Ruth Harris | King's College London (original) (raw)
Papers by Ruth Harris
Family Practice, 2004
Little is known about the frequency with which information from the Internet is presented by pati... more Little is known about the frequency with which information from the Internet is presented by patients within primary care consultations or the subsequent impact that it may have on those consultations. The aims of this study were to describe the frequency with which Internet information was presented within primary care consultations in one inner-city health authority and to describe the characteristics of the subsequent consultation from the perspective of the health professionals involved. A postal survey was used to estimate the frequency of Internet information presentation and eight in-depth interviews were used to obtain health professionals' perceptions of the consultations that followed. Presentation of information from the Internet was relatively infrequent within primary care at the time of the survey (November 2000 to March 2001), but frequencies of presentation were higher for GPs than for any other health professional group. Health professionals have stereotypical views of Internet users and fear for their own professional status in relation to the Internet-informed patient or client. Although presentation of information from the Internet to date remains relatively infrequent, health professionals appear to feel threatened by it and adopt strategies that minimize its impact on the subsequent consultation.
Reviews in Clinical Gerontology, 2006
The involvement of service users as active participants is a stated aim of many current developme... more The involvement of service users as active participants is a stated aim of many current developments within health and social care, and self-assessment has been identified as a key mechanism. For over 15 years, the UK Department of Health has referred to the importance of the service user's views in assessment, 1, 2 and this has been re-emphasized recently in guidance issued to both local authorities social services and the NHS. 3 The concept of the expert patient and the promotion of self-care amongst people with long- ...
International journal of nursing studies, 2005
In order to determine whether post-acute intermediate care in nursing-led inpatient units (NLUs) ... more In order to determine whether post-acute intermediate care in nursing-led inpatient units (NLUs) is effective in preparing patients for discharge from hospital we conducted a systematic review of the evidence. The Cochrane Library, Effective Practice and Organisation of Care specialist register, Medline, Cinahl, Embase, British Nursing Index and the HMIC databases were searched for all available dates up to mid-2003. The science and social science citation indices were searched for papers that cited key works. Authors of papers were asked to identify additional research. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time-series designs that compared the NLU to usual post-acute inpatient care for adults were included in the review. Studies were assessed for quality. Statistical meta-analysis on the results of controlled trials was performed. Sensitivity analyses were conducted to determine the impact of methodological qu...
International journal of nursing studies, 2010
With the changing demographic profile of the nursing workforce, retaining the skill and experienc... more With the changing demographic profile of the nursing workforce, retaining the skill and experience of nurses in mid-life is very important. Work-life balance is a concept that is gaining increasing prominence in today's society. However, little is known about older nurses' experience of family friendly policies and flexible working. This study explored the organisational, professional and personal factors that influence perceptions of commitment and participation in the workforce for nurses working in mid-life (aged 45 and over). A qualitative study using a range of methods including biographical methods, semi-structured face-to-face interviews, focus groups and telephone interviews. Data were analysed using constant comparative method. A large inner city acute teaching hospital and an inner city mental health and social care trust providing both community and inpatient health and social care. 34 nurses and 3 health care assistants participated in individual interviews, 10 n...
Nursing standard (Royal College of Nursing (Great Britain) : 1987)
Intensive and Critical Care Nursing, 2015
to evaluate accuracy, sensitivity, specificity and inter-rater agreement of AVPU (Alert, Voice, P... more to evaluate accuracy, sensitivity, specificity and inter-rater agreement of AVPU (Alert, Voice, Pain, Unresponsive) when used by non-specialist nursing staff assessing consciousness, and to investigate users' views. Video-recorded simulations of assessments of consciousness were developed and verified by an expert panel. Participants scored simulations using AVPU and completed questionnaires eliciting views on the scale. AVPU scores were compared with functional levels agreed by the panel. A large urban teaching hospital. Fifty-one participants scored 255 simulations. Overall accuracy was 82.4% (95% CI=77.7-87.1%), sensitivity 0.94 (95% CI=0.90-0.98), specificity 0.74 (95% CI=0.66-0.82) and inter-rater agreement (un-weighted kappa) 0.782. Accuracy was low for simulations depicting an orientated patient whose eyes open to speech (49% correct) and a confused patient with spontaneous eye opening (61.5% correct). Sensitivity and agreement for levels corresponding to "Alert" and "Voice" were 0.81 (95% CI=0.69-0.93) and kappa=0.506. Participants expressed uncertainty about aspects of AVPU's use. AVPU had low rates of accuracy, sensitivity and agreement in distinguishing between "Alert" and "Voice", and low specificity overall, suggesting it may be unsuitable for early warning scoring. Participants expressed doubts about the use of AVPU.
