DDN is partnering with Addiction Professionals to explore the pathways into the field, and how to progress once you’re there.
This month our careers series turns the spotlight on nursing.
Many people choose to qualify as a nurse so they can pursue a career in addictions. There are also nurses who become interested in specialising in addictions as a result of coming into contact with people with drug or alcohol issues in their working lives. To practise as a nurse in the UK you must be registered with the Nursing and Midwifery Council (NMC). Nurses are required to have a nursing degree or equivalent in order to register with the NMC – there is no externally recognised addictions accreditation.
Nursing gives the opportunity to work in a variety of roles within services including providing specialist interventions in physical and mental health, leading on harm reduction initiatives for bloodborne viruses, needle exchange, provision of naloxone, and support with detoxification from alcohol and/or other drugs. Some nurses choose to study at Masters level, including addictions courses, but these are open to a range of professionals and are not nurse-specific. There are a range of nurse-specific MSc courses – for example in leadership, or mental health – although there are none that focus solely on addictions.
Others study to become nurse independent/supplementary prescribers and play an important role prescribing medication to those with substance problems. To do this, nurses must have one year’s post registration experience.
Email your letters to the careers clinic to the DDN editor.
Case study 1
Challenging, but highly rewarding
Kudzai Mutizhe talks about being a nurse prescriber
My role is to provide quick access to treatment for drug and alcohol clients. This includes prescribing opiate substitute medication like methadone and buprenorphine. I also facilitate alcohol assessments and detoxes. I am a qualified nurse prescriber and have been since November 2014. I qualified as a registered mental health nurse (RMN) in 2000. When I did my training to become a non-medical prescriber (NMP) you were expected to have practised in your area of expertise for at least three years at a senior level.
I work in prison and community settings – in both my role involves reviewing clients’ treatment as well as supporting colleagues with their caseloads.
There are many aspects of my job that I like. One that stands out is when I make a decision that may have looked tough at the time but later a client is appreciative of the progress they’ve achieved. The gratitude of clients when you’ve assisted them in their journey is one of the things that keeps me going. It’s a highly rewarding job that requires an interest in people as a prerequisite. The client group is challenging and the job itself can be character changing.
Case study 2
Every day is different
Jane Milliner shares her role as a non-medical prescriber at Forward Trust
As an NMP my role is to provide high quality clinical assessments to diagnose and prescribe opiate substitute treatment (OST) – the role also includes alcohol assessments to establish and diagnose dependency, supporting alcohol detox, and decision-making for either in-patient or community detox.
The role requires a nurse qualification and NMP course completion. A qualification in substance misuse is preferable and some experience is desirable, however the service is happy to develop nurses to fulfil this role and training and peer support is ongoing. A thorough induction is completed with support from our doctors and other nurses/NMPs to ensure that new staff feel confident and competent to carry out this varied role.
Every day is different – some are extremely busy, others are spent waiting for clients to attend. We see unexpected releases from prison and urgent referrals from GPs, and we cater for clients who often have a diverse range of complex needs. There are numerous other aspects to this role which include assessment of the liver via fibro scans and blood results, assessing the risk for IV drug users and putting a plan of care in place to minimise this risk. We raise awareness of blood-borne viruses, and provide a vaccination service for those at risk as well as onward referrals for hep C treatment.
The role also includes student mentorship, recovery worker support and liaising with other agencies such as GPs and mental health teams to deliver a person-centred approach. We have new initiatives, including piloting the buprenorphine injection/depot, Buvidal.
We aim to provide a service which we would all be happy for our family/loved ones to attend. The most rewarding part of the job is to see people making positive changes and maintaining these changes. I enjoy working with people who have previously been judged and have little self-esteem – to witness our clients gain confidence in themselves to turn their lives around is very satisfying and makes the work worthwhile. This is a very fulfilling role. If you are caring and want to make a difference, this is the role for you.
How do I become a non-medical prescriber?
Natalie Thompson explains the route to qualifying as an NMP
Non-medical prescribing was introduced in May 2006 to improve patients’ access to treatment. It enables quicker access to medicines, delivers high quality, innovative clinical care, and offers choice for the individual. Only nurses and pharmacists that have been trained to prescribe can do so, and they can only prescribe within their area of expertise.
What are the different types of prescribers?
Allied health professionals who have completed an accredited prescribing course and registered their qualification with their regulatory body are allowed to prescribe. The two main types of prescribers are independent prescribers (IPs) and community practitioner nurse prescribers (CPNPs). An IP is someone who has successfully completed a Nursing and Midwifery Council (NMC) independent nurse prescribing course (a v200 or v300) and who is registered with the NMC as an IP.
IPs can prescribe any medication provided it’s in their competency to do so. This includes medicines and products listed in the British National Formulary as well as unlicensed medicines and all controlled drugs in schedule 2-5.
A CPNP is a nurse who has successfully completed an NMC CPNP course (v100 or v150) and is registered as a CPNP with the NMC. Most nurses who have done this course are district nurses and public health nurses (previously known as health visitors), community nurses and school nurses. They are registered to prescribe from the Nurse Prescriber Formulary (NPF) which includes appliances, dressings, and pharmacy.
How can you become a prescriber?
To become an NMP, eligible practitioners will undertake an accredited programme, delivered by a higher education institution. Non-medical prescribing programmes provide the knowledge, skills, and training to prescribe safely and competently.
The Royal Pharmaceutical Society has created a prescribing competency framework for all prescribers that has been designed to help maintain prescribing standards, inform education curricula, and provide a source of recognised guidance for those involved in NMP.
All prescribing roles build on registered professionals’ ability to deliver full instalments of patient care. In turn this enhances patients’ timely access to treatment with medicines and experience while reducing waiting times, hospital admissions and more effectively using members of the healthcare team.
What qualifications and experience are needed?
Registration with the NMC as a first-level nurse or specialist community public health nurse for a minimum of one year prior to application for entry.
Applicants are to be professionally practising in an environment where there is an identified need to regularly prescribe, and able to demonstrate support from their employer/sponsor, line manager, non-medical prescribing lead and practice supervisor and assessor.
Applicants should be capable of safe and effective practice at a level of proficiency appropriate to the module/programme undertaken and their intended area of prescribing practice in the following areas: clinical health assessment, diagnostics/care management, planning, and evaluation of care.
Applicants must be able to demonstrate ability to study at academic level 7.
Applicants must have at least three years’ experience as a practising nurse or specialist community public health nurse and be deemed competent by their employer to undertake the programme.
Employment is subject to enhanced Disclosure and Barring Service (DBS) clearance.
Your approved course will enable you to learn the skills and knowledge you need to qualify. You’ll be able to develop your legal, ethical, and professional knowledge on topics relevant to pharmacology and therapeutics.
What career opportunities will this open up?
Once you’ve completed your course and registered with the NMC, you’ll be able to prescribe independently and in partnership with a medical or dental prescriber and the patient.
Areas you can work in include mental health, substance misuse, travel medicine, HIV medicine, critical care, nutrition, and rheumatology.
You can also progress to higher level courses including advanced nursing practice or advanced clinical practice as well as becoming a prescribing supervisor.
If you’re looking to develop your medical career, take on greater responsibilities and manage enhanced patient care, becoming a non-medical prescriber may be the right direction for you.
Natalie Thompson is at Archer Resourcing, www.archerresourcing.co.uk
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