Prescribing ready: a guide for nurses

Nurse prescribing enables nurses to use their knowledge and expertise to support patients and other healthcare professionals in the safe and effective use of medicines. Nurse prescribers are qualified professionals who:

• improve patients’ access to medicines
• promote medication concordance and adherence to treatment
• work collaboratively with the wider multidisciplinary team to improve patient care

This guide will help nurses to understand the requirements of becoming a prescriber.

Nurse prescribing

Nurse prescribing was first recommended in 1986 in the Cumberledge report (Department of Health and Social Security, 1986). In 1992, community nurses in England were allowed to prescribe from an extended formulary (Dunn and Pryor, 2023). Since then, various acts of parliament, standards and frameworks have been implemented to regulate this role and ensure nurse prescriber competence and public safety.

Currently, nurse independent prescribers can prescribe any medication for any medical condition, including schedule 2–5 controlled drugs, except for diamorphine, dipipanone or cocaine for the treatment of addiction (British National Formulary, 2024). However, the Nursing and Midwifery Council (2024a) emphasises that nurses ‘may only prescribe from the formulary they are qualified to prescribe from and within their competence and scope of practice’.

How to be 'prescriber ready'

Nurses who have qualified under the new Nursing and Midwifery Council (2018a) standards are considered ‘prescriber ready’. The Nursing and Midwifery Council (2018a) updated its standards of proficiency for registered nurses, with learning outcomes including:

• knowledge of pharmacology
• medication administration
• management of polypharmacy
• overview of prescribing principles
• assessment and diagnostic skills

Newly qualified nurses are at the forefront of patient care, so they must be able to recognise changes in the patient’s condition, take action, document clinical findings and communicate these appropriately to other healthcare professionals. Moreover, leadership and decision-making skills have been deemed necessary for newly qualified nurses in providing evidence-based person-centred care. Decision-making skills not only reflect the demands of the clinical environment and the complex needs of service users, but are considered core skills for future nurse prescribers (Prydderch, 2019).

The term ‘prescriber ready’ means that following registration, these nurses are better equipped to progress to a prescribing qualification if they wish to do so. However, there are nurses whose nursing degree does not fall into this category. All nurses will need to demonstrate to higher education institutions (who provide Nursing and Midwifery Council-accredited prescribing courses) that they are competent in assessment and diagnostic skills and capable of practicing safely at the required level of proficiency (Nursing and Midwifery Council, 2024b).

There are many ways in which nurses can demonstrate this. For example, continuing professional development, either in the form of postgraduate learning/training or informal learning, could be considered as evidence when applying for a prescribing course (Royal College of Nursing, 2016; Nursing and Midwifery Council, 2024b). Examples of informal continuing professional development could include attending conferences, study days, webinars and completion of online learning and mandatory training. All of the above must be relevant to the applicant’s specialty and intended area of prescribing practice.

For example, reading this article and logging your progress using BJN inform’s CPD log would be considered informal continuing professional development. Find out more on how to use the CPD log:

Being prescriber ready also means that the employer must ensure that the candidate’s role enables them to practice independently at a high level and they are ready to undertake the course. The need for prescribing within the candidate’s clinical area should be evident and reflected in their job description.

Benefits of being prescriber ready

The benefits of being prescriber ready can be demonstrated at a personal and professional level, as well as through patient outcomes. An increased knowledge of pharmacology, such as the pharmacokinetic and pharmacodynamic properties of medicines, enables nurses to manage polypharmacy as well as make decisions in response to drug interactions and adverse reactions.

The direct application of theoretical knowledge into the clinical setting promotes evidence-based practice and increases nurses’ motivation through positive patient feedback (Lloyd et al, 2023). Moreover, knowledge of the Royal Pharmaceutical Society (2021) framework for all prescribers prepares nurses to prescribe by understanding the assessment process, legal and ethical implications and the importance of shared decision making.

History taking, physical assessment and diagnostic skills are also important for nurses who wish to undertake a prescribing role. History taking and physical assessment skills, such as body system examination and interpretation of findings, are vital for forming differential diagnoses and selecting appropriate drug treatments (Mitchell and Pearce, 2021). These skills are valuable to not only nurse prescribers, but to all nurses who are working autonomously at a high level.

Although some prescribing courses do not require candidates to have completed an accredited university course on physical assessment and diagnostic skills, completion of such courses before applying may be beneficial, especially to nurses who lack confidence and/or experience (Byermoen et al, 2023).

