Introduction
This reflective essay explores the ethical, legal, and professional issues surrounding an episode of prescribing as part of my studies in V300 Non-Medical Prescribing (NMP). As a student training to become a non-medical prescriber, I am tasked with understanding the complexities of prescribing within a framework that prioritises patient safety, adherence to legal standards, and alignment with professional guidelines. Reflecting on a specific prescribing scenario allows for critical evaluation of decision-making processes and the broader implications of such actions. This essay will focus on a hypothetical episode where I prescribed medication for a patient with hypertension, examining the ethical dilemmas of informed consent, the legal boundaries of prescribing authority, and the professional responsibilities tied to accountability and competence. Through this analysis, supported by relevant literature and guidelines, I aim to demonstrate an understanding of these interwoven issues and consider their application to safe and effective prescribing practice.
Ethical Issues: Informed Consent and Patient Autonomy
One of the foremost ethical considerations in the prescribing episode relates to informed consent and the principle of patient autonomy. During the consultation for hypertension management, I had to ensure that the patient fully understood the proposed treatment, including the benefits, risks, and potential side effects of the prescribed antihypertensive medication, such as an ACE inhibitor. Ethically, prescribers are obligated to provide clear, comprehensible information to enable patients to make informed decisions (Beauchamp and Childress, 2019). However, challenges arose when the patient expressed uncertainty about the long-term use of medication and preferred lifestyle interventions. This situation highlighted a potential conflict between beneficence—my duty to act in the patient’s best interest by managing their blood pressure—and respecting their autonomy if they refused treatment.
Reflecting on this, I recognised the importance of shared decision-making, ensuring that the patient’s values and preferences were central to the prescribing process. Indeed, the Nursing and Midwifery Council (NMC) emphasises that practitioners must respect patient choices even when they differ from clinical recommendations (NMC, 2018). Therefore, I spent additional time discussing non-pharmacological options, such as dietary changes and exercise, while explaining the risks of unmanaged hypertension. This experience underscored the ethical imperative to balance clinical judgement with patient empowerment, a principle I aim to embed in future practice.
Legal Issues: Scope of Practice and Prescribing Authority
Legally, non-medical prescribers operate within a tightly regulated framework that defines their scope of practice. In the UK, the Medicines Act 1968 and subsequent amendments, alongside the Human Medicines Regulations 2012, govern prescribing activities (Department of Health, 2012). Reflecting on my prescribing episode, I had to ensure that prescribing an ACE inhibitor fell within my designated formulary and aligned with my level of training as a V300 student under supervision. A key legal concern was confirming that I was acting within my competence and not exceeding the boundaries of my role, as overstepping could result in legal repercussions or patient harm.
Furthermore, documentation emerged as a critical legal issue. Accurate record-keeping of the consultation, rationale for prescribing, and patient consent is not only a professional expectation but also a legal requirement to protect against potential litigation (Royal Pharmaceutical Society, 2016). In this episode, I ensured detailed notes were made in the patient’s electronic health record, including the discussed alternatives and the agreed treatment plan. Reflecting on this, I became acutely aware of how legal frameworks serve as both a safeguard and a constraint in prescribing, reinforcing the need for meticulous adherence to protocols and guidelines in my developing practice.
Professional Issues: Accountability and Competence
From a professional standpoint, accountability and competence are central to non-medical prescribing. The Royal Pharmaceutical Society’s Competency Framework for all Prescribers outlines that prescribers must take responsibility for their decisions and maintain up-to-date knowledge to ensure safe practice (Royal Pharmaceutical Society, 2016). During the hypertension prescribing episode, I felt a significant weight of accountability, particularly as my decision directly impacted the patient’s health outcomes. Reflecting on this, I questioned whether I had adequately assessed all relevant factors, such as potential drug interactions with the patient’s existing medications or allergies, before finalising the prescription.
To address this, I consulted clinical guidelines from the National Institute for Health and Care Excellence (NICE) on hypertension management and sought advice from my supervisor, demonstrating a commitment to collaborative practice—a key professional expectation (NICE, 2019). This experience highlighted my current limitations in expertise and the importance of continuous professional development (CPD) to build confidence and competence. Moreover, it reinforced the NMC’s expectation that practitioners must recognise their accountability to patients, employers, and regulatory bodies, ensuring decisions are defensible and evidence-based (NMC, 2018). Going forward, I intend to integrate regular reflection and peer feedback into my practice to uphold these professional standards.
Interplay of Ethical, Legal, and Professional Issues
Reflecting holistically on this prescribing episode, it is evident that ethical, legal, and professional issues are deeply interconnected. For instance, the ethical duty to obtain informed consent is underpinned by legal requirements for documentation and professional accountability to justify clinical decisions. A failure in one area—such as inadequate patient communication—could cascade into breaches across all three domains, potentially leading to harm, legal action, or professional misconduct charges. This interplay was particularly apparent when I considered the patient’s initial reluctance to accept medication; addressing this required not only ethical sensitivity but also legal awareness of consent processes and professional diligence in documenting the interaction.
Additionally, this reflection revealed the complexity of prescribing as a balancing act between competing priorities. While ethical principles urge respect for autonomy, legal and professional frameworks demand that I advocate for treatments aligned with best evidence, even when patients are hesitant. Navigating this tension demanded careful communication and a problem-solving approach, drawing on resources such as clinical guidelines and supervisory support. This experience has thus deepened my appreciation for the multifaceted nature of prescribing and the need for a robust knowledge base to address such challenges effectively.
Conclusion
In conclusion, this reflective assignment has illuminated the intricate ethical, legal, and professional issues tied to a prescribing episode within the context of V300 Non-Medical Prescribing training. Ethically, the importance of informed consent and patient autonomy emerged as critical considerations, necessitating shared decision-making to align clinical goals with patient preferences. Legally, adherence to prescribing authority and meticulous documentation proved essential to ensure compliance with UK regulations. Professionally, accountability and competence underscored the need for continuous learning and evidence-based practice to safeguard patient outcomes. The interconnectedness of these domains highlights the complexity of prescribing, where a lapse in one area can impact the others. Moving forward, I aim to strengthen my practice by integrating reflective exercises, seeking mentorship, and engaging in CPD to address identified limitations. Ultimately, this reflection not only enhances my understanding of NMP responsibilities but also equips me to navigate future prescribing challenges with greater confidence and integrity.
References
- Beauchamp, T.L. and Childress, J.F. (2019) Principles of Biomedical Ethics. 8th ed. Oxford University Press.
- Department of Health. (2012) Human Medicines Regulations 2012. UK Government Legislation.
- National Institute for Health and Care Excellence (NICE). (2019) Hypertension in adults: diagnosis and management. NICE Guidelines.
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC.
- Royal Pharmaceutical Society. (2016) A Competency Framework for all Prescribers. Royal Pharmaceutical Society.
