A massive opportunity for Mel!

With the growing shortage of GPs in Aotearoa, nurse prescribers are widely regarded as essential for the future of health services, improving equity in healthcare by increasing access to medications, particularly in high-needs and isolated rural areas.?

With that in mind, we’d like to take the chance to congratulate Melissa Kearns, a senior Practice Nurse here at Tui Ora Family Health, who has recently qualified as a nurse prescriber!

So, what is a nurse prescriber?

There are three levels of nurse prescribing:

There are?community nurse prescribers,?who can prescribe simple medications for straightforward conditions in normally healthy people and have a work-based training programme combined with online learning.

Then there are?nurse prescribers in primary health and specialty teams??who can prescribe for common and long-term conditions, with postgraduate education in prescribing. This is Mel's new qualification.?

Finally, there are?nurse practitioners (NPs)?who can prescribe much as doctors can, and have masters-level education.

“Basically, I can prescribe medicine for things that people would otherwise have had to see the doctor for. There is a list of medications approved by the Ministry of Health used to treat common and long-term conditions which I can prescribe from. This includes things like antibiotics, pain relief, diabetes, and heart medication. Quite often there’s a wait to see the doctor, which can sometimes be weeks long, so now I can see them instead. The biggest benefit is certainly that it makes healthcare more accessible, which is really helpful with the nationwide GP shortage.”

“It’s easier for me as well, if I’m seeing a patient and they bring up something that they need medication for, I can do the script myself rather than waiting for the doctor to be free which is really helpful as it saves everyone time in the long run”.

The qualification is a 2-year postgraduate diploma, which Mel completed on a part-time basis through Victoria University of Wellington while working full time. “I worked alongside our head GP Bernard Leuthart for a semester undertaking a clinical log of over 150 hours worth of patient assessments. Bernard also had to read all of my assignments and say that I was fit to do it! I had great support from the whole team, and it was cool to move out of the basic nursing kind of stuff and more into assessment tasks.”

So, what does it take to become a nurse prescriber?

“You have to have worked in the area you want to prescribe in for at least 3 years and have support from an authorised prescriber, which in my case is Bernard. I also need to meet competencies set by the Nursing Council which means I am fit to prescribe as well as complete a nursing council-approved postgraduate diploma. By completing all these requirements, I became a Registered Nurse Prescriber in Primary Care and Speciality Teams in August 2022. I now need to complete 2 yearly reviews with the Nursing Council to make sure my practice remains safe and that I continue to meet the competencies. There’s also a community nurse prescribing course, which is a bit shorter than the one I did, as the list of medicines is a lot shorter and it focuses more on minor illnesses in normally healthy people. When I started going along the prescribing pathway, that course didn’t exist yet! So now that it exists, one of our other practice nurses is doing it.”

There are only around 3 other nurse prescribers in primary care and specialty teams in the region, and about 350 in the whole country. But it seems that numbers are growing with about 200 community nurse prescribers and about 600 nurse practitioners in the country.

“It’s quite a niche thing!” Mel reports “and kind of a newish thing as well. It was hard not knowing anyone that’s done it, but the team’s been really supportive. Our community nursing team have certainly been cheering me on!” The study has been really exhausting, but after having had a semester off, I am feeling way better. After this I think I could probably move on to do my nurse practitioner training, which means I would be able to see a broader range or patients similar to that of a GP. I’ve got one paper left to do, and once I’ve passed that I will just need to do a one-year nurse practitioner placement.”

Nursing is of course not without challenges, something Mel can attest to.

“Sometimes I’ll see a patient and think it’s quite straightforward, and then actually it’s not. Our team is so supportive though, I can always come to them with questions and they might suggest I prescribe this as well as that. It’ nice to have a couple of extra brains behind what I’m doing to bounce ideas off”.

With all this extra responsibility it’s certainly important that Mel can still enjoy her role, so how is she feeling now?

“It’s great, yeah!” I know a lot of the patients quite well. They’re all really happy for me that I can take on all this extra stuff now. I still have to do a lot of the routine nursing stuff as well which can be a bit tricky to fit it all into the day, so I do feel a bit of extra pressure. But it is very rewarding helping whānau who may have otherwise had to wait weeks to see their GP and as I’m getting used to it, the faster I’m getting. For a lot of people, like young females seeking contraception, they’d prefer to see a young female nurse so they can be a bit more comfortable with that kind of stuff, so it’s more for the patient’s benefit really, but it feels great to have upskilled. This year of practicing will be really helpful if I decide to take the nurse practitioner path.”

With the new qualification, Mel is really happy it’s been smooth sailing so far.

“It is a little bit tricky sometimes because on occasion someone that I’ve prescribed for before comes in and sees one of our other nurses for something, but she can’t prescribe, and she’s had to explain that to them. I think next year though the whole team will do the community prescribing training and eventually everyone will be at the same level as I am now.?

“People are usually really stoked that I’m able to do more for them. No one’s ever really questioned it. I had a few patients ask me if I could be their doctor now which I can’t be so have politely declined, but it has been a lovely compliment though knowing that they trust me and like me enough!”