Registered Nurses Prescribe Medications : Paving The Way For Efficient Health Care

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

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

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.

It is no secret that communication is key when providing direct patient care in a skilled nursing facility. However, there is a noticeable lapse in the communication between the care team when providing care to the individual or groups of individuals. Two main parts of any care team are the registered nurse and the certified nursing assistant, as these are the two people whom have the most direct and impactful roles with residents in a skilled facility. The Registered Nurse and the Certified Nursing Assistant play similar roles in providing patient care, but have different roles in its entirety. The role of the Registered Nurse (RN) is defined as having the competency and skill to provide direct and indirect health care to individuals, their families, and communities around them. Services are also provided designed to give out medications, to promote comfort or healing, promote healing, and to also provide the dignity of their patients and patient’s families (American College of Rheumatology, 2015).

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,

1. In the workplace there is a generic Medication Management Policy and Procedures for Adult Services (Issue 10, 2012) document. This is kept to hand in a locked cupboard, readily available to read. It requires that all Healthcare Staff are given mandatory training and refreshers are provided. Legislation which surrounds the administration of medication includes The Medicines Act 1968, The Misuse of Drugs Act 1971, The Data Protection Act 1998, The Care Standards Act 2000 and The Health and Social Care Act 2001

In the State of California, the Business and Professions Code pertaining to Healing Arts, makes provisions for Nurse Practitioners (NPs) and Certified Nurse-Midwives (CNMs) to gain prescriptive authority (CA BRN, 2002, CA BRN, 2010). This policy stipulates this privilege to be accompanied with the stringent criteria that NPs and CNMs can only furnish prescriptions and medical devices under the supervision of a physician or under standard protocols sanctioned by physicians. The California Board of Registered Nursing (CA BRN) along with the State’s Business and Professions Code do not however, advocate for the inclusion of Clinical Nurse Specialists (CNSs) amongst those APNs authorized to be able to furnish (California’s legal terminology for “ordering” medications) prescriptions (CA BRN, 2003).

Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs) are both considered advanced practice nurses (APNs) in Canada (Donald et al., 2010). Although these roles have existed in Canada for decades (Canadian Nurses Association, 2008), confusion still remains about the titles and exact roles that these professionals play (Donald et al., 2010). This paper will use the Saskatchewan Nursing Advanced Practice model as a framework to highlight the similarities and differences between both types of advanced practice nurse. The scope of practice, registration, education, practice settings, and effectiveness of CNSs and NPs will be examined. Although their roles overlap, CNSs and NPs have both been shown to be important members of the health care team (DiCenso & Bryant-Lukosius, 2010). Research has shown that adding CNSs and NPs to our health care system can increase patient satisfaction, decrease wait times, and decrease readmissions (DiCenso & Bryant-Lukosius, 2010). Increased public and health care professional awareness is needed to have these roles fully incorporated into our current health care system (DiCenso & Bryant-Lukosius, 2010).

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

As nurses, we are charged with providing the best possible care to our patients, meeting their needs and working towards positive outcomes. Nurses work with all ages, races, disease processes, every medication from A-Z, independently or with a team. Nurses take orders from physicians face-to-face, over the phone, and in writing. It may be shorthand, misspelled, or pronounced like you have never heard, and you must clarify it with the physician, the pharmacy, the patient’s chart, and the drug book before you administer. Some patient’s curse us, some praise us; We cry with

The role that nurse practitioner (NP) plays within the increasing complex health care system is a constant changing role with the Consensus Model and the introduction of the Affordable Care Act in 2010. The scope of the nurse practitioner (NP) includes the care of the young, the old, the sick and the well. The educational needs of a nurse practitioner vary greatly from that of a Registered Nurse (RN), in the amount of education as well as the focus of the education. NPs provide coordinated primary care with the use of comprehensive health histories and physical examinations, diagnosing and treating acute and chronic illnesses, the management of medications and therapies, ordering and interpreting tests results, and educating and

Changes in the Health Care System and the Practice of Nursing have become complex. Technological changes, complicated client needs, short hospital length of stay, and departure from acute care to community based care, all these changes have underscore the need for professional nurses to think critically in order to provide safe and effective client care. A better educated nursing workforce can provide good health education to patients and their families. The affordable care of 2010 has required the need for nurses to expand their role of practice to meet complicated patient demands. This has prompted the Institute Of Medicine to review the “Future of Nursing, Leading change and Advancing Health”. {Creasia & Fribery,2011}