Nurse/Non Medical Prescribing in Mental Health: News and Speaker Updates
Today’s conference focused on the important issue of Nurse Prescribing in Mental Health. The conference looked at national developments in nurse/non medical prescribing in mental health, improving and maintaining prescribing competence, non medical prescribing within specialist mental health clinics, liaison and crisis services, physical health services, auditing your prescribing practice, monitoring the side effects of medication, reducing medication errors and supporting the expansion of Nurse prescribing practice in Mental Health.
Speakers and Presentations from the day Include:
Gavin Gorman Mental Health Nurse, Chair of the Scottish Government NMAHP Prescribing Leads group Non Medical Prescribing Lead NHS Greater Glasgow and Clyde Board Member, Association of Prescribers
Nurse/Non Medical Prescribing - National Update
- national developments in non medical prescribing
- developing confidence and competence in your ability to prescribe
- demonstrating compliance with the NMC Code for revalidation
- the benefits of non medical prescribing in mental health
Gavin Gorman Full Presentation Click Here
Kirsty Fishburn Lecturer & Module Leader for the Nursing/ Non Medical Prescribing course University of Hull Mental Health Nurse and Expert Advisor to the Care Quality Commission
Non Medical Prescribing in Mental Health
- non medical prescribing in mental health: current issues
- improving confidence in prescribing practice
- empowering nurses to prescribe in mental health
- improving non medical prescribing practice
- supporting non medical prescribers: infrastructure needed to support the safe and effective development and implementation of Non Medical Prescribing
- developing advanced roles around non medical prescribing
- keeping your prescribing knowledge up-to-date: accessing education, training and resources
In her presentation Kirsty discussed:
What are the current issues?
- Qualified prescribers that don’t prescribe – study done by Ross and Kettles in 2012 stated that more than half of the prescribers that participated the study weren’t actively prescribing. – This is a theme of the research!
- We therefore ask our selves why is that?
- What's our worries and barriers to prescribing?
Why, NMP is so important in Mental Health
- Patient Centred
- Medicines Optimisation
- Shared Decision Making
- Access to us
- Nurses roll – holistic – not just medicalised.
How do we improve ourselves:
- Remembering the Prescribing is a skill gained to add to our existing skills – not to eclipse it. First and foremost we are nurses!!
- Giving ourselves permission to not know everything
- Don’t let yourself be rushed and persuaded into what you don’t want to do – our accountability and professionalism.
- Time to learn, learn and learn some more….
Kirsty Fishburn Full Presentation Click Here
Kirsty Fishburn Presentation Abstract:
Even though nurse prescribing is no longer a new concept, we still have a considerable amount of nurses who can prescribe but don’t, and why is that? Kirsty presentation exploreed what we have, what we need and what will helps us to become more confident in order to address this new aspect to our already highly complex role. That will benefit our patient and our colleagues and ultimately us.
As we have the skills and we have the know how…. Sometimes it’s just the doing!
Kirsty Fishburn Biography:
Kirsty Fishburn has been, and loved being, a mental health nurse for 16 years and during that time she has worked mainly in secure forensic hospitals run by private providers. Kirsty has undertaken many courses from CBT to Mentorship and then onto Prescribing and up to her Master’s degree. Kirsty is now undertaking my PhD in Personality Disorder.
Kirsty’s clinical practice career took her from staff nurse to hospital director, then in January 2015 she left practice to go into the world of academia. Kirsty was always on a course at one university or another, so she decided to just go work there and feels very lucky at the University of Hull.
Kirsty is also a governor for the Humber Trust and works with the CQC in a specialist advisor role during their inspections as part of a wider team.
Kristy has recently become the programme leader for mental health at the university and they are working very well as a team and looking at how they can best equip the student nurses with the skills they’ll need to become excellent qualified nurses.
I am the module leader for the nurse’s independent and supplementary prescribing course at the university, a course of which I am very proud to be part of.
When I have free time, I like to relax with my husband and a nice glass of red in front of a scary horror movie.
Judith Graham Advanced Nurse Consultant, Psychotherapy Consultant & Independent Prescriber Rotherham, Doncaster and South Humber NHS Foundation Trust
EXTENDED SESSION: Prescribing within specialist mental health clinics
- diagnostic assessment and prescribing
- physical health assessment
- providing holistic assessment, physical health monitoring and medication management in a clinic setting
- non medical-led prescribing clinics, including Lithium and Clozapine Clinics
- prescribing within our nurse-led clinics for adults with Psychosis, Bipolar Affective Disorder and also Attention Deficit Hyperactivity Disorder
Judith Graham Full Presentation Click Here
Judith Graham Presentation Abstract:
Nurse-led prescribing clinic services have been established in our NHS Trust for just over 6 years. Within this time, the role of a specialist mental health prescriber has increased, and the way in which mental health nurse-led clinic services are used has expanded.
