Non-prescribing Nurses Research Articles

Non-prescribing nurses in aesthetics

Non-prescribing nurses in aesthetics

Nurses’ role in medical prescription: Systematic review

Abstract Aim: To identify and describe the role of non-prescribing nurses in medical prescription, through a critical synthesis of all the studies published worldwide answering this

Mandatory regulation of our sector remains a myth

Journal of Aesthetic NursingVol. 6, No. 9 EditorialsFree AccessMandatory regulation of our sector remains a mythNatasha DevanNatasha DevanSearch for more papers by this authorNatasha DevanPublished Online:7 Nov 2017https://doi.org/10.12968/joan.2017.6.9.457AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail No matter who you make conversation with in aesthetics, there is always one topic of discussion that is inescapable—regulation. Over the past few years, Health Education England (HEE), the Joint Council for Cosmetic Practitioners (JCCP), and its body for setting standards, the Cosmetic Practice Standards Authority (CPSA), have dedicated an immense amount time and effort to establishing aesthetic medicine as a reputable branch of healthcare. But complying with HEE's education and qualification requirements and registering with the JCCP is voluntary, and the flurry of recommendations from Government-endorsed bodies has caused much confusion.HEE proposed that those who wish to provide cosmetic injectables have to be qualified at ‘level 7’. As a result, several training companies set up so-called level 7, ‘accredited’ courses for dermal fillers and botulinum toxin. However, during a panel discussion at Aesthetic Medicine North, interim executive support for the JCCP Paul Burgess said (Aesthetic Business Transformations (ABT), 2017): ‘There are thousands of programmes out there offering a level 7 qualification. It comes with a major health warning—you must check whether it is an officially recognised qualification or not.’Formally accredited courses will be listed on the JCCP's register for education and training providers, but this can only be put in place when the CPSA's standards have been finalised. The standards for non-surgical cosmetic procedures were published in draft form for consultation in September (CPSA, 2017a), and the deadline for comments has now passed; however, the JCCP is welcoming further submissions.There are many aspects of the standards that should be celebrated. As a publication founded on evidence-based practice, the Journal of Aesthetic Nursing (JAN) fully supports the importance placed on data collection for procedures and adverse events. JAN also welcomes the focus on working as a team, as opposed to practising in isolation as so many do. As a first draft, however, there is much room for improvement.The proposed supervision matrix (CPSA, 2017b) suggests that non-prescribing nurses need to be supervised at all times (i.e. immediately available within the premises, with the ability to intervene in the case of a procedure-related complication, adverse event or emergency) when administering botulinum toxin. This will have a drastic impact on the way these nurses, who may have been practising aesthetics for decades without supervision, work, and could put them off from engaging with the standards as a whole.As registered health professionals, nurses, doctors and dentists are bound by their relevant regulatory body's code of conduct, which requires them to, as the CPSA (2017a) standards require, ‘have strong moral principles and act with honesty and integrity’. Non-health professionals, on the other hand, are not regulated and therefore will not be held accountable for complying with the need to practise ethically and prioritise the patient's best interests over financial gain.Although mandatory regulation may arise in the future, at present it does not exist in any shape or form. As Burgess said (ABT, 2017): ‘Nobody has to take these qualifications, and you can just carry on as you are if that's what you want to do’. Whether you choose to embrace the new standards or not, you should always practise ethically and responsibly, and be relentless with raising standards. References Aesthetic Business Transformations. Facebook live video post (23 October 2017). 2017. http://tinyurl.com/y7ljnu56 (accessed 27 October 2017) Google ScholarCosmetic Practice Standards Authority. CPSA clinical and practice standards. 2017a. http://tinyurl.com/yd3dx783 (accessed 27 October 2017) Google ScholarCosmetic Practice Standards Authority. CPSA supervision matrix. 2017b. http://tinyurl.com/ybfwchz6 (accessed 27 October 2017) Google Scholar FiguresReferencesRelatedDetails 2 November 2017Volume 6Issue 9ISSN (print): 2050-3717ISSN (online): 2052-2878 Metrics History Published online 7 November 2017 Published in print 2 November 2017 Information© MA Healthcare LimitedPDF download

Why has prescribing become such a taboo topic in medical aesthetics?

