Nurse prescribing from the community nurse's perspective

Therapeutic radiographer prescribing practices in the United Kingdom: Questionnaire survey

INTRODUCTION

Non-medical professionals in the United Kingdom (UK) have been granted prescribing rights to improve patient care quality and cost-effectiveness. There is limited evidence on how therapeutic radiographer prescribers have impacted medicine management or patient services.

METHODS

An online survey was conducted amongst non-medical prescribing therapeutic radiographers in the UK between 2019 and 2022. The study teams initially analysed the individual data sets, subsequently combined, and secondary analysis was performed to provide a UK perspective, to understand the services provided and identify areas for improvement. Data was analysed using descriptive statistics from Microsoft Excel® and SPSS®.

RESULTS

74 non-medical prescribing therapeutic radiographers who were predominantly over 40 years old and in full-time work participated. The main job categories were consultant radiographers (n = 23, 31.1%) and advanced practice practitioners (n = 18, 24.3%). Many use their prescribing qualifications (87.5%, n = 62), issuing a mean of 15 independent and seven items by supplementary and prescribing per week. Most received assessment and diagnostic skills training before prescribing courses (91.6%, n = 67). Respondents prescribed from a median of six areas, with the highest being in GI (82%), skin (68%), infections (58%), urinary tract disorders (55%) and ear, nose, and oropharynx conditions (54%).

CONCLUSION

This study presents the first report on therapeutic radiographers prescribing in the UK, offering insights into current practices and highlighting the success of non-medical prescribing. Therapeutic radiographers' roles continue to expand into advanced practice and medicine-prescribing responsibilities, contributing to holistic and patient-centred care.

IMPLICATIONS FOR PRACTICE

The results are relevant for nations grappling with oncology workforce shortages and contemplating similar roles for therapeutic radiographers. The study can be a valuable resource for policymakers and healthcare organisations worldwide.

Rapid Evidence Review of Community Engagement and Resources in the UK during the COVID-19 Pandemic: How Can Community Assets Redress Health Inequities?

Community engagement, such as participating in arts, nature or leisurely activities, is positively associated with psychological and physiological wellbeing. Community-based engagement during the COVID-19 pandemic facilitated informal and local mutual aid between individuals. This rapid evidence review assesses the emergence of community-based arts, nature, music, theatre and other types of cultural engagement amongst UK communities in response to the COVID-19 pandemic. Here, we focus on all community engagement with a sub-focus on provisions accessed by and targeted towards vulnerable groups. Two hundred and fifty-six resources were included that had been created between February 2020 and January 2021. Resources were identified through Google Scholar, PubMed, Web of Science, MedRXic, PsycharXiv and searches for grey literature and items in the public domain. The majority reported services that had been adapted to become online, telephone-based or delivered at a distance from doorsteps. Several quality assessment frameworks were used to evaluate the quality of data. Whilst a number of peer-reviewed, grey literature and public domain articles were identified, less than half of the identified literature met quality thresholds. The pace of the response to the pandemic may have meant that robust evaluation procedures were not always in place.

Social prescribing: a 'natural' community-based solution

This paper discusses social prescribing as part of the wider NHS England universal personalised care model, and it describes how community nurses can engage with social prescribing systems to support community resilience. A case study based on the example of gardening, as a nature-based social prescription provided by the RHS Bridgewater Wellbeing Garden, is provided to illustrate the scope, reach and impact of non-medical, salutogenic approaches for community practitioners. The authors argue that social prescribing and, in particular, nature-based solutions, such as gardening, can be used as a non-medical asset-based approach by all health professionals working in the community as a way to promote health and wellbeing. They consider how the negative impact of social distancing resulting from COVID-19 restrictions could be diluted through collaboration between a holistic, social prescribing system and community staff. The paper presents a unique perspective on how community nurses can collaborate with link workers through social prescribing to help combat social isolation and anxiety and support resilience.

Nurse prescribing in primary care: a metasynthesis of the literature

Aim The aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting.

BACKGROUND

Nurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber's experience.

METHODS

An extensive literature search was undertaken in April 2015 (20-24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded. A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge. Findings From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.

