course material

1. Independent Nurse Prescriber…
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The legal ethicalcode of conduct for nurses as provided by the Department of Health in the
UniteKingdom……Adverse effects sothat the decision of the patient is base on informed
consent……. Question 1The roles of a minor illness or injury nurse practitioner within the
emergency department involve management of the patient’ s conditions and assisting other
medical practitioners in treatment of various conditions. According to the Nursing and
Midwifery Council of the United Kingdom (2008), a nurse within the emergency department
must relate the past medical history of all patients with their current therapeutic program
so that an effective treatment plan is reached. The Nursing and Midwifery Council of the
United Kingdom (2008) further provides guidelines for minor illness nurses and nurse
prescribers within the emergency department that would enable them provide effective
management of patients through the application of relevant information gathered from the
patient history. The National Institute for Health and Clinical Excellency (2009), both
pediatric and adult patients respond to the current therapy based on the past medication
and thus it is important for nurses to obtain all relevant information on the patient before
reaching a decision to prescribe. The pediatric patient history can be obtained from the
parents or guardians. The history of a patient which affects prescription includes the
demographic information, past medical conditions, reaction to different drug preparations
and the health conditions associated with the current illness.A nurse prescriber must keep
proper records of the patient history and ensure that they are used solely for the purposes
of medical care. This is provided by the Nursing and Midwifery Council (2008) as a way of
upholding the rights of patients for protection of private information from unauthorized
access or disclosure. It is important to note that a nurse prescriber within the emergency
department must provide the senior practitioners and physicians with the required patient
records for decision making and evaluation. Moreover a nurse prescriber should know her
limitations in using the medical history in prescription of certain controlled drugs such as
diazepam to the elderly and poly-pharmacy patients hence leave the responsibility to the
superior medical officers as explained by Wagle (2011).The assessment models in patient
history taking should be applied by nurse prescribers so that involvement of patients in
treatment is made possible. A nurse prescribe should therefore be able to initiate
conversations with patients, gather relevant information, do physical examination, explain
to the patient about his or her condition and make a proper treatment plan as demonstrated
by Adams (2011). In aIDition, the Nursing and Midwifery Council of United Kingdom
(2008), illustrates that a nurse practitioner must evaluate the condition of the patient by

2. using either a biomedical or psychosocial perspective as a model of taking the patient
history. Though, both these models can be used by nurse prescribers to determine the
necessary tests or medical procedures needed to be performed in order to accurately
diagnose the medical condition of the patient so that relevant therapy is provided. It is
important for a nurse practitioner to ensure that a patient focused care is given so that they
are able to give a positive contribute to care through provision of adequate information
during history taking. Consultation with other practitioners is also an important
consideration in emergency care so that prescription is based in confirmed
diagnosis.Robeznieks (2011) illustrates that a good patient history helps to prevent errors
in drug prescription such as prescribing drugs to a patient with known allergy for the
medication and miscommunication that leads to failure of checking the correct dosage for a
given condition.The Royal College of Nursing (2008) also provides guidelines in caring for
patients by a nurse prescriber which includes using a concordance model of patient care
where the patient is given a chance to be involved in deciding the kind of care given by
practitioners. Toren & Wagner (2010) aIDs that a nurse practitioner must communicate
appropriately and efficiently with other hospital departments such as the laboratory,
radiology or pharmacy so that the various procedures on the patient are carried on without
delay so that the patient is relieved from the pain as soon as possible. Question 2The Royal
College of Nursing (2008) provides policies through which nurses in the emergency
department use to apply their knowledge and experience on the mechanisms of action of
drugs when they are prescribing drugs to the patient as also demonstrated by the National
Prescribing Centre (2008). The framework acts as an important guideline in ensuring that
therapy is provided according to the requirements of various medical conditions. This is
important in prevention of incidences of drug overdose and failure of close monitoring of
the drug actions. The contraindications of various drugs must also be considered by
emergency care nurses because some conditions in patients may lead to adverse effects of
various drugs on the patients. When managing pediatric patients in the emergency
department, it is necessary for a nurse prescriber to use proper formulations such as
prescribing medicines in volume of liquid in ml rather than the actual adult dose in mg.
