Independent nurse prescriber, clinic owner and honorary BACN board member Frances Turner Traill argues that all aesthetic nurses should hold a prescribing licence.
According to the British Association Cosmetic Nurses (BACN) there are currently more than 4,000 nurses practising in the aesthetic specialty,1 many of whom will have probably had very different pathways into this private sector. Whether they have been working in the NHS for over a decade, as many of my peers have, or decided early on in their career that they want to specialise in aesthetics, there is always one question that presents itself very quickly and that in my opinion, validates their expertise. Are they an independent prescriber?
It is important to recognise that many nurses entering aesthetics will already have a prescribing licence and although technically they will be able to prescribe toxins for example, they should know what is within their remit and recognise their limitations. If they have never worked with products such as these before then I believe they should undertake the significant training required to administer toxin, or to prescribe it for others to administer. For those who have not obtained this qualification, they must undertake a specific course, detailed in this article. In layman’s terms, an independent nurse prescriber has the authority to administer prescription-only medicines (POMs) such as botulinum toxin or hyaluronidase. To obtain this qualification, known as a V300,2 nurses will need to undertake a prescribing course at an approved university. They will also need to have been practising for a minimum of one year (university dependent) in the area they wish to prescribe in and have a designated medical practitioner (DMP), usually a doctor, working in aesthetics, prior to the course.3 Generally speaking, it will take around six months to complete, with a minimum of 90 hours of prescribing-related practice under your DMP; all of which is subject to the specific course that you choose to undertake.4 As a non-prescribing aesthetic nurse, you will be taught how to inject POMs, but will need to have a prescriber authorise you to use them. This becomes much more of an issue should a complication arise, from a dermal filler for example, as ultimately you will be relying on a third party to resolve the situation and prescribe hyaluronidase, which consequently results in a poorer service and experience for the patient. In worst case scenarios, it could lead to serious long-term implications. This is one of the many reasons that in my opinion, becoming an independent nurse prescriber in aesthetics is absolutely fundamental and should be integrated into aesthetic nursing training from the get-go.
The patient journey
For most of us, the reason that we started out in nursing was to provide a service and a duty of care to our patients and making the patient journey as smooth as possible is essential for us to accomplish this. It is from this that I believe that aesthetic nurses who do not hold a prescribing licence are not offering their patients a full service because they simply cannot manage their care throughout the whole patient journey; from the consultation stage through to treatment and reviewing them right until they’re discharged, if there ever really is a discharge in aesthetics, which is a whole other topic in itself.
In addition to being able to manage complications should they arise, another point to add to this is that they will also be able to prescribe lidocaine which in turn, will help with patient comfort as it reduces pain for certain injectable procedures.
So many nurses have successfully opened their own clinic and train delegates on behalf of companies but, in my experience, those of which are non-prescribers are now very few and far between, a significant change from a few years ago. In order to excel in your career, as an individual, holding that extra qualification at a time where it is not compulsory yet will not only set you apart from others in the marketplace who cannot prescribe but it will instil you with confidence. I believe that it gives you a far better understanding of pharmacology of your treatments, which in turn will help your professional development. Working autonomously in aesthetics is very common and, in my opinion, should only be possible for those who hold the prescriber’s licence, unless you work under practising privileges with your prescriber as an interim measure and are working towards your prescribing licence. This is because you will not be relying on someone else to authorise access to products for you, particularly in the case of a complication, and instead will be able to take control of your own actions and ultimately be responsible for resolving the issue that you may have caused.
I recognise that not everyone wants to be a nurse prescriber, for example, they may work closely within a clinic environment whereby a prescriber is readily available and that set-up works well for them. Some people would argue that they don’t have to be a prescriber to administer most dermal fillers (although JCCP standards state otherwise),5 so why should they go through all of that time, money and effort? In my opinion, for those who think like this, the likelihood of a complication increases – surely increasing your learning is only going to be a benefit.
Regarding our professional regulators, such as the NMC, we want to ensure that we are as safe as possible at all times. We could argue that if we cannot prescribe 24/7 and are working in isolation we are not being safe. There will be some who do not want the responsibility, in which case I think you should absolutely be working for a clinic that is either registered with Healthcare Improvement Scotland (HIS) or the Care Quality Commission (CQC) so that there is an added safety net for patients to fall back on.6
I also understand that it can be difficult to get onto university prescribing courses and there are stumbling blocks along the way, such as working in the private sector and usually being self-funding.
The biggest hurdle is that it can be incredibly hard for people to find a DMP who is willing give their time and supervise you throughout the whole course. They also usually require a fee. This was one of the concerns raised by a number of members at the BACN board meetings. As a result, my colleague, previous BACN vice chair and independent nurse prescriber Andrew Rankin has worked and continues to work with a number of regulatory authorities to address various nurse prescribing concerns. In addition to this potential role of nurses as DMPs, issues of holding stock, prescribing for complications and even the implications for VAT have required his focus. I believe this will make a significant change within the sector.
For me, being able to be, and offer, ‘the whole package’ makes for a better practitioner with greater patient safety at the core. Being able to prescribe potential live-saving medicines, comes with responsibilities, one of which is diagnosing, which is something not everyone does in medical aesthetics. I hope that it can improve complications management across the board. I’m not saying that holding a prescribing license makes you a better injector, of course it doesn’t, but it allows you to provide a more streamlined, efficient, effective, safer patient journey. In the future, I hope to see that prescribing licences are integrated into the training of all nurses, including those who aren’t in aesthetics, from the beginning of their careers. This could mean that we see a decline in complication rates due to prompter action and improvement in regulation within the specialty.
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