...This paper aims to explore the role of the V100 nurse prescriber. The development of nurse prescribing will be outlined, followed by a reflective case study in which ethical and legal implications will be discussed and finally a reflective conclusion will be drawn. Where appropriate the paper will be written in the first person (Webb 1992). Nurse prescribing was first recommended, by the RCN, in 1980 and became part of the government’s policy agenda in 1986 with the Cumberlege Report (DH 1986). Further, the Crown Report (DH 1989) advocated prescribing by trained community nurses from a limited formulary. Legislation was introduced in 1992 -The Medicinal Products: Prescription By Nurses Act, 1992 followed by secondary legislation, Medicinal Prescriptions By Nurses etc which came into effect in 1994 - providing a legal basis to allow nurses to prescribe (Dimond 2002). Nurse prescribing using the Nurse Prescribers’ Formulary (NPF) was introduced nationally in 1998 following the success of eight demonstration sites set up four years earlier (Luker et al 1998). A second Crown Report (DH 1999) recommended the establishment of two groups of nurse prescribers: independent and supplementary. In 2000 the government announced proposals to extend nurse prescribing further to allow prescribing from an extended formulary following more intensive pharmacological training (DH 2000). In the case study the patient’s name, address, date of birth and gp’s details have been changed...
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...SWOT ANALYSIS STRENGTHS -I am an easygoing/approachable person and normally get on with most people so work well in a team. -I am patient and a good listener and i believe this will be beneficial to my practice especially during listening support visits. -I am willing to learn and open to constructive criticism as i am aware this helps to improve my practice. WEAKNESSES -I am new to community nursing so it will take some time for me to get used to this different style of working. -My knowledge base of SCPHN is limited at the moment so i need to do more reading to get a better understanding the HV role and the local/national services provided. -I don’t know the area(caseload geographical region) so i need to familiarise myself with the area and get a good grasp of the caseload profile. - I am a quiet person and it sometimes takes me longer than most people to get comfortable within a new team. OPPORTUNITIES -I have good support from University, my practice teacher and the whole Health Visitor team. -I will have the opportunity to work with different professionals (both healthcare and non-healthcare professionals) in practice and will be able to gain a better insight on the Health Visitor Service and the other agencies who work closely with the Health Visitors. -BSc in Specialist Community Public Health Nursing. -Good employability(career prospects) after completion of degree. THREATS -Family commitments. -Financial constraints in service delivery hinders...
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...UNIVERSITY OF THE WEST OF SCOTLAND NURSE PRESCRIBING V150 CASE STUDY COURSE: NURS09125 BANNER NUMBER: B00113677 DATE OF SUBMISSION 13/12/10 COURSE LEADER FRANCES DOWNER WORD COUNT: 3745 CONTENTS PAGE 1. INTRODUCTION & GENERAL OVERVIEW, Pgs3-4. 2. ASSESSMENT PROCESS, Pgs 5-8 3. TREATMENT OPTIONS, Pgs 9-12. 4. EVALUATION, Pgs 13-16 5. CONCLUSION. Pg 17 6. COPY OF PRESCRIPTION, Pg 18 7. REFERENCE SECTION, Pgs 19-23 8. BIBLIOGRAPHY, Pg 24. INTRODUCTION In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of prescribing in the community setting. The author a (trainee nurse prescriber) will display the need for a robust assessment, exploring all areas of health and well-being in order to achieve a safe outcome. The author will further follow current guidelines and be mentored by a senior nurse prescriber throughout the process. The aim of the case study is to display the implications involved in issuing a nurse prescription if deemed appropriate. With regard to writing a prescription as a qualified practioner, the author will adhere to the guidance within the Nursing and Midwifery Council (NMC 2006a) standards for safe prescribing. To protect this patient’s identity and maintain confidentiality, she will be referred to as Mrs X throughout the...
