Sonia Riera: “Nurse prescribing gives us more recognition: not just on a legal level, but also socially”
Interview with Sonia Riera, one of the first nurses at the Hospital Clínic to become a nurse prescriber. We talk to her about the breakthrough this has meant and the advantages it brings.
Nurse prescribing, an issue long demanded by nursing staff, was introduced at the Hospital Clínic on 31 January 2022. The pilot group was made up of 15 nurses; most of them advanced practice nurses with an independent role. At present, there are 1,946 at the hospital and 793 have applied for the digital certification process. Of the latter, 417 are already prescribing
We have been calling for its official regulation for a long time, because we have been prescribing for some time now. When a nurse treats a patient, like any other health professional they start by carrying out an assessment, and then plan the treatment or cure they think is required. This is what is called prescription, and we have always been authorized to do this following our clinical judgement. However, until nurse prescribing was approved, we were one step away from completing the entire process. Moreover, it was an administrative procedure, because we were not authorized to issue a prescription order. The fact that this step was missing was like not giving our profession its deserved status or importance. Which I think is extremely important.
"Not being able to finish the bureaucratic process of a prescription is like not being able to finish your work: you leave the patient hanging on and have to bother another professional who is able to do it, in this case a doctor".
Not being able to finish the bureaucratic process of a prescription is like not being able to finish your work: you leave the patient hanging on and have to bother another professional who is able to do it, in this case a doctor. A very typical situation was when you were with a patient with a common cold and couldn't even prescribe a paracetamol, even though she knew perfectly well that that was what they needed. You had to say to them: “Wait a minute please, I know what you need, but I have to go over there to get the doctor to sign the prescription”. And it was not consistent. I remember that sometimes I would finish the consultation with a whole pile of prescriptions waiting to be validated by a doctor. And the other professional also thought that it was not their job to do that.
Advanced practice wound care nurses like me are highly trained in wound care, and thus we operate with far more up-to-date levels of scientific evidence than other people who do not spend all day with this type of patient. With the autonomous role I have here in the consulting room, I make assessments, I plan, prescribe, indicate or recommend treatments and now, at last, I don't have to run after a doctor to get them to extend the patient's prescription. With all that that involves, because if you say, “we’ll give you a prescription", you might get stuck because you can’t find an available doctor, because my consulting room is not shared: since I’m autonomous, I don’t depend on anyone. And what am I supposed to do? Look for a doctor to carry out a virtual visit just to prescribe treatment that they know perfectly well that I am indicating correctly, because I am the one who has the most expertise with this type of patient.
"In the field of healthcare, there is a lot of talk about sustainability, about making the most of resources, but I like to talk about subsidiarity: it means that the professional closest to the problem is the one who ends us solving it".
It saves the health system time and money. Time because the patient does not have to wait until the prescription is ready, and you save time because you can work more quickly and effectively because you do not have to wait for a third person to finish the procedure. And, moreover, there are the resources: if I am the one most highly trained in wound care, I am the most specialised. And, as such, my treatments will always save resources because they will be more efficient. In the field of healthcare, there is a lot of talk about sustainability, about making the most of resources, but I like to talk about subsidiarity: it means that the professional closest to the problem is the one who ends us solving it.
Our pilot group was made up of a group of professionals that the Nursing Management believed were the most diligent at prescribing. There were 15 or 20 of us, above all advanced practice nurses, who has an outpatient practice and a very autonomous profile. Priority was given to need.
First of all, we had to be accredited as nurse prescribers, a procedure that is carried out through the Official College of Nursing. Once you are accredited, you inform your provider, which is the centre where you work, and in our case the Hospital Clínic. They ask for the electronic card that is placed in the terminals to be able to start work, and we were given a training session in order to learn how the programme worked.
The pilot test went very quickly and it was very easy: as all the participants had had to chase up doctors to get them to write prescriptions for us, we already knew how the programme worked. Because often, when you ask them to prescribe a product such as a dressing, the doctor you ask does not know what you are talking about. That’s why you have to go to the doctor’s computer, with them, to look at the programme and find the specific dressing. That is why we were already very familiar with the programme. And after one training session we were already able to start operating.
The idea is that, eventually, all nurses will have a card. At the moment, you may be able to ask for one, depending on the field you work in. Maybe, if you are on a hospital ward and the patients you treat do not appear on any of my prescriptions. Moreover, I imagine that in the long run, when they leave university, nursing graduates will carry out this procedure by default when they qualify. However, it was new for us and we had to carry out this process on our own.
"I don’t see it as a disadvantage that means more work. On the contrary: it meant far more work for me going to find someone to make out a prescription than being able to do my work quickly and easily".
It has all been positive. I don’t see it as a disadvantage that means more work. On the contrary: it meant far more work for me going to find someone to make out a prescription than being able to do my work quickly and easily. Now, when you see a patient, you know you will be able to finish 100% of your work and that they will leave with the prescription you have written. The quality of the service you give the patient is very important. And, as a professional, you transmit autonomy and leadership and that means they look at you in a different way. Nurse prescribing gives us more recognition: not just on a legal level, but also socially.
We have two general lists with the most commonly prescribed products: almost all health products and most medicines. In addition, there is another specific list for each speciality that is referred to in the clinical guidelines for nurse prescribing, which will be published progressively. In my case, that of wound care, it was one of the first guides to be published and you get a specific list with the medicines that correspond to the field, which you are authorized to prescribe.
I am very excited about this. Really, I always felt there was something lacking, and I didn’t like depending on another person to check something that I do myself. I felt like my work was not being given enough importance. Really, the Hospital introducing nurse prescribing was a real breakthrough, because there are many nurses who do a great job with a very autonomous role and needed this tool in order to provide patients with the highest quality care.
