This article will discuss the implications of nurse prescribing in mainstream primary health care and its impact on the fields of mental health and learning disabilities. Complexities and issues which require serious consideration by those nurses wishing to pursue such a specialist and extended role will be discussed in relation to these practice areas. Titchen's (1998) critical companionship model will be illustrated as an example of one framework for clinical supervision. This is to allow the processes, competencies and contextual issues to be explored by both novice and expert prescribers. The article concludes that for safe, effective and competency-based practice, clinical supervision also assists in mediating the professional and political aspirations in support of supplementary nurse prescribing.

A mental health nurse practises the skill and craft of their role in a variety of different settings to reflect the varied range of services provided in today’s mental health services. Whatever the setting or nature of the mental health problem, a set of adaptable mental health nursing skills will be required to enable the nurse to facilitate the safe and effective care of the service user. This care is expected to be individually tailored to the needs of the service user, developed (with only occasional exceptions) collaboratively with the service user, and evaluated with the service user and key partners in care. The principles of the nurse’s practice have to be underpinned and informed by the policies and guidelines that shape contemporary and future services. In the UK, nurses must respond to the essential capabilities (Department of Health 2006a) and the Chief Nursing Officer’s review of mental health nursing (Department of Health 2006b) in order to deliver a service that reflects the reform and quality improvements expected in modern mental health services. Practical skills have to be backed up by a strong knowledge base, with nurses knowing why they do what they do and being able to explain their actions whenever called upon to do so. Where possible and available, what mental health nurses do needs to be done on the basis of the most up-to-date evidence or guidance, which comes in many forms (Sainsbury Centre for Mental Health 2004, National Institute for Clinical Health and Excellence 2004a, Nursing and Midwifery Council 2008a and 2008b). As not all the scenarios that nurses encounter have a textbook answer, it is important that other complementary skills are developed to help them make decisions and deal with scenarios for which there is no clear and obvious answer available. These skills include: • Reasoning using principles and frameworks to weigh up a situation, e.g. ‘To adhere to the NMC Code of Conduct, what do I need to be aware of in this case?’ • Reflecting in or on practice (Schön 1987, Rolfe and Freshwater 2001, Johns 2004) to get a deeper understanding of situations and your own reactions and judgements, especially those values and attitudes you hold that may cause conflict with service users and significant others.