Unit 5 – Prescribing in Practice

Continuing Professional Development

Nurses have a professional responsibility to keep themselves up to date with clinical and professional developments, and this applies just as much to those involved in nurse prescribing.

You, as a prescriber, will be expected to maintain up-to-date knowledge of best practice in managing conditions for which you may prescribe. At the same time, you will need to know how to use drugs, dressings and appliances listed in the Nurse Prescribers' Extended Formulary which you will find in your current BNF.

Nurse prescribing should be introduced and take place within a framework of clinical governance. Clinical supervision sessions provide an excellent opportunity for reflection on prescribing as well as other aspects of practice. Models of clinical supervision should be agreed at local level, taking account of other staff support mechanisms and resources, and should be monitored and evaluated regularly.

Further Reading

Further reading

Charnock, A. (2001) Who's afraid of clinical governance? Nursing Times 97: 50, 34-35.

McSherry, R., Haddock, J. (1999) Evidence-based health care: its place within clinical governance. British Journal of Nursing 8: 2, 113-117.

Reflective practice

One definition of reflection is, "a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice." (Johns, 2002)

Johns further develops this definition by suggesting that reflection helps us, as practitioners, to bridge the gap between what we say we ought to do and what we really do.

Reflection aims to change behaviour, perspective or practice, and should result in learning. It can also help to turn intuitive knowledge into explicit knowledge, enabling further development of practice (Bailey, 1995).

Atkins and Murphy (1994) identified the following reflection skills:

  • Self-awareness An essential prerequisite for reflection, because having self-awareness means you are conscious of your values and are able to analyse their impact on a given situation

  • Ability to describe a vivid description of the events should be recorded as they unfold. The description should be complete to enable someone who was not present to understand the situation

  • Ability to critically analyse This consists of examining in detail the components of the situation, including assessing your knowledge, identifying and challenging any assumptions made, and exploring alternatives

  • Ability to synthesise This means the integration of new knowledge with existing knowledge

  • Ability to evaluate This requires making a judgement on the incident or situation, because evaluation is crucial to developing a new perspective.

It is important to reflect on situations — this may not only expose uncertainty or lack of skills, but may also highlight situations where everything went well and which resulted in a positive outcome.

Cooney (1999) cautions that it is potentially damaging if nurses reflect on their actions in isolation and ignore the context, for example by failing to see that a situation was perhaps outside their control. It is not as simple as thinking about — and then modifying — practice, because factors such as the personalities involved and different situations will impinge on what can be done.

Personal reflection is a useful way of presenting evidence in your portfolio. If you are not accustomed to using reflection, reading the following may be helpful:



Cooney, A. (1999) Reflection demystified: answering some common questions. British Journal of Nursing 8: 22, 1530-1534.

Further Reading

Further reading

Fowler, J. (2006) The importance of reflective practice for nurse prescribers. Nurse Prescribing, 4 (3) 103-106.

Marks-Maran, D., Rose, P. (1997) Reconstructing Nursing: Beyond art and science. London: Baillière Tindall. Chapter 6, 'Thinking and caring: new perspectives on reflection'.

Clinical supervision

Clinical supervision is the term used to describe a formal process of professional support and learning that enables individual practitioners to develop knowledge and competence, assume responsibility for their practice and enhance patient protection and the safety of care in complex clinical situations.

It is central to the process of learning and should be seen as a means of encouraging self-assessment, and analytical and reflective skills.

Clinical supervision is a formal arrangement, which is time protected in order to bring nurses together to discuss clinical work and reflect on practice.

According to Bishop (1998), the aims of clinical supervision are to:

  • Safeguard standards of practice
  • Help with individual development, both professionally and personally
  • Promote excellence in healthcare.

These three aims are pertinent to the changes that nurse prescribers are undergoing. In areas where clinical supervision is practised, time spent positively exploring feelings and professional anxieties should have a positive impact on patient care and allow clinicians to feel supported, thus increasing morale and encouraging professional growth.

Further Reading

Further reading

Johns, C. (1993) Professional supervision. Journal of Nursing Management 1: 3, 9-18.

Kohner, N. (1994) Clinical Supervision in Practice. London: King's Fund Centre.

Maintenance of professional knowledge and competence

One of the NMC's principles concerns the maintenance of professional knowledge and competence. In the 1980s, nurses extended their scope of practice by taking on duties in an 'extended role' capacity. The idea behind this was to ensure 'competence' in a particular skill through a linear process of education (where the nurse first observed the skill), practice, then achievement of competence (where a 'skilled other' individual deemed the nurse competent to practice that skill).

Signed certificates were collected to state that the nurse was competent in the stated extended duty. This practice has been replaced because the NMC felt that these limited parameters of practice rather than extended them. Now, individual nurses make decisions about their own competence themselves, and they are individually accountable for their actions.

This places full responsibility on each nurse to determine the skills needed for a particular procedure and to ensure they can carry these out competently.

Although the Scope of Professional Practice document has largely been incorporated into the NMC 's Code of Professional Conduct: Standards For Conduct Performance and Ethics (2004), it is useful to read the UKCC Perceptions of the scope of professional practice (2000), which looks at how practitioners should apply their professional knowledge, competence and accountability.


Consider how you will maintain your knowledge and competence in relation to nurse prescribing.

Make Notes

Are there some areas of your practice in which you feel less skilled than in others?

In what ways can you remedy any deficits in order to meet the needs of your clients/patients?

There are two useful competency frameworks which have been developed to assist individual prescribers and their managers to identify, support and develop prescribing competencies. These frameworks provide a valuable tool for your personal, professional development.

National Prescribing Centre (2001) Maintaining Competency in Prescribing: An outline framework to help nurse prescribers

NHS Education for Scotland (2003) A Template for Continuing Professional Development in Prescribing
www.nes.scot. nhs.uk/docs/publications/cpd_03.pdf

Further Reading

Further reading

Basford, L. (2003) Maintaining competence in nurse prescribing: experiences and challenges. Nurse Prescribing, 1 (1) 40-45.

Bramley I (2006) Continuing professional development: what is it and how do I get it? Nurse Prescribing, 4 (3) 117-120.

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