Faculty of Medicine, Dentistry and Health
School of Nursing and Midwifery
Independent/Supplementary Nurse/Midwife
Prescribing programme
Guidelines for Designated
Medical Practitioners
March 2012
Contents Page no.
Introduction 3
Support for the Designated Medical Practitioner 3
What the programme looks like 3
What your student will learn in school 3
Directed work/handbook – Your role 4
How to get your colleagues involved 5
What we ask of your student 5
What is in it for you? 5
The supervision process 5
Ways of supervising a student 6
Checking out learning 7
Ways in which learning can be maximised: Learning and
developing your Student’s potential 7
How to review the work of the student 7
The final interview 8
Appendix 1 9 - 10
Appendix 2 11 – 12
Appendix 3 13
Contact details 14
Introduction
Welcome to the programme and thank you for agreeing to be a mentor assessor. This handbook is intended to be a helpful guide to the process and should be used alongside the National Prescribing Centre’s Guidelines for Designated Medical Practitioners found with this handbook and at http://www.npc.nhs.uk/resources/designated_medical_practitioners_guide.pdf
We ask that you work closely with your student and meet regularly for review of progress. Also, that relevant staff in the whole practice area, (GP surgery, A&E Department, Clinic, etc.) know about the programme, so that as much help as possible is available to you as supervisor and to the student. Your student has their own handbook, but please check out each other’s understanding, to avoid any misunderstandings.
Aims of Non Medical Prescribing
· To make more effective use of the skills and expertise of groups of professions
· To improve patients’ access to treatment and advice
· To improve patient choice and convenience
· To contribute to more flexible team working across the NHS
(National Prescribing Centre 2011)
Support for the Designated Medical Practitioner
You will be invited to attend an update session at the beginning of each programme. If you are supporting a student for the first time the programme facilitator will meet with you and your student before the programme begins to discuss the programme and individual roles. Your student will be asked to liaise and arrange a mutually convenient meeting. Subsequently, at the midpoint of the programme the student’s programme lecturer / academic mentor will meet with you and your student to discuss progress to date and carry out the intermediate assessment of progress towards competence. You will also receive an email inviting you to join the University of Sheffield Independent/ Supplementary Prescribing Course Mentors Uspace site, where programme information, an FAQ section and a contacts list will be available.
Programme Structure
This is an intensive 6 month programme. Your student will be university based one day per week for a total of 26 study days. They will also be expected to undertake 12 days equivalent (90 hours) of structured learning in practice, which is an integral part of the programme, and which you will oversee.
On successful completion of the programme the nurse / midwife will have the Independent / Supplementary Prescriber qualification recorded on the Nursing and Midwifery Council Professional Register, and as soon as confirmation of that registration is received from the NMC and the nurse or midwife is registered as an independent prescriber with the employing NHS Trust, he / she will be able to prescribe from the formulary as an Independent / Supplementary Prescriber. As you know, it doesn’t end there and it would be most helpful if you would continue in an advisory supportive role.
The University of Sheffield programme
We aim to enable students to develop their ability to undertake a consultation and make rational decisions about the treatment of their patient, based on the National Prescribing Centre Seven Principles of Safe Prescribing. In order to achieve this, we will provide sessions on pharmacology, consultation and decision making skills, legislation and policy and evidence-based practice, to name but a few. There is a blended learning approach in the learning and teaching strategy, consisting of lectures, discussion, group work, seminar presentations and case study formats. This is designed to assist students to learn in an active way and apply learning to and from practice. Your student will be expected to bring anonymised experiences and interesting cases / issues from practice to aid their own and group learning. They will also discuss how they can implement theory and ideas generated into their own practice.
Case study and assignment use promotes the acquisition of critical thinking alongside the development of conceptual and problem solving skills and enables the student to relate theory to practice and visa versa. The student’s own case studies are utilised to ensure that student learning is grounded in the reality of personal practice.
Student led seminars enable students who are the ‘authority’ on a subject to share their experience with others. This method of learning has been valued highly by previous cohorts, as there is always a wealth of knowledge and experience within this group of students. For those not used to undertaking presentations it is also a safe environment to practice the skills required.
Lectures and other sessions will be provided by a variety of specialist speakers from both within and outside the university: doctor, pharmacist, experienced nurse prescribers, other clinicians and university academic staff.
Your role
Firstly, you are not alone. We are available for support and advice (please refer to contact details at the end of this booklet). Secondly, there are a number of other designated medical practitioners working alongside students. Your role is as a guide, someone to be there to answer questions and facilitate learning, show ‘how to’, let the student know when they do something well or how to do it better. Be a role model, but make it real. We all know what the world should look like, but also know how it actually is.
At the beginning of the programme you should undertake the initial interview. Between you identify activities (ways of learning) and evidence (concrete proof that the learning has taken place) that will contribute to the assessment. About half way through the programme please arrange a formal review of the student’s learning (intermediate interview) and revision of the action plan to achieve the outstanding competencies, in a tripartite arrangement with the student’s personal academic mentor, who will also be present.