According to Steiner, Blitz & Stagg (2008), in treatment of patients within the emergency
department, physiological parameters that affect the drug dosage such as weight must also
be applied in prescribing to ensure that correct amount of dosage is given to the
patients.According to the Department of Health (2010) about 4% of the deaths of adults
aged between the ages of 59-84 have been attributed to aripiprazole therapy. In aIDition to
drug adjustments to hepatic diseases among the elderly patients, a nurse prescriber should
consider the contraindications of drugs in patients with renal diseases so that they are
protected from renal failure induced by therapy. Moreover, the nurses in the emergency
department should apply the Yellow Card Scheme to report Adverse Drug Reactions (ADRs)
suspected to occur from medication of patients of various ages and conditions Culley
(2010).Safe prescription of drugs must be based on the patient history. Therapy which does
not consider the patient history would lead to prescription of medication that has failed to
provide healing to the patient before hence nurse prescribers should use alternative
medications for various illnesses through having an interactive communication with the

3. patient about previous therapy and its medical effect on the patient. As explained by
National Prescribing Centre (2008), the cost effectiveness of various drugs in relation to the
ability of the patient to pay for them can be obtained from the patient history. In aIDition,
the past and current medical conditions of the patient affect the drugs that patients are
given. Therefore a nurse prescriber should apply relevant knowledge of patient history such
as past reaction to some drugs or conditions such as pregnancy that leads to
contraindication of some drugs.Department of Health (United Kingdom) has reported
prescribing errors among children hence the need for professionalism and accuracy in
prescribing pediatric patients in the emergency department. The errors usually result to
non compliance of correct medical procedures in care of pediatric patients. All nurse
prescribers must apply their knowledge on the mechanisms of action of various drugs
among child and adult patients so that adverse actions are minimized hence ensure safety in
therapy. As a result National Prescribing Centre (2008) demonstrates that it is only
competent, skilled and experienced nurses are allowed to prescribe for pediatric patients in
the United Kingdom. Standards are reinforced by the Department of Health in UK on the
prescription of drugs for children. The prescription of drugs for adult patients in the
emergency department within the UK has been challenged by patient factors such as
resistance, lack of compliance to therapy and inability to afford the drugs and therefore
nurse prescribers should take the patient factors into consideration to enable cost-effective
and safe prescribing. Question 3The legal ethical code of conduct for nurses as provided by
the Department of Health in the Unite Kingdom provides that nurse prescribers must
provide compassionate competent and safe medical care to all patients. The care of patients
should thus be aimed at promoting the well being and health of the patient while preserving
their dignity. Moreover, nurse prescribers must maintain privacy and confidentiality of
patient information. According to Wagle (2011), nurse prescribers who fail to promote
justice in medical care are taken accountable for their actions through a disciplinary
body.The codes of nursing practice provided by the National Prescribing Centre of the
United Kingdom (2008) illustrate that nurses must uphold the principles of health care
ethics. The United Kingdom legislation provides that nurses and other medical practitioners
must act to promote and not harm the condition of the patient under all circumstances as
explained by Lowe (2010). The best interests of the patient therefore must be considered in
emergency care so that legal suits do not result from the medical malpractice in prescribing
drugs to patients. In the UK, patients have the right to sue medical practitioners if they feel
that proper medical practice has not been provided to them and also in cases of medical
negligence especially in administration of therapeutic formulations.The Shipman inquiry
has affected drug prescriptions especially for the controlled drugs because doctors are now
prevented from stockpiling drugs through false prescriptions of drugs such as diamorphine.
