Nadia Day - My path to independent prescribing

Our latest guest blog is by Nadia Day, a Urology Advanced Practitioner from University Hospital Southampton. She describes her experience of becoming one of the first therapeutic radiographers to qualify as an independent prescriber.

I am a urology advanced practitioner: in other words, a therapeutic radiographer who specialises in bladder and prostate cancer patients. Unbelievably, I have 19 years’ worth of experience in radiotherapy, with 6 of those years specifically in urology. Where on earth did that time go! Of course, I obviously still look like I am 21.

I am now a year post-qualification of a prescribing course[1]. Legislation was passed in April 2016, permitting therapeutic radiographers to train as non-medical independent prescribers[2]. This was brilliant news, long awaited, and would benefit the clinics I ran where I reviewed patients during their radiotherapy . Just imagine discussing a patient’s radiotherapy-related side effects in clinic with them, knowing exactly what medication they needed to help them cope. Not being able to help them there and then with that prescription was frustrating: knowing a simple solution was just out of my grasp. Leaving the patient in the clinic or waiting room, I would rush up flights of stairs (not normal flights of stairs, but segmented flights of 5 or 6 that would make anyone out of breath, regardless of physical fitness!) to track down the patient’s consultant or a lovely registrar who would listen to me plead that patient’s case. This only worked if I remembered to ask all the relevant questions, else the stair scenario might have been on repeat. Little did I know these supportive consultants and registrars had already begun my training in the prescribing world.

Now? Well, I still rush up those stairs, but not as frequently or with the same intent. I sit in clinic with the patient and can make an informed decision whether to prescribe. This is much more efficient and allows more satisfaction for the patient and me. While I was training, the amazing patients were so encouraging and supportive of the principle of a radiographer prescribing their medication. Without their encouragement, at times I think I would have lost hope.

Getting to this point was challenging, interesting, exhausting and at times just plain scary. This was OK as I had a buddy: a close colleague who took the course at the same time. We supported the local shop’s economy in wine, coffee and chocolate (you know, survival measures). In our group were 2 therapeutic radiographers, 2 physiotherapists and a good representation from the nursing profession. Being the second intake of registered HCPC (Health and Care Profession Council) professionals following the legislation, the glitches for therapeutic radiographers and physiotherapists had (mostly) been smoothed out. I had been warned by experienced prescribing professionals this would be a hard undertaking: “be prepared for the worst”… “put your life on hold”…“you will be consumed”…

During my training, an underlying chronic illness reared its head, leaving me at times with limited vision. On the bright side, this was useful in calming the nerves when presenting the drug profile of micro-enemas to fellow students: I didn’t have to imagine them naked, they were all just one big blur!

As well as presentations, we had to take exams, including maths … eek! What had I got myself into? I went to sleep dreaming of drug interactions and had nightmares about simple mathematical calculations and how legible my handwriting was for the pharmacy to decipher (still a recurring dream!). Do you know how scary writing on a piece of paper can be? We practised and practised writing fake prescriptions, making sure we completed the correct boxes, gave the medication the right names and gave the correct instructions (enemas are no use being taken orally, apparently).

Our final piece of work for submission involved a mountainous piece of cross-referencing known as ‘the portfolio’, which I found extremely hard and left me wishing for an essay; I could do an essay. I wouldn’t wish the portfolio on my worst enemy!

The results were good! Qualification gained, and the all-important tick on the HCPC register was present: I am now an ‘Independent and Supplementary Prescriber’, should you look me up. A number of hospital formalities had to be completed: an official signature for pharmacy records, addition of my name to the non-medical prescriber register and a training course for an inpatient prescribing system. To top it off we had our pictures taken to publicise our achievement on the intranet (if I’d have known, I would have tamed my sticky-out hair bits).

Finally, we could put everything we had learnt into practice. It felt surreal. I wanted to frame my first prescription; my colleague thought I was mad. I cannot remember it now though. What I do remember, and am reminded of frequently, is the patients’ responses when a medication I have prescribed has benefited them. It has made all the wobbles worthwhile.

A year on, and I get asked for prescribing advice on patient management and consulted about other patients with urological issues. It is an amazing feeling. Today, I imparted my newly drilled (acquired, I mean) knowledge about a drug to a pharmacist, who then asked me for the supporting literature to use in their team’s continuing professional development.

Would I do it again? Was it worth it? Yes, of course. This extension to my role was not just about prescribing; it has ultimately benefited my patients. The clinical oncologists I work closely with also benefit as it frees their time for more complex duties. I am honoured by their professional trust and the support they give as I continue to learn and grow. It isn’t over yet!