Background
In New Zealand, Diabetes Nurse Specialists (DNS) are a major workforce group in the care of people with diabetes, but prescribing of medicines has resided in the domain of medical or nurse practitioners. In 2011 a new regulation was formed under the Medicines Act enabling appropriately qualified Registered Nurses (RN) practising as DNSs to prescribe a range of diabetes-related medicines (including insulin, oral agents, statins and anti-hypertensives) under the supervision of an authorised prescriber.

Methods
The NZSSD was contracted by Health Workforce NZ (HWNZ) to implement a six month project to demonstrate that supervised prescribing by suitably qualified DNSs was safe, effective, provided service efficiencies and improved access for patients. Following enactment of the regulation, the Nursing Council of New Zealand authorised 12 experienced DNSs with postgraduate qualifications in patho-physiology, assessment and pharmacology to prescribe from four NZSSD selected demonstration sites. Supervision occurred through regular case review. Extensive clinical data was collected for all contacts with data analysed and reported by an external evaluator.

Results
Over six months, the 12 DNSs made 3396 prescribing decisions for 1274 adults with diabetes who had between one to five co-morbidities. Seventy percent of prescribing decisions were for insulin or oral agents with lipid lowering and antihypertensive therapy prescribing increasing as DNSs’ confidence grew. Project data demonstrated that prescribing by DNSs was safe and effective. Clinical measures remained stable or improved. No adverse advents were reported. Positive outcomes were noted with respect to patient access, patient satisfaction, cost efficiency, team functioning, GP satisfaction and role satisfaction for DNSs. Service efficiency gains were unable to be identified within this short time frame.

Conclusions
Prescribing under supervision by suitably qualified and experienced DNSs was demonstrated to be safe, effective and improved patient access. HWNZ plan for DNS prescribing to be rolled out throughout New Zealand.