A nurse prescriber should therefore take responsibility and accountability for the use of
controlled drugs within the emergency department Considine & Winter (2009).The
legislation on medical practice in the United Kingdom provides that nurses must report
incidences of abuse to patients. An emergency nurse practitioner therefore has the
responsibility of ensuring that any non legal practice in prescription of drugs is reported to
the relevant authorities as demonstrated by Wand & White (2007). The legal framework of

4. the UK gives patients the right to determine what happens to them. According to Bray,
Dawson & Plowright (2010) competent adults have the legal right to refuse therapy but
nurses should take the responsibility of directing patients through professional consultation
and advice on various therapies. This will enable the patient to determine what medication
is appropriate hence reach an informed decision. Pediatric patients do not have a mental
capacity to decide on the kind of medication that they are given hence their parents must be
consulted by the nurse so that ethical legal aspects of nursing practice are adhered to.The
legal framework of medical practice within the United Kingdom provides for fair treatment
of all patients without prejudice. As demonstrated by Wagle (2011), nurse prescriber must
adhere to the legal framework of medical care and follow the correct ethical practices in
treatment of both pediatric and adult patients. In an emergency department, treatment of
minor illnesses should also be ethical so that the dignity of patients is not violated. Nurse
prescribers should also ensure that the privacy of the patients in terms of the therapy
prescribed for them is maintained private. Disclosure of patient information to a third party
without his or her consent is illegal in the United Kingdom and hence failure to follow the
ethical practices in care would lead to legal suit by the patient or disciplinary action to the
nurse concerned. Question 4The influence of patients in nursing care is inevitable because
of their rights in determining what is done to them in medical care. The history taking
models such as concordance provides that patients must be involved in treatment so that
their legal right to denial or acceptance of a given medical procedure is not denied. It is
notable that the medical care provided by a nurse prescriber would also be influenced by
the relatives of the patient especially for pediatric patients. This calls for all nurse
prescribers to adhere to the legal and ethical standards of practice to ensure that the
influence on treatment does not violate the application of justice in nursing care for all
patients. Gaudine & Thorne (2011) aID that the diversity among patients in terms of age,
social background, financial abilities and educational level and general awareness of
medical issues determines the direction of nursing care. A nurse prescriber thus is faced
with challenges of managing the various factors that influence care such as the behavior of
the patients, parents and compliance to therapy.In prescribing drugs for patients, nurses
should be able to analyze the psychological behavior of patients and attitudes towards
treatment because it would determine their compliance to the therapy as explained by
Culley (2010). Consultation between the nurse and the patient should thus involve the
patient with professional advice on the benefits of the drugs or procedures and the possible
adverse effects so that the decision of the patient is base on informed consent. Considine &
Winter (2009) say that it is through informed consent that the law of concordance is
adhered to by medical practitioners including nurse prescribers.Nurse prescribers should
also apply the health believe model especially in administration of drugs within the public
health context because perceptions of individuals play a vital role in the adherence to
therapy. The psychological aspect of treatment should be encompassed in the management
of patients by nurses so that the constructs of perceived susceptibility, severity, barriers
and benefits are included in therapy as demonstrated by Kaufman & Birks (2009).
Moreover, various demographic variables must be put into consideration by nurses so that
care is effective.When nurse prescribers provide therapy for pediatric patients, the

5. influence of the parents and guardians is inevitable. As illustrated by National Prescribing
Centre (2008), parents tend to be concerned about the drugs that their children are
ascribed to hence nurse practitioners should explain all detains of the drug including its
action and relevance to the illness of the patient. This is a way of avoiding conflicts with the
parents especially when the drugs that must be described have some adverse effects on the
pediatric patient. Moreover, the behavior of adult patients determines their compliance to
therapy. Some patients may take less than the prescribed dose of a drug because of the fear
of the adverse effects hence failure of full recovery due to under dosage. The nurse
prescriber should therefore be able to convince the patient the importance of compliance to
the mediation through proper communication as said by Courtenay, Carey & Stenner
(2010).The abilities of the patients to afford various drug formulations vary depending on
their social economic background. Some patients have access to insurance making them
able to pay for expensive drugs. According to Nursing and Midwifery Council (2008), nurse
prescribers should provide alternative prescriptions to patients depending on the social
economic influences on therapy but the goal of the health care should be aimed at providing
cost effective recovery and adherence to the ethical framework of nursing care. Question
5Within the emergency department are various health care providers with diverse
knowledge, education, experience, behaviors and responsibilities. Because of this diversity,
it is inevitable that ethical issues would arise following differences in opinion, judgment,
professional behavior and attitudes towards medical care. Therefore, an emergency
department nurse prescriber should be able to practice with due consideration of the legal
framework so that patients receive justice in care. Responsibility should therefore be taken
by a nurse prescriber in case of non ethical behavior within the emergency department. The
Nursing and Midwifery Council (2008) explains that a nurse prescriber must use various
skills in order to ensure effective and efficient relationship and communications with other
health providers in the emergency department. This is because emergency care requires
coordination and proper cooperation of the health care providers so that emergency
treatment is effectively given to the patient.In the emergency department there are nurse
assistants, students, nurse prescribers and doctors whose roles vary. The responsibilities
played by each member of the team should however be aimed at providing effective care to
the patient as explained by Lowe Grey (2010). Moreover, genetic enzyme variants in
various ethnic groups must be considered by nurse prescribers because they cause
diversity in the metabolism of drugs by various individuals.In an emergency department
proper evaluation of patients and keen assessment are important so that justice in health
care is provided to patients. Conflict among practitioners may result from non compliance
to the proper medical procedures and ethical considerations in care for emergency
department admissions. Moreover, the relationship of the patient with a nurse may be
jeopardized by the adverse effects of various drugs making the patient prefer some nurses
more than others. Therefore, nurse prescribers should be accommodating so that patient
needs are taken into consideration. Kaufman & Birks (2009) say that it may be necessary
for a nurse to consult a colleague for a second opinion so that the patient feels that all
considerations are taken before decisions on medication are made.The levels of education
in nursing vary as their roles within an emergency department. Good relationship is

6. required among nurses so that treatment is focused at relieving the pain of the patient.