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...1648 1 Law, Accountability and Ethics in prescribing During my supervised practice in an outpatient clinic the non-medical prescriber I was with was asked by a colleague to prescribe for a patient on her behalf. In my role as a vascular clinical nurse specialist, I run nurse led clinics working alongside other nonprescribing colleagues seeing patients with peripheral vascular disease, this can range from patients with leg ulcers or diabetic foot ulceration with wound infections to patients with intermittent claudication, Abdominal Aortic Aneurysm or varicose veins, all of whom may or may not need medications or wound management treatments prescribed. It is very likely that during these clinics once I qualify as a non-medical prescriber I will be asked the same. In this essay I will explore the issues of law, accountability and ethics raised by prescribing on behalf of others. The legal system of England and Wales has two branches of law; criminal and civil Criminal Law: Statues are acts of parliament which are presented via the House of Commons moves to the House of Lords where amendments are made, returns to House of Commons, for final discussion when complete the Bill is given Royal Assent and passes into law. Criminal law involves offences against the state, it is usually the Crown that brings the action against the defendant (Gagan 2010 cited by Courtnay & Griffin). In terms of non-medical prescribing there are two important statues The Medicines...
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...A. The boards of nursing and professional nursing organizations are an important part in the field of nursing. The board of nursing is a regulatory agency within each state charged with the responsibility to administer the nurse practice act of that state. In the state of Florida, the Florida Board of Nursing is a regulatory agency made up of 13 members. Their mission is to license, monitor, discipline, educate, and rehabilitate its licensees to assure their fitness and competence in providing health care services for the people of Florida. The Florida Board of nursing’s responsibility is to ensure that every nurse practicing in Florida meets minimum requirements for safe practice, which is the purpose of the Nurse Practice Act. In contrast, the Florida Nurses Association, which is a professional organization, purpose is to advocate for all nurses in the state of Florida. They speak on behalf of nursing in Tallahassee as well as before many regulatory bodies and partner with other organizations that share their vision to create a unified nursing advocacy program for nurses in our state. B. The American Nurses Association Code of Ethics influences my nursing practice daily. Provision 1 of the Code of Ethics states “the nurse practices with compassion and respect for the inherent dignitity, worth, and unique attributes of every person.” I follow this code with every patient and family member. In the hospital I work at, I interact with many patients that have different cultural...
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...of the patients. Before 1996 there were many issues that has rise the concerning of patient privacy. The HIPPA Act includes “Health insurance portability, fraud and abuse control, tax related provision, group health plan requirements, revenue offset provision, and administrative simplification requirements (Physicians Billing Associates International, 2006). The article that I had read was about a woman who was a nurse and started to use the narcotic from the patient and it was also between an individual’s right to privacy. It shows the process of which the administrator determines a course of action is reviewed but his context of workplace realities through an ethical analysis. This article was about a woman named Jackie that was a nurse and she was overwhelmed with her job. She tried talking to her husband but was convinced to continue working because who pay check was making their saving grow extremely large. To make her husband happy she continues to work as a nurse. She was working in different units that she started to use the narcotic that were prescribing to the patient that she was caring for. She started to take the patient pain medications that weren’t asking for their medications. Then Jackie started to replace the medications with the saline. Jackie had an addiction to pain medication. The administrative Michelle found out because Jackie was working in the surgical unit and the pharmacist had notice there was errors on the medication log sheet. Michelle had requested...
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...that a physician did. In the past, a distinct division subsisted between a physician and a nurse. The nurse operated within a well-defined framework that mainly entailed implementing orders from the physician. The roles of diagnosing patients, treating their different symptoms, and prescribing medication to them were solely roles of the physician. Thus, it was virtually unprecedented for a physician's orders to be criticized by a nurse since nurses (Peterson & Zimmerman, 2006). However, times have changed, and the roles of a nurse have substantially changed. Presently, nurses commonly assume some physician's roles such as patient's examination of patients, diagnosis, and their subsequent treatment without any arranged supervision of a physician. Nursing has evidently matured into an increasingly specialized, advanced, sophisticated, and independent profession hence expanding the roles of a nurse. Resultantly, the liability for fundamental nursing negligence has moved to its professional counterpart, which is malpractice liability. Nevertheless, obstetrical nursing is the field of nursing that is highly taxing since it involves the most delicate tasks of assisting doctors to handle pregnant women and delivering them of their babies (Peterson & Zimmerman, 2006). A situation in which a nurse can be held liable for negligence According to the American Nurse Association (ANA), a nurse owes duties to all the patients they are serving. Their roles must hence ensure that they...
