On the 1st of June 2003 I took up the post of Nurse Consultant (Older Adults, Mental Health) in Cumbria Partnership NHS Foundation Trust. I trained as an Independent Prescriber in 2004 and started to develop a Nurse Led Dementia assessment unit. In 2006 I was asked to take on the role of Non Medical Prescribing Champion for the three Trusts,- Acute, PCT and Mental Health, and I have helped develop competency workbooks, audit tools, reflective practice and ongoing professional development for all prescribers in Cumbria.
I hold an honorary lecturer post at the University of Cumbria and teach on the student nurse and Dementia degree course
The concept of developing a Nurse Led Unit started in 2003 due to concerns around the over prescribing of psychotropic medication in dementia care, with ‘Person centred care’ talked about, but not observed in practice. The Trust was developing a new Unit but had no vision around developing something different ‘“If you only do what you have always done you will only get what you have always had” Albert Einstein
Following discussion with the commissioners, the medical and nursing director, I put a business plan forward for the development of a Nurse Led Unit as well as a training development plan for myself and the staff .
With the completion of the non-medical prescribing course in 2004 I started reviewing the patients medication, reduced and stopped antipsychotics and looked at behavioural management, pain relief and alternative therapies.
I started to take on the role of assessing , diagnosing , prescribing medication and discharging patients under the mentorship of the Consultant Psychiatrist. As my confidence and competencies grew his hours on the ward reduced until he had one session a fortnight and this was to review the patents who were detained under the Mental Health Act.
In 2007 the Mental Health Act was reviewed and allowed a broader range of professionals to carry out a range of functions under the Act. Nurses were now able to undertake the Approved Clinician (AC) and Responsible Clinician role . A Responsible Clinician (RC) is the AC who has been given overall responsibility for a patient’s case. ACs allocated as RCs would undertake the majority of the functions previously performed by Responsible Medical Officers (RMOs), whose role ended on the implementation date of the Act.
Following the AC training, it has enabled me to be the Responsible Clinician for all the patients admitted to the Dementia assessment ward, the role normally held by a Consultant psychiatrist, and only require the Consultant for clinical supervision and covering my annual leave