In addition, we require that you assess your student in practice at the end of the programme. The final assessment must use the acid test: Do I consider that this nurse is a safe and effective prescriber? At this time, you will have observed enough of their practice, discussed sufficient cases and reviewed enough case notes to know if your student is safe. We only ask that you will decide if the student is safe or unsafe and has achieved the required competencies in practice. If at any time you have doubts or concerns please contact us. Our contact address can be found later in this handbook. Please do not wait until the last week of the programme to voice your concerns. If we can deal with problems early, the chances of your student achieving safe and effective prescribing practice are much greater.
The student will have to undertake other forms of assessment including an OSCE and an unseen written examination, which tests pharmacological knowledge and drug calculation skills. The OSCE is marked on a pass / fail basis. Part 1 of the Unseen Examination is pharmacology based and must achieve 80% to pass. Part 2 is Drug Calculation and must achieve 100% to pass. The student will also have to submit their portfolio of evidence to support claim to competence, which has been developed throughout the programme. . All the aspects of the assessment have to be passed, but the student will have a second chance to resit any failed aspect. Whilst guidance is given in developing the portfolio of evidence by the course leaders, your help will also be invaluable.
Getting colleagues involved
It is important to get everyone in the practice area involved otherwise this will not work. It is part of the student’s learning to be assertive and seek support, but they cannot be expected to set this up single-handed. Your medical colleagues will need to be informed that the nurse or midwife is undertaking the programme, and their role in being involved in some teaching and learning activities. It is enormously helpful to have other people’s perspectives on the student’s ability and progress. Also, when colleagues see what the student is capable of, they can feel more confident in their competence and will accept referrals accordingly.
The student’s responsibility
It is important that the student manages their own learning, although this does not mean that they are expected to do it all themselves. The student is expected to take responsibility for documenting their learning activities with reflective entries in their assessment of practice booklet. They may collect testimonial entries from yourself and your colleagues involved in teaching and learning activities. They must also keep their paperwork available for review by you and any colleagues involved in the teaching/learning experience. They are also responsible for booking times and venues for the initial, intermediate and final interview dates with you.
WHAT’S IN IT FOR YOU?
At present, the student who works with you has a great deal of knowledge and expertise; otherwise they would not be on this course. But as yet, you cannot utilise their skills to their full potential, neither can the nurse or midwife achieve their full potential within their sphere of competence and practice. How many times in a day do they have to interrupt you in order to sign a prescription or review investigations with them? It is very frustrating for both you and the nurse or midwife that the inability to issue the prescription has caused inconvenience for the patient and wasted valuable time. Once the student has the prescribing qualification, and feels competent, further role development will occur. They will still need to consult with you over certain things or ask you to review a particular patient, but it will probably be because there is a situation outside of their sphere of practice and competence they cannot deal with rather than something simple, which they are currently not allowed to deal with. In the long term you should find that your role changes and you should have more time with your patients and the practice area is running more efficiently and effectively.
The Mentor Assessment Process
This starts before the programme commences. The better planned the process is, the more likely it is to be successful. For the student to be considered for the programme they will have to have the agreement of the NHS Trust Non Medical Prescribing Lead or GP Practice Principal that they will have access to the prescribing budget and will prescribe once qualified, support from their manager and a named mentor assessor for the duration of the programme.. We also strongly advise the student to seek the support of an experienced non medical prescriber in their clinical area, to act as a co-mentor. Once the student is accepted, review their workload and working practices. By adding a slot to each session so that particular patients could be discussed or consultations shared, there will be almost no slippage in appointment times and it becomes part of the culture.
Once the student has commenced the programme, interview dates should be set. Ensure enough time is set aside in order to do this successfully with adequate privacy and no interruptions. The initial interview should review the current situation and set an initial learning contract. It is important to do this as assumptions are easily made. The student may perceive that they need additional learning in areas that you believe they already have competence and conversely, you may not be fully aware of some aspects of his/her competence.
The first interview is also a form of negotiation regarding how the mentor will meet need; when it will happen; where this will take place; who will be involved and what is to be supervised and assessed. This programme depends to a great extent on the practice area and well as the student’s needs.
Mentoring your student
We don’t ask that you spend most of the time shadowing them or for them to shadow you. At the start of the programme they will want to observe you, and perhaps your experienced colleagues, undertaking consultations, examinations etc. If the student can gain a fairly broad perspective of consultation styles and consultation cases they will be more likely to find a method that is comfortable (and works) for them. This can be in short bursts, not necessarily for a full session. The student will log their time to make sure they meet the requirements of the programme. During the programme the student will not be expected, or allowed to prescribe in their own right. For models of supervision please see Appendix 1.
Once the programme is under way you can spend time observing the student’s consultation practice. Again, full sessions are not expected. It is important that they know just where they are doing well and how to progress. As you both become more confident in the student’s improvement, they will consult you, or a colleague, for advice and opinion on specific cases. Also, allow for opportunistic learning and involve the student when you have a patient with a relevant presenting problem or an interesting prescribing scenario. It can be useful to demonstrate cases outside the student’s future remit, so that they can see the difference and define the limits of their competence.
It is useful to review the notes after each supervised practice session and make comments accordingly. Again, compare thoughts with any colleagues who have been involved. When you consider that the student has achieved competence in any aspect of prescribing practice and has sufficient evidence to support competence in that element, it can be signed off. There is no need to wait until the final interview. It sounds a lot of work, and it does take commitment, but the benefits should soon outweigh the work it takes over the next 6 months.