs Regulations (2007), Health Act (2000) The Care Standards Act (2000), Domiciliary Care Agencies Regulations (2002) Control of Substances Hazards to Health (2002), Hazard Waste Regulations, Controlled Waste Regulations (1992), The Handling of Medic9ines in Social Care and The Safe and Secure Handling of Medicines; a Team Approach.

* Nursing care providers are not covered by this legislation and must make their own arrangements for the disposal of unwanted medicine through a licensed waste management company.

Outcome 1 – Understand the legislative framework for the use of medication in social care settings.

Since the inception of the Nurse Practitioner (NP) role in the 1960s, NPs have thrived in the delivery of primary healthcare and nurse case management. Despite patient satisfaction with NPs ' style of care, nurses have been critical of NPs, while physicians have been threatened by NP encroachment on MD practice. Balancing assessment, diagnosis, and treatment with caring defines NPs ' success as primary care providers. Understand the role and Scope of Practice of NPs is sometimes difficult for some to understand. The purpose of this paper is to define the role and history of NP, compare and contrast licensure versus certifications, understand NP Scope Of Practice and Standards of Care, discuss how the State Practice Acts regulate FNP practice, discuss credentialing and privileging, and differentiate between legislative and regulatory processes.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

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

The prevalence of chronic diseases globally such as heart disease, diabetes and kidney disease are continuously increasing due to risk factors such as obesity, physical inactivity, poor diets, smoking and excessive alcohol consumption (1). In Australia, this trend is also evident; thus, there is a need for primary health care interventions to prevent these diseases. The Pharmacy guild of Australia (The Guild) has proposed to the government for pharmacies to undertake annual health checks. These health checks would comprise of weight, body mass index, blood pressure, blood glucose, cholesterol and ask about lifestyle factors such as smoking and alcohol consumption. These checks would allow identification of patients at risk of chronic