Nurse prescribing roles in acute care: an evaluative case study (original) (raw)

The effectiveness of nurse prescribing in acute care

2011

Aim. This paper is a report of an evaluation of the implementation of nurse prescribing in an acute care hospital in England. Background. At the time of the study, evaluation of nurse prescribing had taken place in community settings, but little was known about its impact and effectiveness in acute care. Although nurse prescribing has permitted doctor-nurse substitution in acute episodic care, some doctors have expressed concerns about patient safety in relation to nurse prescribing. Methods. A mixed methods single-case study was conducted in 2005-06, using purposive sampling. Semi-structured interviews were carried out with 18 hospital staff, non-participant observation of two nurses and two doctors undertaking 52 patient-prescriber consultations with 47 patients, and a questionnaire survey with 122 patients (response rate 61%: n = 74). Results. Nurse prescribing was found to benefit patients through service delivery improvement and using staff skills differently. Nurse prescribers and their colleagues were positive about role and service changes and their impact on patient care. No differences were found between the ways in which nurses and doctors performed prescribing roles, but there was a statistically significant difference between the medication-related information satisfaction ratings of patients who had seen a nurse prescriber, compared to those seen by a doctor. Conclusion. Nurses and doctors were found to provide equivalent care. Shared vision, local champions, action learning and peer support were the enabling factors that helped to embed the new prescribing roles within the study site.

Benefits and challenges of nurse prescribing

2004

Benefits and challenges of nurse prescribing Background. Since 1999, all health visitors and district nurses in the United Kingdom (UK) have received additional education to permit their registration as independent prescribers from a limited list of medicinal products. Little research has investigated how more than 20 000 health visitor and district nurse prescribers have implemented their new role since the evaluation of the pilot sites. Aims. The aims of the study were to describe prescribing practices of health visitors and district nurses, the factors (contextual and professional) which enable and facilitate nurse prescribing, and views about the Nurse Prescribers' Formulary. Method. A mail survey was conducted of all health visitors and district nurses working in three trusts in southern England. A 74% response rate was achieved (n ¼ 91). Findings. Most respondents prescribed less than three times a week, with district nurses prescribing significantly more than health visitors (P £ 0AE001). Over twothirds of the sample found nurse prescribing at least moderately helpful to their professional role and over four-fifths reported that they were more than moderately confident nurse prescribers. A range of information sources was identified as helpful, regarding both new products and for continuing educational needs. Over two-thirds reported that the current Nurse Prescribers' Formulary did not cover their prescribing needs, and a number of factors were identified as hindering prescribing. Most respondents said that their general practitioner/primary care team was at least moderately supportive of their prescribing role. Limitations. The survey was conducted in three primary care trusts in southern England, which may be unrepresentative of trusts elsewhere in UK.

Nurse prescribers: who are they and how do they perceive their role?

Journal of Advanced Nursing, 2005

Aims. This paper reports a study to elicit background data from recently qualified nurse prescribers and explore aspects of their work.Background. Nurse prescribing has been introduced quite recently in the United Kingdom. Although a certain amount of information is available about the characteristics of nurse prescribers, relatively little is known about their professional backgrounds, their reasons for choosing to become nurse prescribers and their perceptions of their emerging role. More information is needed to inform the selection, education and support of nurse prescribers.Method. All nurses who undertook a nurse prescribing course in one university in the West Midlands during 2003–2004 were invited to participate in the study. A 40-item questionnaire was used to gather data on demographics, expectations of nurse prescribing, personal and professional development and perceived education needs.Findings. Respondents considered that, despite initial problems, the nurse prescribing initiative would ultimately prove to be a cornerstone of improved service delivery for service users. The majority of nurses were already heavily involved in prescribing ‘by proxy’ and the course merely formalized what they were currently doing. Potentially, prescribing could advance the professional development of nurses, improve communication between professionals and patients, and make the experience of patients more beneficial. However, some concerns were expressed about how supportive the current climate in health care could be, given the multiple demands on time and energy required by so many other innovations.Conclusions. Respondents appeared balanced in their perceptions of this innovation and what it could realistically achieve. They were not indifferent to the many short and long-term problems that need to be resolved before it can be claimed to have become embedded in practice. The success of non-medical prescribing may depend on organizational support, coupled with a robust continuing professional development strategy for all nurse prescribers.

Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists

Journal of Nursing Management, 2008

Nurse prescribing as an aspect of future role expansion: the views of Irish clinical nurse specialists Aim Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. Background The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. Method A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. Results and conclusions Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. Implications for nursing management While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers new understandings on the views of senior clinicians concerning nurse prescribing at a time of ongoing professional policy iteration and practice change in the area.