Nurse Researcher, 2013
The aim of this paper is to inform and advise researchers on the practical issues associated with... more The aim of this paper is to inform and advise researchers on the practical issues associated with involving stroke patients and their carers in research. The involvement of patients and carers in research is increasingly recognised as important, yet researchers are often unclear on how to do this in practice. This is particularly evident in the field of stroke care, where there is limited information available about how to involve stroke patients and their carers in research effectively, or about the difficulties associated with this. Experience of developing a patient and carer advisory group. This paper reflects on the process the authors undertook when developing a stroke patient and darer advisory group as part of a research study exploring the effect of interprofessional team working on the experiences and outcomes after stroke of patients and carers. This paper discusses the challenges and the benefits of deveong a stroke patient and carer and advisory group, and offers advice to other researchers undertaking a similar process. It aims to provide some practical suggestions that may aid researchers wishing to involve stroke patients and carers in their research. Stroke patients are likely to be older and have long-term physical disabilities or communication problems that may make their involvement in research more challenging to implement. However, with planning and consideration and the allocation of sufficient time and resources, stroke patients and their carers can be effectively involved, resulting in benefits to the research process and output, and to researchers, patients and carers. Pay attention to planning and the practical details of involving stroke patients and their carers in research, ensuring that meetings are arranged in an accessible venue. Use straightforward language in all forms of communication. Listen carefully to their views and perspectives and be prepared to make changes to the study and revise methods if appropriate.
Journal of Nursing Management, 2005
The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital w... more The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit. Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs. The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure. Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was 1044 pounds sterling per point improvement of the Barthel Index. The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.
Journal of Advanced Nursing, 2007
This paper is a report of a study to establish which timings and assumptions of the Northwick Par... more This paper is a report of a study to establish which timings and assumptions of the Northwick Park Dependency Scale and Care Needs Assessment are appropriate to the inpatient rehabilitation setting and which, if any, require adjustment. Cost-effective provision of nursing care relies on being able to adjust staffing levels in accordance with patient dependency. The Northwick Park Dependency Scale and Care Needs Assessment enables direct assessment of nursing care needs in community settings. An observational study was conducted in 2004 to record the time taken to complete direct nursing care interventions in a rehabilitation ward and to compare these times with simultaneously recorded time-estimates provided by the Care Needs Assessment. A total of 1168 nursing interactions were timed for 50 care episodes. There was considerable variation in the time taken for each nursing intervention, depending on overall patient dependency and the number of nurses required. Although there was good correlation between observed care times and those estimated by the Care Needs Assessment, observation confirmed that most interventions took substantially less time than the estimates. There was also a very different pattern of care in hospital compared with the community, with shorter, more frequent interactions as nurses distribute their time between different patients, and activities other than direct patient care. The Northwick Park Care Needs Assessment tool already has widespread application in other countries and its continued use for estimating community care needs remains relevant. The tool, once fully developed, will have the potential to contribute to international rehabilitation nursing workforce planning and research.
Journal of Advanced Nursing, 2008
The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in o... more The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. Two reviewers independently extracted data and assessed study quality. Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality ( OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher qaulity studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
Journal of Advanced Nursing, 2001
Journal of Advanced Nursing, 2013
Abstract Background: A growing number of countries legislate for nurses to have medication prescr... more Abstract
Background: A growing number of countries legislate for nurses to have medication prescribing authority
although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional
qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The
policy intention for primary care was to improve efficiency in service delivery through flexibility between medical
and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing
activities, over time, in English primary care settings.
