Developing nurse independent prescribing in a specialist palliative care setting

Nurse independent prescribing (NIP) has been at the centre of government policy in the UK to improve patient care. Clinical nurse specialists (CNSs) are key workers in the delivery of specialist palliative care services, and NIP enables them to improve the quality of care their patients receive. However, there are known barriers that prevent qualified NIPs from prescribing, including lack of NIP policies in organizations and difficulties in ensuring ongoing mentoring and support. This article describes how an NIP policy was developed and introduced within an independent specialist palliative care setting (hospice community team). The process undertaken by the NIP policy team is described as well as approaches to overcoming potential and actual barriers. Challenges in creating a NIP policy are explored, including such issues as managing off-label prescribing, obtaining peer support and securing insurance cover. As CNSs often work independently, it was felt important to provide mentoring following qualification by senior medical staff in order to gain confidence in their new roles in NIP. Wider influences, such as initiatives to increase care of patients in the community and 7-day working by CNSs are also considered. This article aims to support other health care providers, both in the independent and national health sectors, who plan to deliver the NIP agenda. Barriers to NIP must be addressed in order to achieve success and to ensure specialist palliative care nurses trained in NIP are able to put their extended skills into practice.