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...Ethics: Mrs. Moonjeli functions as a patient advocate/navigator, treating patients and families with respect, dignity and courtesy as defined by the American Association of Nurses Code of Ethics (1995). She fosters positive relationships with patients and families and delivers the services with respect to patients and family’s knowledge, values, beliefs and cultural backgrounds in a non- judgmental and nondiscriminatory manner. She honors the patients and family perspectives and choices. For example, last week, an end stage heart failure patient who is on inotrope dependent and on high diuretic dose walked into the clinic for his follow up visit after hospital discharge . He gained approximately thirty pounds within two weeks and his legs...
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...documentation would require the involvement of an interdisciplinary team. This team would be comprised of several members, each with a specific job. The first member selected would be a Clinical Nurse Informaticist. This team member would be charged with giving valuable input on the software needed for nurses to properly care for and chart on their patients. With the knowledge of nursing practice and informatics, this team member would very valuable in bringing the two together in the most efficient way possible. The next team member would also be from the IT department. A Director of Clinical Informatics would be chosen for this project. The Director of Clinical Informatics play a vital role in the project because of the knowledge of current hospital technology, upgrades that may be needed, software that is available, and regulations for patient privacy. A Chief Nursing Information team member would in charge of researching what each department needs in a software system. With each unit being different in charting needs and the flow of the unit, this team member would be very important and work closely with the Clinical Nurse Informaticist. These two team members would work closely with nursing staff to ensure everyone becomes competent with the system once it is in place. Just as nurses need a representative, the Doctors would also have a team member on this project. This would be a Chief Medical Information team member. This team member would be an experienced physician and...
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...This reflective account demonstrates an ability to critically reflect on experiences within my nurse training, particularly within my third and final year. The reflective model selected is Gibbs (1998) (appendix 1) which incorporates description, feelings, evaluation, analysis, conclusion and an action plan which is divided into sections for ease of reading. All names have been changed in accordance with the NMC (2008a) guidelines regarding confidentiality. This piece includes reflections on my own learning using the NMC proficiency, managing care. As this covers a vast array my focus is primarily on medicine management, managing risk and delegation. Description of events During placement within the Accident & Emergency (A&E) department I saw my paediatric mentor on three occasions, the remainder of the time I worked with adult trained staff. As a consequence of this when a child was admitted, I was given the responsibility of caring for them. For the duration of a particular shift I worked with Sue, an adult nurse. Sue recognised that I was competent in my practice as I had worked with her on previous occasions with adults and consequently praised me. Sue, qualified for over twenty years, indicated that she only knew the basics of children’s nursing and suggested that I probably had more knowledge of children than her. This comment left me unsure of her depth of knowledge of paediatric nursing and somewhat concerned me. During my shift, Jay, a two year old was admitted...
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...According to a collaborative publication from the American Nurses Association’s APRN Consensus Work Group and the National Council of State Boards of Nursing’s APRN Advisory Committee (2008), the Advanced Practice Registered Nurse (APRN) is a graduate nurse who possesses national certification, advanced knowledge and skills, and who is prepared to responsibly assess, diagnose, and manage the patient’s ailments through the use of pharmacologic and other therapies. More specifically the role of the nurse practitioner (NP) is to provide care along the health continuum in a variety of settings, such as family practice. As deliverers of healthcare, NPs practice holistically and autonomously and ensure continuity of care for the patient. (American...