Methods: A secondary data analysis of a national primary care prescription database 2006-2010 and National Health
Service workforce database 2010 was undertaken.
Results: The numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in
2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and
authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items
prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the
category of penicillins, followed by dressings. However, the category where independent nurse prescribers
contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%).
In contrast, community practitioner nurse prescribers’ greatest volume and contribution was in the category of gel
and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly
higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per
capita, but the correlations were weak and warrant further investigation.
Conclusions: The percentage of prescriptions written by nurses in primary care in England is very small in
comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative
advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health
promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the
prescribing role between nurses and general practitioners.
Family Practice, 2004
Little is known about the frequency with which information from the Internet is presented by pati... more Little is known about the frequency with which information from the Internet is presented by patients within primary care consultations or the subsequent impact that it may have on those consultations. The aims of this study were to describe the frequency with which Internet information was presented within primary care consultations in one inner-city health authority and to describe the characteristics of the subsequent consultation from the perspective of the health professionals involved. A postal survey was used to estimate the frequency of Internet information presentation and eight in-depth interviews were used to obtain health professionals' perceptions of the consultations that followed. Presentation of information from the Internet was relatively infrequent within primary care at the time of the survey (November 2000 to March 2001), but frequencies of presentation were higher for GPs than for any other health professional group. Health professionals have stereotypical views of Internet users and fear for their own professional status in relation to the Internet-informed patient or client. Although presentation of information from the Internet to date remains relatively infrequent, health professionals appear to feel threatened by it and adopt strategies that minimize its impact on the subsequent consultation.
Reviews in Clinical Gerontology, 2006
The involvement of service users as active participants is a stated aim of many current developme... more The involvement of service users as active participants is a stated aim of many current developments within health and social care, and self-assessment has been identified as a key mechanism. For over 15 years, the UK Department of Health has referred to the importance of the service user's views in assessment, 1, 2 and this has been re-emphasized recently in guidance issued to both local authorities social services and the NHS. 3 The concept of the expert patient and the promotion of self-care amongst people with long- ...
International journal of nursing studies, 2005
In order to determine whether post-acute intermediate care in nursing-led inpatient units (NLUs) ... more In order to determine whether post-acute intermediate care in nursing-led inpatient units (NLUs) is effective in preparing patients for discharge from hospital we conducted a systematic review of the evidence. The Cochrane Library, Effective Practice and Organisation of Care specialist register, Medline, Cinahl, Embase, British Nursing Index and the HMIC databases were searched for all available dates up to mid-2003. The science and social science citation indices were searched for papers that cited key works. Authors of papers were asked to identify additional research. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time-series designs that compared the NLU to usual post-acute inpatient care for adults were included in the review. Studies were assessed for quality. Statistical meta-analysis on the results of controlled trials was performed. Sensitivity analyses were conducted to determine the impact of methodological qu...
International journal of nursing studies, 2010
With the changing demographic profile of the nursing workforce, retaining the skill and experienc... more With the changing demographic profile of the nursing workforce, retaining the skill and experience of nurses in mid-life is very important. Work-life balance is a concept that is gaining increasing prominence in today's society. However, little is known about older nurses' experience of family friendly policies and flexible working. This study explored the organisational, professional and personal factors that influence perceptions of commitment and participation in the workforce for nurses working in mid-life (aged 45 and over). A qualitative study using a range of methods including biographical methods, semi-structured face-to-face interviews, focus groups and telephone interviews. Data were analysed using constant comparative method. A large inner city acute teaching hospital and an inner city mental health and social care trust providing both community and inpatient health and social care. 34 nurses and 3 health care assistants participated in individual interviews, 10 n...
