Analysis

Exclusive: Newly qualified nurses should have limited prescribing powers, draft NMC plans reveal

Graduating nurses in the UK will be given limited prescribing powers, according to the Nursing and Midwifery Council's draft education plans as seen by Nursing Standard.

Graduating nurses in the UK will be given limited prescribing powers, according to Nursing and Midwifery Council's (NMC) draft education plans as seen by Nursing Standard


According to the NMC's new draft Standards for Registered Nurse Education, graduating nurses 
will be able to prescribe from an 'agreed formulary'. Picture: iStock

The unpublished plans, called Standards for Registered Nurse Education, are under consideration by the Nursing and Midwifery Council (NMC) in its 'radical' overhaul of nursing education.

The document offers much more detail on the skills nurses should have at the point of registration than the current guidelines.

Nurses will be able to prescribe from an 'agreed formulary', according to the standards, and should also complete a lengthy list of intravenous procedures, including venepuncture, cannulation and various intravenous therapies.

It is not clear how similar the final document will be to its current form, which is understood to be in its eighth revision.

The NMC told Nursing Standard the document will be refined further ahead of a full public consultation in the spring.

Standardised skills

Many of the changes have been welcomed by experienced nurses and nursing leaders. The RCN says that while some nursing students learn the listed skills on their course, others do not, and therefore standardisation could be a useful means of determining skillsets across the board. 

28,300

accepted onto nursing degree courses in the UK in 2016.

'What they are trying to do is at the point of registration make sure everyone knows what skills and knowledge that person will have, and also they are upping the level of expected skills and knowledge,' says RCN head of education Anne Corrin.

'The general direction of travel is good, but to deliver that we would need to look at funding issues, mentors and good placements, which will be crucial to delivering more clinical skills.'

Under seven headings, the document contains a list of outcome-based standards for nurses to demonstrate by the end of the course. These are generic competencies that describe the 'roles, responsibilities and accountabilities' for all registered nurses. Technical annexes to these standards, which are under development, will provide 'some indication of potential field specific content', it states.

Ms Corrin says she believes the regulator may introduce a structure of two years of general nursing education followed by a year of specialist training, as advocated by Health Education England's Shape of Caring review in 2015.

The standards appear to draw on Lord Willis' review, which stated: 'Greater acquisition of skills that were previously considered advanced or post-registration should be included in the pre-registration programme.'

Assessment concerns

However, there are concerns that the standards will create a more generic approach to nurse training, with nurses expected to be competent in complex skills from the point of registration.

2010 

last time the pre-registration standards were reviewed by the NMC.

Doreen Crawford, nurse adviser with independent consultancy Crawford MacKenzie, says she believes the proposed standards could threaten patient safety. She says that currently, many of the interventions required in the draft plans would be carried out under extra supervision, and would often only take place after further training. 'I am particularly concerned with regards to IV therapy and patient safety, especially when it comes to the care of small babies and young children,' she says. 

Birmingham City University independent consultant nurse and visiting professor of prescribing and medicines management Matt Griffiths, who has not seen the draft, welcomed plans to give all newly qualified nurses limited prescribing options, but called the plans 'bold'. He says nursing students will need to be trained by qualified prescribers and carefully assessed. 

'Alongside the ability to administer intravenous drugs, are nurses also competent at dealing with associated emergencies, such as anaphylaxis?' he says. 'Have they been tested for numeracy, and will they continue to be assessed? Intravenous drug administration is among the highest risk procedure when medicines are administered.

'I believe that the NMC is interested in getting all registrants to be able to prescribe from the community nurses formulary and not the extended independent and supplementary prescribing formulary,' he says. 'There are only a handful of prescription-only medicines on this formulary at present and most inclusions are devices and dressings. Even for some medicines it does seem crazy that a shop worker can sell a packet of paracetamol or ibuprofen and a qualified nurse can't.

2,000 

Nursing associates due to be trained over the next two years.

Legislation change

The new standards are under way at a time of great change in the nursing workforce. While the NMC has said it doesn't intend to act on them immediately, it is currently developing legislation to introduce the new role of nursing associate. 

There are plans for 1,000 nursing associates to begin training this year, with members of staff to be regulated by the NMC and trained to deliver hands-on care. 

Council of Deans of Health executive director Katerina Kolyva says the new standards can help make clear the difference between registered nurses and nursing associates.

'When nursing associates begin, we will want the separation between them and registered nurses to be very visible,' she says. 'We welcome this direction of travel to stretch and really articulate what the profession does, which the previous standards didn't really do.'

Ms Kolyva also welcomed the move to outcome-based standards, but urged the NMC to allow universities to achieve them innovatively and flexibly in their courses.

NMC reply

An NMC spokesperson says the health and care landscape is changing at an unprecedented rate. 'Nurses and midwives are being asked to undertake more complex roles across a range of health and care settings,' they add.

'We are undertaking a radical review of our pre-registration nursing and midwifery standards, thinking about what the public need from nurses and midwives now and in the future. We have worked closely with stakeholders to develop draft pre-registration nursing standards, which are undergoing user testing. These draft standards will be refined further ahead of a full public consultation in the spring.

'In relation to the four fields of nursing,' the spokesperson says, 'the NMC's legislation specifies that nurses are registered against a field of practice. We have been developing new standards of proficiency for nursing that apply to all four fields, on the basis of feedback that we need to ensure all nurses, regardless of field, have better skills and knowledge in areas such as mental health and learning disability. The specific programme requirements will still set out what is required of programmes leading to registration in each field. As the four fields are set out in legislation, any changes to these fields would require a full public consultation and there are no plans to include this in the consultation on our new nursing standards in the summer.'

Some of the skills nurses will have at the point of registration, according to the draft NMC paper:

  • Prescribing.
  • Cannulation. 
  • Venepuncture. 
  • Management of continuous infusion of intravenous drugs and fluids and safe use of infusion pumps. 
  • Injection (bolus or push) of intravenous drugs. 
  • Intermittent infusion of intravenous drugs and safe use of infusion pumps. 
  • Subcutaneous administration and safe use of syringe pumps. 
  • Subcutaneous infusion of fluids. 

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