Karen Jones was authorised last month by the Nursing Council of New Zealand as a registered nurse (RN) prescriber under regulations that came into force on September 20 allowing suitably qualified RNS to prescribe a limited list of medicines used in long-term and common conditions
The primary health nurse works fulltime for the Te Manu Aute Whare Oranga clinic at Manurewa Marae as part of an “extremely supportive” team of three part-time GPs and, more recently, a part-time nurse practitioner.
Jones says one of her GP colleagues told her when she applied for prescribing rights that it was likely that her first prescription would “feel like a let down” as it would be for something like paracetamol.
But she says it still felt “awesome” as a patient had rung up late on a Friday needing pain relief for the weekend and, with no doctors on site, she was able to meet the patient’s needs. She had also talked to the local pharmacy about the new regulations and shown them proof of her new status on the Nursing Council website so her first prescription went smoothly.
Jones, who trained at Manukau Institute of Technology graduating in 1992, recently completed her clinical masters degree through Massey University including her prescribing practicum. She says she has been working in primary health for 15 years, with a particular interest in diabetes, and had began work towards becoming a diabetes nurse prescriber when the new regulations came into force allowing her to apply to be an RN prescriber.
The main pathway to RN prescribing rights will be through the new postgraduate diploma in prescribing being offered next year but some nurses, like Jones, who have already completed a prescribing practicum as part of their clinical master’s degree, have been able to apply since October 1.
The community clinic Jones works for has 1400 patients enrolled, 90 per cent Māori, and Jones says long-term conditions is a major focus of the clinic’s work with her own special interests being diabetes and lung disease.
She says as she spends a lot of time working with people with diabetes it had been “wonderful” to be able to titrate insulin for her patients, which was saving time for both patients and the team’s GPs and NP. Jones believes the new regulations will be good for the whole health system with GPs and NPs able to focus more on the acutely unwell or those with complicated conditions while RN prescribers like herself could see patients coming in for routine review appointments or needing repeat medications that are covered by the list of medications she was authorised to prescribe from. In her first few weeks of prescribing she says the most common medications she is prescribing are diabetes medications.
Jones, who thanked her husband, two teenage daughters and mentor Dr Rod Wynne-Jones for their support in gaining her new status, says her next step will be looking at become a nurse practitioner.
The first nurse practitioner prescriber was authorised in 2003 and NPs now have the same autonomous prescribing status as dentists and doctors.
Diabetes clinical nurse specialists have been prescribing as part of a collaborative team for the past five years but the new regulations opened the doors to suitably qualified nurses working in a general practice to district nursing and specialist outpatient clinics to rural nurse specialists to become prescribers as long as they are working collaboratively and have access to a prescribing mentor (see full requirements below)
RN prescriber workplace requirements
Registered nurses applying for authorisation to prescribe in primary health and specialty teams must have the following in place in their clinical area:
- Employer support to develop a role that permits registered nurses to assess and manage patients e.g. nurse led clinics
- A collaborative multidisciplinary team model
- Access to peer review, medicines audit and continuing education
- Authority to order and obtain results of laboratory tests
- Quality management systems in place including policies, processes and evidence of continuous quality improvement
- Established links to senior nursing support and other nurse prescribers
- Access to a minimum of one authorised prescriber, who will act as a mentor and
- Approval from the Service Manager of the DHB, or PHO, or other employer
- Prescribing mentor who provide supervision for the first year of prescribing practice