Nursing standard (Royal College of Nursing (Great Britain) : 1987)
Intensive and Critical Care Nursing, 2015
to evaluate accuracy, sensitivity, specificity and inter-rater agreement of AVPU (Alert, Voice, P... more to evaluate accuracy, sensitivity, specificity and inter-rater agreement of AVPU (Alert, Voice, Pain, Unresponsive) when used by non-specialist nursing staff assessing consciousness, and to investigate users' views. Video-recorded simulations of assessments of consciousness were developed and verified by an expert panel. Participants scored simulations using AVPU and completed questionnaires eliciting views on the scale. AVPU scores were compared with functional levels agreed by the panel. A large urban teaching hospital. Fifty-one participants scored 255 simulations. Overall accuracy was 82.4% (95% CI=77.7-87.1%), sensitivity 0.94 (95% CI=0.90-0.98), specificity 0.74 (95% CI=0.66-0.82) and inter-rater agreement (un-weighted kappa) 0.782. Accuracy was low for simulations depicting an orientated patient whose eyes open to speech (49% correct) and a confused patient with spontaneous eye opening (61.5% correct). Sensitivity and agreement for levels corresponding to "Alert" and "Voice" were 0.81 (95% CI=0.69-0.93) and kappa=0.506. Participants expressed uncertainty about aspects of AVPU's use. AVPU had low rates of accuracy, sensitivity and agreement in distinguishing between "Alert" and "Voice", and low specificity overall, suggesting it may be unsuitable for early warning scoring. Participants expressed doubts about the use of AVPU.
Nurse Researcher, 2013
The aim of this paper is to inform and advise researchers on the practical issues associated with... more The aim of this paper is to inform and advise researchers on the practical issues associated with involving stroke patients and their carers in research. The involvement of patients and carers in research is increasingly recognised as important, yet researchers are often unclear on how to do this in practice. This is particularly evident in the field of stroke care, where there is limited information available about how to involve stroke patients and their carers in research effectively, or about the difficulties associated with this. Experience of developing a patient and carer advisory group. This paper reflects on the process the authors undertook when developing a stroke patient and darer advisory group as part of a research study exploring the effect of interprofessional team working on the experiences and outcomes after stroke of patients and carers. This paper discusses the challenges and the benefits of deveong a stroke patient and carer and advisory group, and offers advice to other researchers undertaking a similar process. It aims to provide some practical suggestions that may aid researchers wishing to involve stroke patients and carers in their research. Stroke patients are likely to be older and have long-term physical disabilities or communication problems that may make their involvement in research more challenging to implement. However, with planning and consideration and the allocation of sufficient time and resources, stroke patients and their carers can be effectively involved, resulting in benefits to the research process and output, and to researchers, patients and carers. Pay attention to planning and the practical details of involving stroke patients and their carers in research, ensuring that meetings are arranged in an accessible venue. Use straightforward language in all forms of communication. Listen carefully to their views and perspectives and be prepared to make changes to the study and revise methods if appropriate.
Journal of Nursing Management, 2005
The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital w... more The nursing-led inpatient unit is designed to substitute for a period of care in acute hospital wards and to improve patient outcome prior to discharge to the community. This paper aims to evaluate the cost, from the UK National Health Service perspective, of transfer to a nursing-led inpatient unit for intermediate care and to discuss the impact of these findings to the future development and sustainability of the nursing-led inpatient unit. Recent economic analyses have showed that nursing-led inpatient units are associated with increased costs of care with length of stay as the main driver of inpatient costs. The cost-effectiveness analysis was part of a randomized-controlled trial with a sample size of 175, of which 89 were in the nursing-led inpatient unit arm and 86 in the control arm. Resource use data included length of stay, investigations performed, multiprofessional input and nursing input. Clinical outcome was measured using Barthel Index, a functional status measure. Cost per day was lower on the nursing-led inpatient unit although cost per hospital stay was higher due to significantly increased length of stay. Postdischarge community care costs were lower. The incremental cost-effectiveness ratio of the treatment was 1044 pounds sterling per point improvement of the Barthel Index. The nursing-led inpatient unit was associated with higher costs however, the question of whether the nursing-led inpatient unit is cost-effective has not been clearly answered because of the limited follow-up period of the study. The increased cost of care on the nursing-led inpatient unit was not a major factor in local management decisions about the future of the unit. The changes in the context of service provision within which the nursing-led inpatient unit operated as a result of substantial investment in intermediate care did have a major impact.
