Extending the prescribing framework to nurses: Lessons from the past

Understanding pharmaceutical care and nurse prescribing in Spain: A grounded theory approach through healthcare professionals' views and expectations

BACKGROUND

Pharmaceutical care has been implemented and regulated differently across Europe with no consensus among countries in relation with professional competencies and especially on nurse prescribing. Demophac Project funded by the European Commission aims to develop a Pan-European Pharmaceutical Care Model with collaboration of 14 partner teams across Europe including Spain where nurse prescribing is starting its implementation at regional level. The aim of the study was to increase understanding of the role of nurses in Pharmaceutical care in Spain after the Nurse Prescribing Regulation approved in 2018 throughout exploring the views and expectations of health professionals involved in the representative settings.

METHODS AND FINDINGS

In depth interviews were conducted in a structure previously agreed by the European Demophac partnership around four topics associated with the Nursing ideal role in pharmaceutical care and the ideal interaction with other healthcare professionals. A grounded-theory approach based on Corbin & Strauss was conducted to interpret collected data from the Spanish most representative settings (primary care, specialized care and residential care for older population). Participants were health professionals involved in pharmaceutical care that accepted to participate (nurses (n = 7), physicians (n = 8) and pharmacists (n = 9)). A pharmaceutical care comprehensive model for the Spanish context considering the recently approved Nurse Prescribing role and the interprofessional collaboration and communication was developed towards facilitating the understanding in such context and the contribution to the unified European Demophac Framework.

CONCLUSIONS

Nurses are primarily responsible for population's Pharmaceutical Care while other professionals pivot on them to provide quality healthcare on a multidisciplinary level. Nurse prescribing may contribute efficiently to the Spanish Health System though more consensus in terms of nurses' training nationwide and enhancement in communication among different professionals within healthcare organizations is required to achieve adequate integrated care into practice.

Perceptions of underlying practice hierarchies: Who is managing my care?

BACKGROUND

The introduction of new health professional roles, such as that of the nurse practitioner and pharmacist prescriber in primary health care can lead to changes in health service delivery. Consumers, having used these roles, often report high satisfaction. However, there is limited knowledge of how these individuals position nurse practitioner and pharmacist prescriber roles within existing practice structures.

METHODS

Semi-structured interviews were conducted with 21 individuals receiving services from these practitioners in New Zealand primary health care. Interviews were recorded and transcribed verbatim for thematic analysis.

RESULTS

Participant views reflect established practice hierarchies, placing advanced practitioners 'below' general practitioners. Participants are unable to articulate what it was about these practitioners that meant they operated at lower tiers and often considered practitioners to act as 'their doctor'. They also highlight structural barriers impairing the ability of these providers to operate within their full scope of practice.

CONCLUSIONS

While seeing value in the services they receive, consumers are often unable to position nurse practitioner and pharmacist prescriber roles within health system contexts or to articulate how they value their practitioner's skills. Embedded structural barriers may be more visible to consumers than their interactions with the health system suggest. This may influence peoples' ability to receive intended or optimal health services. Consumer 'health professional literacy' around the functions of distinct health practitioners should be supported so that they may make informed service provision choices.

Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

RN Prescribing: An Expanded Role for Nursing

PURPOSE

With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States.

METHODS

We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing.

FINDINGS

Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined.

CONCLUSION

Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education.

The Oncology Nurse Prescribing: A Catalonian Survey

OBJECTIVE

This study identifies the capability, knowledge, and satisfaction of oncology nurses in Spain after approval of the nurse prescribing law in 2006.

METHODS

A descriptive cross-sectional study was conducted among 140 nurses in three cancer centers in Catalonia, Spain, by using convenience sampling method. The principal variables of this study were nurse satisfaction, knowledge about what products nurses are allowed to prescribe, the nurses' perception of their own prescribing ability, and their opinion on education and training needs with regard to the new approved law. The secondary variables included years of professional experience, place of work, and sociodemographic variables. Data were collected during a 3 months period by using a piloted 29-item self-assessment questionnaire.

RESULTS

Analyses of univariate and bivariate data showed that 82.2% of the nurses were aware of the approved law, but 94.2% indicated that they lack information about it. The mean satisfaction with the approval of the law was 6.64 ± 1.76 (numerical scale 0-10). In addition, 68.1% and 55.1% of the nurses were prepared to prescribe medical devices and drugs, respectively. To date, 61.1% of the nurses prescribe medical devices and 66% prescribe pharmacological products daily.

CONCLUSIONS

Nurses expressed general satisfaction with the approval of the Law 29/2006. Nurses currently provide prescriptions, but widespread knowledge of the allowed prescriptions is lacking.

Evaluation of a diabetes nurse specialist prescribing project

AIMS AND OBJECTIVES

To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing.

BACKGROUND

Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines.

DESIGN

The study was a process and outcome clinical programme evaluation.

METHODS

The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes (n = 117) and prescriptions (n = 227), and qualitative data from interviews with project participants (n = 18) and patients (n = 19). All data were analysed descriptively.

RESULTS

Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team.

CONCLUSIONS

These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended.

RELEVANCE TO CLINICAL PRACTICE

Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care. As novice prescribers, nurses need to be well prepared educationally and have access to supportive clinical supervision.