The role of the registered nurse
Registered nurses have considerable expertise in administering and supervising medication, additionally they can provide advice and support to residents, care home staff and families. Nurses are educated in pharmacology and can explain the ways in which medication works, the side effects and the monitoring processes such as blood tests or physiological observations such as checking a pulse.
Administering medication is not a mechanistic task, the complexity of ensuring the correct person receives the correct dose at the correct time is key to safety and avoiding unwanted effects. Nurses professional autonomy, accountability and expertise allow them to make judgements when drugs should be omitted, titrated or changed in method of administration.
Many older people experience complex conditions and are prescribed multiple medications to treat and manage these conditions. Very often the interplay between the conditions and the medications can create complications and undesired side effects. Registered nurses have the knowledge and understanding of chronic conditions and will monitor and detect any presenting complications. Older people particularly may have reduced kidney and liver function and medications such as cardiac drugs can build up causing a slow pulse. A registered nurse can monitor this and consider omitting medication to prevent adverse effects. Omitting medication is not done lightly and liaison with the prescriber or GP practice will follow with the professional able to describe and defend the decision. Additionally, they may be able to request the required bloods for laboratory testing.
Titration is the management of medication within a pre-set range, examples of this include insulin and painkillers. Using the professional skill, knowledge and judgement a registered nurse can make changes to a person’s medication regime to ensure they receive the correct therapeutic effect whilst avoiding unwanted side effects such as low blood sugars in the case of insulin or drowsiness with analgesia.
Working in a care setting often allows nurses to develop relationships that cannot be established during short periods of acute care. A long-standing relationship with an individual allows nurses to notice the nuance of changes in wellbeing or physical function, notably a person’s ability to eat and drink. Many people receiving care have difficulties swallowing, nurses are trained to notice deterioration and to refer for expert support. Deterioration in swallowing ability may mean that a person’s medication regime may need to change for example changing to an injectable form of the drug if the individual is in danger of inhaling the medication.
Not only are nurses able to refer and progress any changes, they have a pivotal role in educating the person, their families and the wider workforce about medication, its planned effects, side effects and monitoring. Additionally, there is role in educating people to manage their own medication supporting them through a programme of self-administration to become independent in taking medication particularly if this is new or changed. An example of this might be a person starting to take a new drug through an inhaler.
It is important to be aware that registered nurses can prescribe medication once they have undertaken an approved programme of study, they are then registered as prescribers and this can provide considerable benefit to those in their care, providing informed access to medication in a timely way. A care home nurse who is a prescriber can significantly reduce the time and disruption in requesting assessment from professional outside the home and have the knowledge and skill to tailor the prescription to the needs of the individual.
For people receiving care, employers and colleagues, the registered nurse working to the full scope of their practice is a tremendous asset, providing high levels of safety and medicines management, enhancing a business and improving outcomes.
