Non-prescribing diabetes nurse specialist views of nurse prescribing in diabetes health

Abstract

IntroductionDiabetes mellitus (DM) is one of the most common chronic diseases throughout the world. Its management is complex and requires a lifetime of behaviour modification (Courtenay & Carey, 2008; Kara, van der Bijl, Shortridge-Baggett, Asti, & Erguney, 2006). The World Health Organisation (WHO) has predicted that there will be 366 million people with diabetes by 2030 (Kara et al., 2006). Price-Waterhouse-Coopers estimate the financial implications of diabetes will reach NZ$1000 million by 2021 (Joshy & Simmons, 2006). There will be a profound impact on the New Zealand health service as the number of people with diabetes increases along with life expectancy. Diabetes nurse specialist (DNS) prescribing has the potentialto increase accessibility and services to people with diabetes, help alleviate some of the pressure on the health service, and provide a more holistic model of care (Latter, Maben, Myall, Young, & Baileff, 2012; Wilkinson, Carryer, & Adams, 2013).Nursing practice has evolved considerably over the last 20 years with nurses extending their roles, taking on new roles, and specialising in particular areas (Bodington, 2011). Nurses who specialise in diabetes can be professionally recognised by means of a voluntary accredition process available through the New Zealand Nurses Organisation (NZNO) (Aotearoa College of Diabetes Nurses, 2014). Accreditation is defined by the National Diabetes Nurses Knowledge and Skills Framework (KSF) (New Zealand Society for the Study of Diabetes, 2009) and is aligned with the Nursing Council of New Zealand (NCNZ) requirements for professional development and recognition programmes. There are four levels in the KSF, with the most advanced being 'specialist diabetes nurse' (level 4). These nurses have developed expert diabetes practice and provide care for people with diabetes who have complex health needs. Specialist nurses have undertaken post graduate study towards or completion of a Masters degree.In addition to supporting people with diabetes to make lifestyle changes, many nurses who specialise in diabetes make changes to the dose or frequency of insulin or oral hypoglycaemic medications using standing orders (Medicines (Standing orders) Amendment Regulations, 2011). Any prescriptions for new or repeat medicines however must be provided by an authorised prescriber. Until recently, nurse practitioners have been the only nurses able to prescribe medicines in New Zealand.The primary legislation governing the supply, manufacture and prescription of medicines in New Zealand is the Medicines Amendment Act 2013. This Act enables prescribing for two classes of prescriber: authorised prescribers (medical practitioners, nurse practitioners, dentists, optometrists and midwives); and designated prescribers (nurses working in diabetes health, pharmacists and dietitians). Designated prescribers a re able to prescribe from a limited formulary within their area of practice. Specific regulations were passed in 2011 allowing DNS's to prescribe from a schedule of 26 diabetes-related medicines (Medicines (Designated Prescriber-Registered Nurses Practising in Diabetes Health) Regulations, 2011). The schedule of medicines includes lipid-lowering agents and antihypertensive medications.A project to trial DNS prescribing took place in 2011 with twelve DNS located in four demonstration sites around New Zealand authorised to prescribe underthe new regulations. The evaluation of the trial found DNS prescribing to be safe, of high quality and appropriate (Wilkinson et al., 2013). A staged roll-out to other DNS has since taken place (Budge & Snell, 2013). The 2011 project evaluation included the views of various groups of professionals who were affected by DNS prescribing, including the non-prescribing nurses who worked with the DNS who were participating in the trial.As a new initiative that would extend beyond the demonstration sites it was important to gauge the level of interest amongst the nurses most likely to become the next prescribers. …