How to obtain a prescribing qualification

The Nursing and Midwifery Council provides information on how to become a prescriber and offers a search tool for Nursing and Midwifery Council-approved prescribing programmes (Nursing and Midwifery Council, 2024b). Currently, there are two types of courses: the community practitioner nurse prescribing course (V100/V150) suitable for district and public health nurses, and the independent and supplementary prescribers course (V300). Candidates should ensure they meet the requirements of their selected programme and note any application deadlines.

Before selecting a prescribing course candidates must ensure there is funding available either through their organisation or self-funding. Candidates must also follow the governance structures of their employer necessary to enable them to undertake such course (Nursing and Midwifery Council, 2024a). For example, nurses must have adequate clinical support throughout the course in addition to protected learning time. A meeting with the non-medical prescribing lead may be required to ensure arrangements for clinical supervision are in place and identify any areas of concern.

Candidates will need to identify a practice assessor or designated prescribing practitioner and a practice supervisor to support their learning in clinical practice, provide constructive feedback and assess their competence (Nursing and Midwifery Council, 2024a). The practice assessor must be an experienced prescriber and from the same specialty as the candidate to enable them to understand the principles of prescribing within their field of practice. The practice supervisor must be a registered prescriber to support students’ learning in practice; however, students can work with additional supervisors, from different specialties, to enrich their learning and meet the course requirements.

During the programme, students must complete a set amount of supervised practice hours to address the competencies in the Royal Pharmaceutical Society framework, pass a pharmacology exam and a numeracy assessment. Additional academic work such as assignments, exams or completion of e-learning may also be required depending on the provider.

Following successful completion of the course, the qualification must be registered with the Nursing and Midwifery Council within 5 years and registration requires a one-off fee. Once the qualification is on the Nursing and Midwifery Council register, nurse prescribers must follow their organisation’s mandatory governance processes before starting to prescribe. Many employers require extensive internal processes to be completed before prescribing can commence. For example, the employer may require a scope of practice, the individual’s prescribing formulary, in addition to an annual review of the individual’s competency. Nurse prescribers must also have appropriate indemnity arrangements in place (Nursing and Midwifery Council, 2022).

The Nursing and Midwifery Council (2018b) Code states that:

Nurse prescribers are accountable to the Nursing and Midwifery Council and responsible for undertaking relevant training activities and additional supervision if needed to maintain their prescribing competence (Royal Pharmaceutical Society, 2021). Activities may include participation in audit and service evaluation, attending prescribing forums, conferences and study days or reflective practice (Wright and Jokhi, 2020; Royal Pharmaceutical Society, 2022).

Resources to help nurses be prescriber ready

The following resources have been curated to support nurses in medicines management and being prescriber ready.

Learn about the prescribing principles:

• The Royal Pharmaceutical Society competency framework for all prescribers can be used to understand the principles of safe and effective prescribing
• The British National Formulary offers guidance on prescribing. This resource includes information on prescription writing, controlled drugs and prescribing for specific groups, such as older adults or patients with renal impairment

Learn about adherence and optimisation of medicines:

• The National Institute for Health and Care Excellence has developed clinical guidelines to support healthcare professionals and patients in making decisions regarding medication adherence
• The British National Formulary offers guidance on medicines optimisation

Learn about the prevention of medication errors:

• The RCNi Learning platform has developed a CPD module titled ‘Reducing medication errors in nursing practice’, which aims to examine the factors that contribute to medication errors and how to prevent them. An account is required to access this resource

Update your knowledge on pharmacology and medicines management:

• Script is a national e-learning programme, designed to encourage safe and effective prescribing and medicines management. It is free with an NHS account
• SN@P - preparing to prescribe is a ‘readiness to prescribe’ resource designed for nursing students. It supports students in building their knowledge on pharmacology, prescribing and numeracy. The resource offers a free trial, after which it is available for a small fee
• Health & Education Cooperative has developed resources aimed at healthcare professionals who require to refresh their pharmacology and medicines management knowledge before applying for a prescribing course. Preparing to become a prescriber is a resource for qualified nurses and includes modules on consultation, pharmacology and prescribing governance. It is available for a small fee

Preparing to prescribe:

• The University of Surrey has developed a prescribing implementation toolkit that offers advice, information and signposting to resources to support those planning to undertake a prescribing qualification in the UK. Users can log in with their NHS Open Athens account, e-learning for healthcare credentials or create a new free account