Prescribing nurses at Waikato Regional Diabetes Service (left to right): Vickie Corbett, Vikki Lowe-Reid and Helen Ashton with clinical nurse manager Susan Ryan. Absent: Christine Bierre, Maria Wynen, and Bryan Gibbison who are the others in the team of six diabetes nurses with prescribing rights.
Waikato DHB is a strong supporter of nurse prescribing rights, and was one of the first to embrace the opportunity for nurse practitioners and then diabetes nurses to gain authority to prescribe.
The latest extension to nurse prescribing rights, announced today by the Minister of Health Dr Jonathan Coleman, means a big increase in approved medications that nurses can prescribe (from about 26 to more than 200) and opens prescribing to an even wider range of nurses, particularly in primary care roles.
“The extension is significant, and indicates just how successful nurse prescribing has been to date,” says Waikato DHB director of nursing and midwifery Sue Hayward.
Originally only nurses who had reached the level of nurse practitioner could gain prescribing rights. Waikato DHB employs eight nurse practitioners in a range of specialties, and all but one are authorised prescribers.
In 2014 the scheme was extended by changes in the legislation to allow registered nurses working in the field of diabetes to prescribe.
The Waikato Regional Diabetes Service was one of the first in New Zealand to take up the opportunity. Diabetes clinical nurse manager Susan Ryan says the registered nurse pilot was held in a couple of areas of New Zealand, and Waikato Diabetes Service closely followed its progress and started preparing for it.
“As soon as nurse prescribing got the green light, we were ready to go. We put two diabetes nurses into the programme straight away and have continued to put another two through every six months since then.”
Currently Waikato Regional Diabetes Service has a total of six diabetes nurses with prescribing rights, and another two in the process of obtaining rights.
“Our aim is to have all our 14 diabetes nurse specialists with registered nurse prescribing rights,” Ryan says.
Obtaining prescribing rights is not an easy process. It involves completing a post graduate pharmacological paper, clinical assessment, and a specialty paper in diabetes. A nurse’s prescribing practice continues to be supervised by a senior clinician, so it really ensures a well-qualified and safe prescribing practice.
As Susan Ryan puts it, “Being one of the first diabetes services to put staff through the programme, we wanted to do it really, really well. In the two years of nurse prescribing in our service, there has been not a single incident.”
The diabetes nurses see benefits for patients and for their own professional development.
Vickie Corbett and Vikki Lowe-Reid both work with youth and young adults with diabetes. Lowe-Reid says young people often get caught up in their own lives and don’t plan ahead with their medications.
“They suddenly run out, and if they can’t get a prescription renewal straight away it means they go without their insulin for a few days. With nurse prescribing, they can get in touch with us and we can give the script straight away, so it is a good result.”
Vickie Corbett adds that the diabetes nurses know their patients so well, and often over a long time (especially if they are young people).
“This means when we make changes to their medication we are very familiar with how they manage their diabetes, what’s happening for them, their family situation, and so on.”
Helen Ashton is another nurse with prescribing rights in the Waikato Regional Diabetes Service. She says the scheme gives much improved access to care medications for patients. “Before there could be a delay in getting a GP or specialist appointment, and sometimes the logistics of making an appointment would put people off, but now they can contact us. It is more straight-forward for them.”
And also more straight-forward for the nurses. “Previously, if someone contacted us for a prescription, we had to do a lot of running around to get it signed off by a doctor, and now we can sign it ourselves.”
It is a situation that is well supported by the service’s doctors, too.
“Our consultants think it is a great thing for us professionally, and it relieves them of some of the routine work so they can focus on other things,” Susan Ryan says. “In particular, I’d like to acknowledge our clinical director Dr Peter Dunn who has been incredibly supportive of this initiative right from the start, and also director of nursing Sue Hayward for her interest and encouragement.”