At a time where an increasing number of non-prescribing nurses and beauty therapists are providing non-surgical cosmetic procedures, such as botulinum toxin and dermal fillers, questions continue to be raised around the ethics of prescribing for others. Amy Senior discusses why this has remained a topic of interest and urges nurses to raise concerns with their regulatory body about the lack of guidance in this area

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

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. …

Beliefs about medicines among prescribing and non-prescribing nurses in Sweden

Background: The beliefs patients and health care providers have about medicines are important for communication about medicines, which is a central tool for patient-centered care and the quality of care. This study aimed to analyze general beliefs about medicines among prescribing and non-prescribing nurses. Methods: In this cross-sectional study a survey (Beliefs about Medicines Questionnaire, socio-demographic factors, years of professional experience and the right to prescribe) was sent to 303 nurses in Region Västra Götaland, Sweden, in 2007 (response rate: 80.5%). Analyses were made with independent t -tests, analyses of variance and linear regressions. Results: The beliefs about medicines among nurse prescribers did not differ from those of non-prescribing nurses. Professional experience was, however, important for harmful beliefs about medicines. Non-prescribing nurses with 16-30 years of professional experience had more harmful beliefs about medicines compared with non-prescribing nurses with less professional experience. Conclusions: It is important to further examine the possible effects of education and professional experience on beliefs among nurses. During the communication between nurses and patients there is a need for increased awareness of the importance of professional experience for beliefs about medicines.

Prescribing for medical aesthetic patients outside of nurse prescribers’ immediate care

Foreword by Lorna Bowes Much work has been put in by a dedicated team of aesthetic nurses, all members of the British Association of Cosmetic Nurses, who volunteered their knowledge, time and varied experiences to put together a document in the immediate aftermath of the BBC's expose on remote prescribing and subsequent positions of the General Medical Council and Nursing and Midwifery Council. The draft guidelines were then reviewed by a further group of aesthetic nurses and examined for relevance and accuracy. This is, as would be expected, a work that will develop and evolve as aesthetic medicine changes and guidelines from the Nursing and Midwifery Council, Medicines and Healthcare Products Regulatory Agency and other bodies affect practice. The first review of the guidelines is set for as early as October this year. The document is intended for use by nurse independent prescribers prescribing for patients outside of their immediate care, and the non-prescribing nurses who will be administering the prescribed treatments. The guidelines are published in full here, and thanks must go to the team expertly led by prescriber and nurse practitioner Andrew Rankin.

Nurses' reported influence on the prescription and use of medication

To identify the activities senior nurses report undertaking that may influence the prescription and use of medicines. While much attention has focused on the role of nurse prescribing, little is known about the extent to which non-prescribing nurses influence medication decision making. The pharmaceutical industry recognizes this influence in its marketing strategies, and courts nurses by provision of promotional material and sponsorship of nursing professional development. We undertook parallel web- and paper-based surveys of 100 senior registered nurses employed by government-funded health boards in two distinct New Zealand regions. Only 2/96 (2%) of nurses had prescribing rights, yet 74/94 (79%) reported recommending treatments to the prescribing doctor, 74/95 (79%) stated they provided advice to patients about over-the-counter medications and 71/92 (77%) participated in the development of guidelines or policies that include the use of medications. All nurses in this sample reported influencing the prescription of medicines in one way or another. From actually writing prescriptions to providing feedback on treatment outcomes, there are many opportunities for nurses to influence the decision making of medical and other prescribers, which open nurses to exploitation from commercial forces. Policy and education regarding prescriber relationships with the pharmaceutical industry should also recognize the role of non-prescribing nurses.