Journal of Advanced Nursing, 2007
This paper is a report of a study to establish which timings and assumptions of the Northwick Par... more This paper is a report of a study to establish which timings and assumptions of the Northwick Park Dependency Scale and Care Needs Assessment are appropriate to the inpatient rehabilitation setting and which, if any, require adjustment. Cost-effective provision of nursing care relies on being able to adjust staffing levels in accordance with patient dependency. The Northwick Park Dependency Scale and Care Needs Assessment enables direct assessment of nursing care needs in community settings. An observational study was conducted in 2004 to record the time taken to complete direct nursing care interventions in a rehabilitation ward and to compare these times with simultaneously recorded time-estimates provided by the Care Needs Assessment. A total of 1168 nursing interactions were timed for 50 care episodes. There was considerable variation in the time taken for each nursing intervention, depending on overall patient dependency and the number of nurses required. Although there was good correlation between observed care times and those estimated by the Care Needs Assessment, observation confirmed that most interventions took substantially less time than the estimates. There was also a very different pattern of care in hospital compared with the community, with shorter, more frequent interactions as nurses distribute their time between different patients, and activities other than direct patient care. The Northwick Park Care Needs Assessment tool already has widespread application in other countries and its continued use for estimating community care needs remains relevant. The tool, once fully developed, will have the potential to contribute to international rehabilitation nursing workforce planning and research.
Journal of Advanced Nursing, 2008
The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in o... more The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. Two reviewers independently extracted data and assessed study quality. Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality ( OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher qaulity studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
Journal of Advanced Nursing, 2001
Journal of Advanced Nursing, 2013
Abstract Background: A growing number of countries legislate for nurses to have medication prescr... more Abstract
Background: A growing number of countries legislate for nurses to have medication prescribing authority
although it is a contested issue. The UK is one of these countries, giving authority to nurses with additional
qualifications since 1992 and incrementally widened the scope of nurse prescribing, most recently in 2006. The
policy intention for primary care was to improve efficiency in service delivery through flexibility between medical
and nursing roles. The extent to which this has occurred is uncertain. This study investigated nurses prescribing
activities, over time, in English primary care settings.
Methods: A secondary data analysis of a national primary care prescription database 2006-2010 and National Health
Service workforce database 2010 was undertaken.
Results: The numbers of nurses issuing more than one prescription annually in primary care rose from 13,391 in
2006 to 15,841 in 2010. This represented forty three percent of those with prescribing qualifications and
authorisation from their employers. The number of items prescribed by nurses rose from 1.1% to 1.5% of total items
prescribed in primary care. The greatest volume of items prescribed by independent nurse prescribers was in the
category of penicillins, followed by dressings. However, the category where independent nurse prescribers
contributed the largest proportion of all primary care prescriptions was emergency contraception (9.1%).
In contrast, community practitioner nurse prescribers’ greatest volume and contribution was in the category of gel
and colloid dressings (27%), medicated stockings (14.5%) and incontinence appliances (4.2%). There were slightly
higher rates of nurse prescribing in areas with higher levels of socio-economic deprivation and fewer physicians per
capita, but the correlations were weak and warrant further investigation.
Conclusions: The percentage of prescriptions written by nurses in primary care in England is very small in
comparison to physicians. Our findings suggest that nurse prescribing is used where it is seen to have relative
advantage by all stakeholders, in particular when it supports efficiency in nursing practice and also health
promotion activities by nurses in general practice. It is in these areas that there appears to be flexibility in the
prescribing role between nurses and general practitioners.