- A change in clinical structure concerning prescribing, to ensure all people entering services have access to an appropriately trained prescriber dependent upon their level of complexity.
- Recognition of the challenges posed in terms of collective identity, role delineation, supervision, and responsibility and accountability.
- The development of a clear role delineation chart concerning Band 5 - Band 8c Mental Health Nurses.
- The development of structured advice and guidelines for non-nursing supervisors.
- The development of enhanced nurse-led clinic services targeting physical health interventions, supporting the Mental Health Taskforce (2016) and recommendations.
- Current work being conducted between senior nurse prescribers, psychiatrists, and GPs, concerning discharge and deprescribing pathways.
This specialist community initiative has been successful, resulting in complete eradication of traditional medical-led out-patient clinics, replaced by nurse-led clinics with medical involvement, providing holistic assessment, physical health monitoring, and medication management. Patient feedback is positive, specifically regarding faster clinic response time and lengthened appointment duration.
Despite positive patient feedback, cultural and process issues were identified as the reform of medication management services progressed. These included the advancement of nurse prescribing roles, the recognition of the need for supported governance surrounding this role, and also the expanded training pathways required for specialist clinic services.
Current and future focus:
All health services face challenges with service reform, transformation, and capacity and demand issues. The current focus within the Rotherham, Doncaster, and South Humber NHS services are focused upon working closer with GPs and primary care providers to enable enhanced recovery pathways, which include reduced medication prescription and supportive discharge pathways rather than shared care in certain services.
- Collective identity in nursing.
- The challenges of role delineation.
- Inter and Intra-professional conflict concerning nursing role advancement.
- The challenge of patient expectations concerning traditional services.
- Differences between nursing and medical leadership and supervision structures.
- Stigma regarding certain mental health diagnosis.
- The definition and acceptance of recovery being different for different care providers, patients, and carers.
Since the introduction of the New Ways of Working (DoH, 2007), there has been significant focus upon reconfiguring services and extending different clinical roles within the MDT. Arguably, nursing has been the profession most affected by this change, enabling the development of more enhanced nursing roles.
This development was not without challenges, however our organisation provides examples of how multi-system changes have realised the enhanced potential of specialised nursing posts. This promising start only serves to demonstrate what can be achieved. As public and professional expectations and perceptions of nursing gradually change, the roles of Advanced Nurses, leading care from the front, will continue to expand, as a complementing rather than competing role with medical colleagues.
Finally, with better understanding and joint working between specialist and primary care mental health services, specifically concerning symptom and medication management, capacity and demand issues can be better managed, and patients can progress in their recovery journey with focus upon being empowered to self-manage symptoms.
Judith Graham Biography:
Judith is a qualified mental health nurse who has worked in the NHS between both inpatient and community mental health setting for over 12 years. Post-registration, she has completed a BSc in Acute and Forensic Mental Health, an MSc in Cognitive Behavioural Psychotherapy, an MSc in Advanced Nursing Practice, and she is in the final stages of completing her Doctorate qualification. Judith’s current clinical role includes the provision of specialist assessment and treatment for adults and older adults who have a range of mental health problems and learning disabilities, and also people with substance misuse problems. She is a qualified Independent Prescriber, specialist assessor for people with Autistic Spectrum Conditions, and was awarded the title of Queen's Nurse in 2015.
Judith has been published in several scholarly heath journals, and has presented at national and international conferences on mental health issues, specifically regarding Personality Disorder, complex trauma, prescribing ethics, and systems leadership. As well as direct clinical care, her current role includes research and development of new service initiatives, particularly related to service and organisational change and its effect on service users, carers, and professionals. Judith is involved in regional forums including Autism Partnership Boards, and has also contributed to National Policy Change via contribution at NICE stakeholder events and within her role as an elected board member of the NHS Confederation Mental Health Network Board. Judith is passionate about service user and professional education, clinical teaching and supervision is also a core part of her work, and she has lectured at several universities on various mental health topics.
Future events of interest:
Nurse Prescribing in Paediatrics and Child Health
Safe Staffing Summit: A Practical Guide to Safe and Effective Nursing Staffing Levels and Skill Mix
Nurse Prescribing in Cardiology
Nurse Clinics 2016
Masterclass: Medico-Legal Aspects of Nurse Prescribing in today's NHS
Masterclass: Nurse Led Discharge
Effective Nurse Prescribing in End of Life Care
27 September 2016