How nurse prescribing influences the role of nursing

Because role change can be disruptive, the introduction of nurse prescribing could potentially lead to confusion and conflict over role boundaries and definitions. This article considers how adopting prescribing has influenced the role of nurse prescribers who treat and manage patients with diabetes. Interviews with 10 nurse prescribers, nine doctors and three non-prescribing nurses were collected as part of a case study of nine UK sites where nurses prescribed medicines for patients with diabetes. We found that nurses resisted the ‘medicalization’ of their role. They strove to ensure that their consultations continued to follow a ‘nursing model’ which involved holistic assessment, health promotion and patient-centred care. There were perceived differences in the level of decision-making between doctors and nurse prescribers. To conclude, nurses adopted prescribing while maintaining a nursing approach to practice. For specialist nurses, this expanded role included higher levels of decision-making more traditionally associated with doctors.

Relationships in nurse prescribing: revealing the processes

Nurse prescribing, a relatively recent policy initiative in the NHS, has the potential to initiate long-term changes to the ways in which the various actors in primary care relate to each other. Focusing primarily on the working lives of district nurses, this article explores the ways these practitioners and others interact, using their own words as a source of data. Semi-structured interviews are undertaken with a number of professionals in a purposive sample (17 nurse prescribers, four non-prescribing nurses, two pharmacists and one general practitioner) employing an iterative approach. Data revealed are analysed thematically to produce detailed explanatory accounts of activity centering around prescribing. Concepts generated from the themes (team working, effects on roles, prescribing mechanisms and relationships) are discussed. Findings indicate that working relationships generally operate smoothly, although some staff nurses, pharmacists and GPs appear unclear about some legal aspects of the prescribing role.

Nurse prescribing in dermatology: doctors’ and non‐prescribing nurses’ views

This paper is a report of a study conducted to explore doctor and non-prescribing nurse views about nurse prescribing in the light of their experience in dermatology. The cooperation of healthcare professionals and peers is of key importance in enabling and supporting nurse prescribing. Lack of understanding of and opposition to nurse prescribing are known barriers to its implementation. Given the important role they play, it is necessary to consider how the recent expansion of nurse prescribing rights in England impacts on the views of healthcare professionals. Interviews with 12 doctors and six non-prescribing nurses were conducted in 10 case study sites across England between 2006 and 2007. Participants all worked with nurses who prescribed for patients with dermatological conditions in secondary or primary care. Thematic analysis was conducted on the interview data. Participants were positive about their experiences of nurse prescribing having witnessed benefits from it, but had reservations about nurse prescribing in general. Acceptance was conditional upon the nurses' level of experience, awareness of their own limitations and the context in which they prescribed. Fears that nurses would prescribe beyond their level of competence were expected to reduce as understanding and experience of nurse prescribing increased. Indications are that nurse prescribing can be acceptable to doctors and nurses so long as it operates within recommended parameters. Greater promotion and assessment of standards and criteria are recommended to improve understanding and acceptance of nurse prescribing.

Nurses' confidence and pharmacological knowledge: a study.

The introduction of nurse prescribing will assist the government to deliver its agenda of providing patients with faster access to advice and health services. This study evaluated the knowledge base, self-rated knowledge and confidence, for a prescribing role, in a group of community nurses in Essex. A questionnaire was distributed to 183 community nurses recruited using a random, stratified method, and 110 nurses returned completed forms. Nurse prescribers in the sample were more confident and rated their knowledge more highly when compared with non-prescribing nurses. However, prescribers' actual medication-related knowledge, relative to their high levels of confidence, was not confirmed with performance on case scenarios. In responses to the case scenarios, prescribers did not perform as well as non-prescribers on all five analysed scenarios. The overall assessment of the nurses' response to the OTC case scenarios showed a poor performance when compared with prescription cases. There is a need to improve community nurses' levels of confidence and their abilities in coping with medication-related issues at pre-registration and post-registration level.