According to the Department of Health, nurse practitioners in the United Kingdom have the
responsibility of guiding student nurses through the medical procedures and prescription of
various formulations so that their role in providing training for the next generation nurses
is achieved.Nurses have a big influence in empowering patients and they would determine
the decision of patients. A nurse prescriber within an emergency department should adhere
to the ethical standards of medical practice so that patient rights for proper care are not
neglected. The voice of pediatric patients and the concerns of the parents are heard through
the nurse concerned especially in providing a go ahead for some medical procedures such
as CT scans. In aIDition, Culley (2010) asserts that a nurse prescriber should perform
various roles within limitations and reporting to the physician I charge and the
administrative officers on various issues related to care is mandatory. ReferencesAdams,
Johnson 2011, ‘ Nurse prescribing ethics and medical marketing’ , Nursing Standard, 25,
29, pp.62-66Bray, K, Dawson, D & Plowright, C 2010, ‘ British Association of Critical Care
Nurses positionstatement on prescribing in critical care’ , Nursing In Critical Care, 14, 5, pp.
224-234Culley, Farah 2010, ‘ Professional considerations for nurse prescribers’ , Nursing
Standard, 24, 43, pp.55-60Considine, J, & Winter, C 2009, ‘ Defining the scope of practice of
the emergency nursepractitioner role in a metropolitan emergency department’ ,
International Journal Of Nursing Practice, 12, 4, pp. 205-213,Courtenay, M, Carey, N, &
Stenner, K 2010, ‘ Nurse prescriber– patient consultations: a casestudy in dermatology’ ,
Journal Of Advanced Nursing, 65, 6, pp. 1207-1217Department of Health (United Kingdom),
(2010), The Code: Standards of Conduct, Performanceand Ethics for Nurses (2008) p
3Gaudine, A, & Thorne, L 2011, ‘ Clinical ethical conflicts of nurses and physicians’ ,
NursingEthics, 18, 1, pp. 9-19,Kaufman, G, & Birks, Y 2009, ‘ Strategies to improve patients’
adherence to medication’ , NursingStandard, 23, 49, pp. 51-57,Lowe Grey 2010, ‘ Scope of
emergency nurse practitioner practice: where to beyond clinicalpractice guidelines?’ ,
Australian Journal Of Advanced Nursing, 28, 1, pp. 74-82,National Prescribing Centre (UK)
(2008), Guidance for Continuing Professional Developmentfor Nurse Prescribers (2008), p
8-15NICE (National Institute for Health and Clinical Excellency), (2009), NICE guidelines 88,
2009,p 6-7.Nursing and Midwifery Council (NMC), UK, (2008), Standards of Proficiency for
NursePrescribers, p 7-11.Robeznieks, Adson 2011, ‘ Helping hands: Roles and
responsibilities are expanding for nursepractitioners and physician assistants– but not
without some resistance’ , Modern Healthcare, 41, 21, pp. 26-29.Royal College of Nursing
(2008), Standards for Infusion Therapy, 20 Cavendish Square,London, W1G 0RNSteiner, I,
Blitz, S, & Stagg, A 2008, ‘ Introducing a nurse practitioner into an urban
Canadianemergency department’ , CJEM: Canadian Journal Of Emergency Medicine, 10, 4,
pp. 355-363Toren, O, & Wagner, N 2010, ‘ Applying an ethical decision-making tool to a
nurse managementdilemma’ , Nursing Ethics, 17, 3, pp. 393-402,Wand, T, & White, K 2007,
‘ Exploring the scope of the Emergency Department mental healthnurse practitioner role’ ,
International Journal Of Mental Health Nursing, 16, 6, pp. 403-412Wagle, Steven 2011,
‘ Using the British National Formulary: best practice for nurse prescribers’ ,Nursing
Standard, 26, 3, pp. 43-48