The number of nurse prescribers has grown rapidly since the introduction of legislation enabling the development of the role (Smith et al, 2014) and over the subsequent years government policy directives have continued to support the development of the nurse prescriber role (Scottish Government, 2017a; 2017b; Health Education England (HEE), 2017; NHS Education for Scotland (NES), 2018).
Nurse prescribing is seen as an advanced nurse role (International Council of Nurses (ICN), 2020) and is a core requirement for advanced nurse practice (Scottish Government, 2017b; Royal College of Nursing, 2018; ICN, 2020). This article reflects on the Nursing and Midwifery Council (NMC) (2018a; 2018b) changes to standards for the supervision and assessment of student nurse and midwife non-medical prescribers.
New standards
In 2018, the Nursing and Midwifery Council (NMC) (2018a; 2018b) published new standards governing the supervision and assessment of aspiring nurse and midwife prescribers, which have now been embedded in non-medical prescribing programmes throughout the UK. Designated medical practitioners (DMP) are no longer required to be the mandatory mentor. Since 2020, any registered health professional with the requisite knowledge and skills can perform this role, with practice supervisors supporting and supervising practice learning (NMC, 2018a; Royal Pharmaceutical Society (RPS), 2019).
Evidence from UK-based research that focused on the views of nurse prescribing students regarding the mentorship of their DMP showed that students valued DMP mentorship (Ahuja et al, 2009). These findings were supported by Weglicki et al (2014) and Afseth and Paterson (2017), who found that DMP mentorship was highly regarded.
Just over a decade ago, a report evaluating the Scottish extension to nurse prescribing authority (Watterson et al, 2009) concluded that consideration should be given to nurse prescribing students having two mentors: one clinical (at that time this could only be a DMP) and the other an experienced nurse prescriber.
The national study by Smith et al (2014) looked at independent nurse prescribers' experiences of education, continuing professional development and clinical governance and found that community-based nurse prescribers had less access to support. The authors suggested that access to team support after qualifying should be considered. The NMC (2018a) has supported this method, stating that students should have access to a variety of appropriate people to facilitate their learning.
A multitude of factors affect the availability of medical mentors and Watterson et al (2009) found that the workloads of DMPs were significantly increased if they were acting as mentors for nurse prescribing students. Other impacting factors include the introduction in 2003 of the European Working Time Directive and issues with local recruitment and retention of medical staff within the acute and primary care sectors (British Medical Association, 2019), which also affected the availability of medical staff.
Additionally, the extension of prescribing authority to a wider range of professional groups (Allied Health Professionals Federation, 2017; Health and Care Professions Council, 2019) further increased pressure on the number of available DMPs and has led to a change of approach to broaden the pool of health professionals qualified to supervise and assess nurse prescribing students (NMC, 2018a; 2018b).
Interprofessional learning
According to the World Health Organization (WHO) (2010), interdisciplinary and interprofessional education should be at the forefront of educational approaches to programme delivery for health professionals. WHO states that this approach strengthens and improves collaborative practices and health outcomes and the specifics of the approach should be contextualised locally.
This is a view that has been supported by Homeyer et al (2018), who indicate that effective interprofessional collaboration ensures high-quality patient care. West et al (2020) agree that effective interprofessional collaboration supports the establishment and effectiveness of good teamwork and healthy working environments and empowers staff.
Afseth and Paterson (2017) advised that, in relation to non-medical prescribing programmes, interprofessional learning enables a robust appreciation of a different profession and that this approach to supervision and assessment does not limit learning to the student. The authors' study, which looked at interprofessional competency assessment, led them to conclude that it was not only the non-medical prescribers who benefited—the DMPs' role was also enhanced as a result of such interprofessional collaboration.
This was also the view of earlier research by McCormick and Downer (2012) that reviewed students' perceptions of learning in practice and being mentored by a DMP. Initially, DMP mentorship was a logical pragmatic approach for prescribing students because it was imperative that mentorship was provided by a professional with the requisite knowledge and skills.
However, the move away from the requirement that mentorship of non-medical prescribing students should be undertaken by a DMP—to enable assessment and supervision to be undertaken by non-medical prescribers—will reduce such interprofessional collaboration and may reduce any aligned benefits.
Since its inception, the non-medical prescribing programme has offered students learning this advanced skill the unique opportunity to actively seek interdisciplinary and interprofessional support. Students tend to identify a range of potential health professionals to approach to verify their competence development, supporting the aligned approach to prescribing (RPS, 2016).
Such a shared approach to assessment and supervision for student nurse and midwife prescribers should continue to be encouraged because it aligns with both the regulatory bodies (NMC, 2018a; 2018b) and policy directives (HEE, 2017; NES, 2019), which all promote this approach.