Improving Education: Promoting Practice-Based Prescribing Competencies for New Nurse Practitioners

The release of the Institute of Medicine's publication, To Err is Human: Building a Safer Health System revealed the amount of medical errors and threats to patient safety that occur within the U.S. healthcare system. Since its publication, many initiatives have been created in order to reduce medical errors and promote patient safety. As such, much importance has been placed on the use of competency-based learning in healthcare education and practice because competencies outline the knowledge and skills necessary to deliver safe and ethical care. In the U.S., nurse practitioners' (NP) scope of practice allows the ability to prescribe medications. Prescribing is a complex process that needs to be done safely and competently in order to promote patient safety and optimize healthcare delivery. NPs first obtain their prescribing competency in their formal education. Several studies have shown that new prescribers report having low prescribing confidence and insufficient prescribing competency which may lead to medication errors, malpractice, and patient harm. Healthcare curricula are now moving from the method of "knowledge acquisition" to "knowledge demonstration" by instituting competency-based learning. A systematic literature review of various methods to improve prescribing competency suggests that competency-based learning is the most effective method. The American Association of Colleges of Nursing (AACN) released a white paper in 2015 urging that advanced practice registered nurses' (APRN) education should be competency-based and further mentions that no current nationally accepted method of defining, measuring, and assessing for practice-based prescribing competency exists. Therefore, the purpose of this project was to develop a practice-based prescribing competencies for new NPs. The first objective of this project was to develop and refine current core prescribing competencies for new NPs. The second objective was to create practice-based outcome statements that effectively demonstrate the developed core prescribing competencies for new NPs. The third objective was to create a checklist of observable actions which achieve the developed practice-based outcome statements and competencies in a clinical setting. Finally, the fourth objective was to disseminate project findings at a poster presentation at a local medical/surgical conference. Thirty-one prescribing competencies developed by the Oregon State Board of Nursing (OSBN) for APRN pharmacological management evaluation were placed into a survey and were emailed to NPs practicing in Utah. The survey asked the NPs to rate which prescribing competencies were most important for new NPs. The results of the survey were analyzed and a list of current practice-based prescribing competencies was created. A low survey response rate greatly limited the generalization of this project's findings. A clinical practicum checklist of observable actions was then created which addressed each competency and outcome statement in order to help facilitate the assessment of an NP's demonstration of the practice-based prescribing competencies. Competency-based learning is becoming widely used in healthcare education and promotes patient safety and quality of care. The final product of this project will help improve NP education and practice and thus have a positive impact on patient safety and improvement of quality of care.