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...Singapore Nursing Board Standards for Nursing Practice defines that Nurses/midwives have the professional responsibility and accountability to uphold Standard of care and to contribute to their dissemination, interpretation and development despite medical advances, social and demographic changes and an increasingly complex healthcare delivery system that challenge the ability of nurses to provide safe quality of care. Should nurses fail to uphold certain standards and by doing so cause harm or injury to the client, they would be held liable in the tort of negligence. Description of a practical situation which raised ethical issues: Mr Lim 70 years old has been hospitalised for medical treatment with the diagnosis of chronic heart failure. He was ordered intravenous therapy by Dr Peter the medical resident. Nurse Su questions the order because it is for an infusion of Dextrose 50%. Dr Peter tells her that he checked it with Dr Lee, the medical officer. Nurse Su checks it with Nurse May before administration. Later, Mr Lim has a cardiac arrest and suffers extensive brain damage as a result of the infusion. The hospital inquiry is held and it determined that the correct infusion would be Dextrose 5%. Mr Lim’s family members are very upset and seek legal advice. All names mentioned in the above scenario are pseudonym. Identification of the ethical issues within the situation: Negligence Negligence is the breech of an obligation or duty to act with care, or failure...
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...Ashley, I enjoyed reading your post and getting the perspective of an emergency room nurse. I can understand how tough it is to deal with the same patients coming in for the same reasons repeatedly. While I agree with you and I believe having limits and rules can help curb the problem of patients constantly arriving in the ER, I feel that there is a much bigger problem in that there are not enough treatment programs for the people suffering from addiction and abuse issues. According to the Journal of Addictions Nursing (2015), “Roughly half of the patients diagnosed with such disorders in 2012 did not have access to medication-assisted treatment facilities” (p. 157). Emergency rooms must have resources and facilities available to aid and...
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...plan requirements, revenue offset provision, and administrative simplification requirements (Physicians Billing Associates International, 2006). The article that I had read was about a woman who was a nurse and started to use the narcotic from the patient. It shows the process in which an administrator determines the course of action that will be taken. Also the context of workplace realities through an ethical analysis. This article was about a woman named Jackie that was a nurse and she was overwhelmed with her job. She tried talking to her husband but was convinced to continue working because who pay check was making their saving grow extremely large. To make her husband happy she continues to work as a nurse. She was working in different units that she started to use the narcotic that were prescribing to the patient that she was caring for. She started to take the patient pain medications that weren’t asking for their medications. Then Jackie started to replace the medications with the saline. Jackie had an addiction to pain medication. The administrative Michelle found out because Jackie was working in the surgical unit and the pharmacist had notice there was errors on the medication log sheet. Michelle had requested for the entire narcotic log sheet and the names of the nurses that were working on those days. Michelle had to inform Karen who was another administrative and explain to her...
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...INTRODUCTION I am a 43 year old mother of two teenage daughters and have been taking stock of what I have achieved and where my career may take me. Hence my partaking in this module to assist the journey I hope to pursue. I have been working in my current position as a band 5 registered nurse for 6 years since I completed a returned to nursing course in September 2005 facilitated by the trust where I am now employed on a full time basis. I have enclosed a current job description at Appendix 1 (attached). For the purpose of this study I have chosen to reflect on 3 learning events that have impacted on me to provide positive outcomes and enrich my working practice. Within the main body of the study I will expand on each individual learning experience based on Gibbs’ cycle of reflection (1988) combined with influence from Johns’ cycle of reflection (1994). See Appendix 2 - 2a (attached). I have chosen to incorporate Gibbs model of reflection as I feel it is quite straight forward and clearly outlines a framework to help me logically describe the event, discuss feelings, evaluate the experience and how it impacted on me and my practice. It leads to a final conclusion with considerations for improvement that I will refer to as my action plan. I have incorporated aspects of Johns’ model of reflection as it quite usefully prompts more detailed consideration of the processes of analysing a situation e.g. influencing factors within an experience. I will explore the implications...
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