Changes in nurses' views and practices concerning nurse prescribing between 2006 and 2012: results from two national surveys

Journal of Advanced Nursing, 2014

Aims: To assess changes in the prescribing practices and views about nurse prescribing of Registered Nurses in the Netherlands between 2006 and 2012. Background: Considering the developments that took place in the Netherlands between 2006 and 2012, such as increased opportunities for nurse prescribing education and stricter control of nurses' prescribing practices, this study examines the extent to which nurses' prescribing practices and views have changed in the intervening years. In both years, nurses were not legally allowed to prescribe. Design: Survey study. Methods: Surveys were conducted in 2006 and 2012. Questionnaires were sent to a national sample of nurses. The questionnaires addressed nurses' views on nurse prescribing and the extent to which nurse prescribing took place in the respondents' work setting. Results: There were 386 and 644 respondents to the 2006 and 2012 surveys respectively. The proportion of nurses who said that they felt adequately equipped to prescribe medicines remained constant around 12%. Insufficient knowledge to prescribe remained the most important reason for feelings of inadequacy. More than a quarter of the nurses in both surveys stated that nurses in their team sometimes write prescriptions. There were few changes in views on the consequences of nurse prescribing for nurses' practice. Conclusion: Overall, nurses' support for nurse prescribing remained stable at a fairly cautious level, while the number of nurses feeling inadequately equipped to prescribe remained high. As nurse prescribing is expected to improve the quality and continuity of care, this should be taken into account in policy expectations.

The experiences of being a registered nurse prescriber within an acute service setting

Journal of Clinical Nursing, 2017

A descriptive phenomenological design underpinned by Husserl's philosophy was used as the guiding framework. Methods: Data were collected using semistructured interviews and purposive sampling of 11 current registered nurse prescribers from two acute hospitals. Colaizzi's seven steps were employed to analyse the data and develop themes which reflected the participants' experiences of prescribing. Results: The study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing. The nurses interviewed were proud to be prescribers and perceived their prescribing practice as safe. This was a unique finding, not described by other research. Increased job satisfaction was also important to those interviewed as identified in previous studies pertaining to prescriptive authority. Ongoing challenges affecting prescribers included staff shortages, extra workload arising from prescribing and the need to educate colleagues about nurse prescribing. Those interviewed also suggested standardising both the prescribing course and local Drugs and Therapeutics Committees nationally, to overcome identified issues. Conclusions: Further research into the safety of nurse prescribing is recommended to ascertain if what was described locally applies nationally. A larger study into the experiences of nurse and midwife prescribers is also required, to promote and maintain this practice and to ensure future prescribers embrace this extended scope of practice. Relevance to clinical practice: Insight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.

Physicians’ attitudes towards the development of the nurse prescribing role in critical care and emergency departments

BMC Nursing, 2023

Background The progression of the nurse prescribing role encounters numerous challenges, with physician resistance being a significant obstacle. This study aims to assess physicians' perspectives regarding the expansion of the nurse prescribing role within critical care and emergency departments. Methods This cross-sectional study employed convenience sampling to enroll 193 physicians. Data collection instruments included a demographic information form and a researcher-developed questionnaire. Descriptive and inferential statistics were used to analyze the data using SPSS-22 software. Results A total of 193 physicians participated in the survey, with a mean age of 41.9 ± 10.7 years. Among physicians from various age groups, genders, educational backgrounds, and clinical experiences, more than 60% acknowledged prescribing medicine as an essential component of their professional responsibilities. However, a significant majority of physicians in these categories agreed that in emergency situations, nurses should be allowed to prescribe medication to save patients' lives. It is worth noting that, unlike specialist and fellowship physicians, a majority of general practitioners (83.3%) held the view that nurse-prescribed medications do not contribute to the professional development of nursing. The nurse prescribing role encountered several predominant obstacles, namely legal consequences (78.8%), interference of duties between physicians and nurses (74.1%), and a legal vacuum (77.2%). Conclusion The majority of physicians expressed a favorable attitude towards nurse prescribing in emergency and critical care departments. To facilitate the development of the nurse prescribing role, it is essential to ensure the acquisition of scientific qualifications and implement necessary changes in nursing curricula across bachelor's, master's, and doctoral programs.

Trends over time in prescribing by English primary care nurses: a secondary analysis of a national prescription database

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.

Nurses, physicians and patients’ knowledge and attitudes about nurse prescribing

BMC Nursing

Background One of the roles that nurses have acquired in recent years is the role of prescribing. This study aimed to investigate the knowledge and attitudes of critical care nurses, physicians and patients about nurse prescribing. Methods A descriptive cross-sectional study with the participation of 152 nurses, 53 physicians and 75 patients was carried out. Participants were selected by stratified random sampling from the critical care units of six hospitals in Tabriz, Iran. Demographics and participants’ knowledge and attitudes about nurse prescribing questionnaires were used to collect data. The collected data were analyzed using SPSS-22 software. Results The mean scores of total knowledge about nurse prescribing in nurses, patients and physicians’ were 15.41 ± 1.85,16.45 ± 2.31, 14.74 ± 1.7 respectively (from a range of 10 -20), and the mean score of knowledge by physicians was significantly higher than others (P = 0.000) and they had more knowledge about nurse prescribing. The ...