The role of the nurse in Europe is changing, rheumatology expert Hanneke Voorneveld-Nieuwenhuis told delegates at the DIA Biosimilars Conference in London last month. Voorneveld-Nieuwenhuis is a nurse practitioner in the outpatient clinic of the Maasstad Hospital in Rotterdam, the Netherlands.
“Traditionally, nurses have been trained in the ‘five checks’ of medication administration: the right medicine, the right dose, the right administration route, the right time, and the right patient,” Voorneveld-Niewenhuis explained.
However, what is generally lesser known is that specialised nurses are also involved in, and contribute to, hospital-based pharmaceutical management, she said. This can include compliance and adherence monitoring, clinical trials support, and data management, as well as the education and training of healthcare providers.
As a result, nurses play a crucial role in ‘switch management’ between biological medicines, Voorneveld-Nieuwenhuis told delegates: “While the physician is most commonly the authorised prescriber, nurses can take the lead in implementing the transition between branded and biosimilar biological medicines. This includes managing the process before, during, and after the switch.”
Depending on the country, nurses can also help to improve access to biosimilar medicines and actively support switching from originator biologics.
“For example, in the Netherlands, nurse practitioners can prescribe [medicines] within their own specialty,” she explained.
Communication and education
Facilitating communication between patients and physicians, especially when treatment regimens and medications are initiated or altered, is a major part of the nurse’s role, Voorneveld-Niewenhuis explained.
“[Nurses’] experience and their communications skills mean that they are ideally placed to explain to patients about the rationale and impact of changes to their treatment. This can be particularly important in the transition from the originator biological medicine to its biosimilar form,” she said.
However, the role is not without hurdles, and nurses are faced with challenges every time a new class of medicine, such as biosimilars, enters the market.
“Biosimilars are complex, and education regarding these products should be disseminated to health care practitioners, including nurses,” Voorneveld-Nieuwenhuis told delegates, citing the major risks of poor knowledge to include a lack of confidence in therapy, the ‘nocebo’ effect, non-adherence, and adverse effects.
In addition, improved education for nurses and patients alike can increase patient confidence, which “may prevent switching back to the original product,” she said. “[Patient confidence] will be critical for the successful incorporation of biosimilars.”