Consultation on the first test case of nurse prescribing is underway with nurse leaders hoping to see a pilot up and running for 2011.
Prescribing by diabetes nurse specialists (DNS) was first floated last year but legislative barriers to nurse prescribing caused delays.
Now a joint consultation document is seeking feedback on a new regulation to allow the nurse specialists to become designated prescribers and also on what qualifications and experience the would-be nurse prescribers must have.
Helen Snell, a prescribing nurse practitioner in diabetes, is welcoming the chance for demonstration sites to pilot an alternative for DNS to the frustration of prescribing under standing orders. The current cumbersome system can require a physician to sign off the hundreds of prescriptions a week issued by the specialist registered nurses.
Snell is to lead the planned pilot project for the New Zealand Society for the Study of Diabetes, which initiated the project in collaboration with Health Workforce New Zealand (HWNZ) and the nursing innovation team of the Ministry of Health.
Helen Pocknall, nurse leader and HWNZ board member, was delighted to see a joint consultation document on the project being released by HWNZ, the Ministry and Nursing Council. She said it not only showed that the groups could work in partnership but also the joint document meant consultation should move forward more quickly.
Pocknall said the proposed demonstration sites pilot is one of the workforce innovations being backed by Health Workforce New Zealand that set aside a $4 million budget for innovation projects in its first year.
Snell said, if the demonstration sites went ahead, the society’s role would be to evaluate the safety and effectiveness of diabetes nurse specialist prescribing as one example of how nurse prescribing could better meet the needs of consumers.
“I think this will provide really good evidence and impetus to change the Medicines Act to provide a more permissive prescribing framework for nursing.”
At present under the Medicines Act 1981 registered nurses cannot prescribe so - until long awaited reform takes place - a regulation is required to give limited designated prescriber status to the diabetes nurse specialists.
The consultation document points out that the Government intends to introduce a Medicines Amendment Bill, specifically to allow regulation of natural health products, but amending the prescribing framework “to make it more flexible and responsive to innovative practice” could be considered at the same time.
The HWNZ-initiated consultation section seeks feedback on the proposed regulation to allow “suitably qualified and experienced registered nurses employed in diabetes services to become designated prescribers under the Medicines Act 1981” of a specific list of medicines and medical devices.
It says currently New Zealand has a “range of health professionals” including nurses who could deliver “better, sooner and more convenient care” if legislation was amended to better reflect current practice and current qualification levels.
Diabetes nurse specialists already take “substantial responsibility” for many diabetes patients’ care and allowing them to prescribe would ensure greater continuity of care and greater convenience for patients no longer needing a second appointment with a medical practitioner for routine prescriptions. The demonstration sites would involve DNS prescribing under supervision in collaborative multidisciplinary settings.
Following the consultation HWNZ was to forward a recommendation to the Minister who would decide whether or not the new prescribing regulation goes to cabinet for approval.
The second part of the consultation is lead by the Nursing Council and seeks feedback on what qualifications, training and knowledge should be required by the diabetes nurse specialists to gain Nursing Council authorisation as designated prescribers.
The Nursing Council stresses that it remains committed to a review of the Medicines Act to allow other registered nurses to prescribe and to give nurse practitioners the same authorized prescribing status as midwives, dentists and medical practitioners.
It is asking for feedback on whether first-time prescribers need a postgraduate certificate, diploma, clinical masters degree or another qualification option. Also whether they would need a prescribing practicum or clinical exam and what level of experience or knowledge they needed to demonstrate to be able to safely prescribe.
Consultation closes on September 10. The consultation document can be found at:
