References
Non-medical prescribers: prescribing within practice
Abstract
Since its inception in Ireland in 2007, the Nurse Prescribing Programme has prepared registered nurses and midwives to prescribe from a limited formulary in their area of clinical speciality. However, registration numbers have declined in recent years, prompting changes to the registration processes. This article present the findings of a study conducted on the prescribing behaviours, practices and confidence of registered nurse/midwife prescribers following these changes, reporting the findings from the qualitative arm of a larger mixed-method study. Interviews with participants (n=6) explored their prescribing behaviours, practices and confidence. The findings suggest that organisational and professional factors influence prescribing. Scope of practice and expert decision-making is seen to influence engagement with treatment. Interprofessional cooperation continues to develop in making prescribing decisions. There is a clear need for interprofessional education to increase cooperation between health professionals in making prescribing decisions and including national competencies for all prescribers.
While medical prescribing by registered nurses has been operational in the USA since the 1960s, the Republic of Ireland only introduced it relatively recently with the first registered nurse/midwife prescriber (RNP/RMP), prescribing medicines in 2007 (Government of Ireland 2006, 2007; Nursing and Midwifery Board of Ireland (NMBI), 2019). Independent prescriptive authority, from a limited formulary, is open to all registered nurses and midwives with relevant clinical experience, who have completed the accredited generic nurse and midwife prescribing education programme, delivered in five Higher Education Institutions (NMBI, 2019; Office of the Nursing and Midwifery Services Director, 2018).
In part fulfilment of the requirements of the prescribing programme, assessment of competence to prescribe is demonstrated through clinical assessments based on the candidate’s area of practice by their assigned clinical mentor. The candidates are guided in prescribing practice by the Decision-Making Framework for Nursing and Midwifery Prescribing, set down by the NMBI (Bord, 2017). The parameters for each prescribing decision by an RNP/RMP are that the practitioner works within their scope of practice, a patient history and a thorough physical examination are undertaken, prescribing practice is supported in the employing organisation, and the patient or family is included in, and understands the treatment (Bord, 2017). All requirements must be met prior to the writing of a new or continuing prescription, or cessation of a medication. In addition, a National Nurse and Midwife Prescribing Minimum Dataset to record and monitor prescribing activity across the country has been developed and implemented (Creedon et al, 2014). RNPs work in adult or childrens’ services in a variety of settings including disability support, mental healthcare, primary care and acute hospital-based services, with RMPs working in midwifery. There are RNP/RMPs practicing at the professional grades of Staff Nurse/Midwife, Clinical Nurse/Midwife Specialist, and Advanced Nurse/Midwife Practitioner.
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