components associated with assessment. Assessment requires the nurse to:
observe the patient
undertake a clinical examination
gather data
communicate
undertake various measurements.
Figure 1.1 A systematic approach to care provision.
Clinical judgment is used to determine the type of assessment required. It is important during the assessment phase to ensure the use of a framework to guide the process as this will help to provide structure and order.
The NMC has suggested that newly qualified nurses will be able to go on a prescribing course soon after their initial pre‐registration education; in order to do this, there is a need to include more prescribing theory in undergraduate nursing programmes allowing nurses to prescribe from a limited formulary. It is important to note that nurses will not prescribe at the point of entry to the register (when their pre‐registration nurse education is complete), but will complete a post‐registration qualification in order to prescribe (NMC, 2018b).
All nursing professionals must practise in line with the requirements of The Code (NMC, 2018a), the professional standards of practice and behaviour that nurses, midwives and nursing associates are required to uphold.
The Code of Conduct
The NMC is the nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands. It exists to protect the public and it does this in a number of ways. The NMC sets the standards of education, training and conduct that nurses and midwives are required to adhere to so as to deliver high‐quality healthcare. The NMC ensures that nurses and midwives keep their skills and knowledge up to date (through revalidation; NMC, 2017) and uphold the standards of the Code (NMC, 2018a). Where an allegation is made about a nurse's standard of practice or behaviour, the NMC have processes in place to investigate those allegation: they take action if concerns are raised about a nurse's fitness to practice.
The Code sets out in detail the professional standards that nurses must uphold and all nurses, regardless of setting, are required to align their practice and behaviour to the Code. The values and principles that are set out in the Code are not negotiable or discretionary.
All nurses will exercise professional judgment in their work as they offer care to people, including the care that is associated with medicines and medicines management: each nurse is accountable for their actions and omissions. Nurses are required to uphold the Code within the limits of their competence associated with the contribution they make to overall care provision. Practising within your sphere of competence and your scope of practice is key to the underpinning principle of the Code – to protect the public – and must be upheld at all times.
Figure 1.2 The Code. Source: Olympus America, Inc. With permission.
The Code is made up of a series of statements that taken together imply what good practice looks like. It makes clear that the interests of patients and service users come first, that care is safe and effective and that it promotes trust through professionalism (see Figure 1.2).
Clause 18 of the Code is specifically related to medicines. Nurses are required to advise on, prescribe, supply, dispense or administer medicines that are within the limits of their training and competence, the law, and in relation to NMC guidance and other relevant policies, guidance and regulations. In order to do this, the nurse must:
Prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if the nurse is suitably qualified) if the nurse has enough knowledge of that person's health and is satisfied that the medicines or treatment serve that person's health needs.
Adhere to appropriate guidelines when providing advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs.
Ensure that the care or treatment that the nurse advises on, prescribes, supplies, dispenses or administers for each person is compatible with any other care or treatment that the person is receiving, including (where possible) over‐the‐counter medicines.
Take all steps to keep medicines stored securely.
Wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship.
It should be noted that prescribing is not within the scope of practice of everyone on the NMC register. Nurses who have successfully completed a further qualification in prescribing and recorded it on the NMC's register are the only people on the register that can prescribe.
The Nursing and Midwifery Council's Standards of Proficiency
In 2018, the NMC published future nurse proficiencies for registered nurses (NMC, 2018b) and for nursing associates (NMC, 2018b) along with a range of other revised and updated standards. The standards of proficiency provide the education and training standards that underpin all aspects of nurse education delivery and management.
The standards make significant changes to proficiencies for nurses, introducing a new education framework. The standards of proficiency are designed to enable nurses to meet the changing health needs of the population, to provide them with more clinical autonomy where appropriate, and to prepare them for leadership roles in the sphere of care provision ensuring the nurse is fit for purpose. The standards are based on the following requirements (platforms) to:
be an accountable professional;
promote health and prevent ill health;
assess needs and plan care;
provide and evaluate care;
lead and manage nursing care and work in teams;
improve safety and quality of care;
coordinate care.
As well as understanding the principles of safe and effective administration and optimisation of medicines and adhering to local and national policies, the nurse must also demonstrate proficiency and accuracy when they are calculating dosages of prescribed medicines. The nurse has to demonstrate knowledge of pharmacology and the ability to recognise the effects of medicines, allergies, drug sensitivities, side effects, contraindications, incompatibilities, adverse reactions, prescribing errors and the impact of polypharmacy – and also over‐the‐counter medication usage. See Table 1.1 for the procedural competencies for nurses (registered and associate) that are essential for best practice, evidence‐based medicines administration and efficacy.