What factors are driving increasing demand for community nursing?

Demand for district nursing services is increasing significantly. With increasing economic pressures, services are struggling to meet increases in demand, and are looking to become more proactive in planning for future demand. Traditional quantitative forecasting methods have limited use, because of the complexity of inter-linking factors that potentially drive demand for community services. Qualitative system dynamics approaches can be useful to model the complex interplay of causal factors leading to an effect, such as increased demand for services, and identify particular areas of concern for future focus. We ran a facilitated qualitative system dynamics workshop with representatives working across community nursing services in Cornwall. The generated models identified 7 key areas of concern that could be significantly contributing to demand for district nursing services. We outline the identified problem areas in this paper, and discuss potential recommendations to reduce their effects based on causal links identified in the models.

Evaluating prescribing competencies and standards used in nurse independent prescribers’ prescribing consultations

Background Independent prescribing of medicines by nurses is widely considered to be part of advanced nursing practice, and occurs within an episode of patient care that can be completed independently by a nurse. Nurse prescribers therefore require the competencies necessary to manage a consultation—such as history taking and diagnostic skills—and subsequently need to decide on any appropriate medicine to be prescribed. Safe prescribing should also involve an accurate, legible and comprehensive written prescription and documentation of the consultation in the patient’s records. However, the extent to which nurse independent prescribers use prescribing competencies and standards in practice had not been researched prior to this study.

Aim To describe the frequency with which nurses use a range of prescribing competencies in their prescribing consultations, in order to provide a measure of the quality and safety of nurses’ independent prescribing practices.

Design and methods Across 10 case study sites, 118 nurse independent prescribers’ prescribing consultations were analysed using non-participant observation and a structured checklist of prescribing competencies. Documentary analysis was also undertaken of a) prescriptions written ( n =132) by nurses and b) the record of the prescribing episode in patient records ( n =118).

Sample and setting 118 prescribing consultations of 14 purposively selected nurse independent prescribers working in primary and secondary care trust case study sites in England.

Findings Nurse independent prescribers were issuing a prescription every 2.82 consultations; nurses used a range of assessment and diagnosis competencies in prescribing consultations, but some were employed more consistently than others; nurses almost universally wrote full and accurate prescription scripts for their patients; nurses recorded each of their prescribing consultations, but some details of the consultation and the prescription issued were not always consistently recorded in the patient records.

Conclusion The findings from this observation study provide evidence about the quality and safety of nurses’ prescribing consultations in England.

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

BACKGROUND

Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA.

METHODS

NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011.

RESULTS

The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001).

CONCLUSION

NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This workforce is contributing to medicines management activities in a range of care settings. If non-medical prescibers are to maximise their contribution, robust governance and support from healthcare organisations is essential. The continued use of supplementary prescribing is questionable if maximum efficiency is sought. These are important points that need to be considered by those responsible for developing non-medical prescribing in the United Kingdom and other countries around the world.

Challenges to nurse prescribers of a no-antibiotic prescribing strategy for managing self-limiting respiratory tract infections

AIMS

To report a qualitative study of the experiences of nurse prescribers in managing patients with self-limiting respiratory tract infections.

BACKGROUND

Patients frequently attend primary care with respiratory tract infections. Although a no-prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non-clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations.

DESIGN

Semi-structured interviews and focus groups.

METHODS

Fifteen semi-structured interviews and three focus groups (n=5, n=4, and n=12) with a purposive sample of nurse prescribers (n=34) and other non-medical prescribers (n=2) were conducted between November 2009-November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups.

FINDINGS

Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision-making and welcomed the benefits of peer support in dealing with 'demanding' patients. However, the newness of nurses and other non-medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections.

CONCLUSION

Training for nurses and other non-medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care.

‘It's showed me the skills that he has’: pharmacists' and mentors' views on pharmacist supplementary prescribing

Objectives

Supplementary prescribing has seen pharmacists assume greater responsibility for prescribing in collaboration with doctors. This study explored the context and experiences, in relation to the practice of supplementary prescribing, of pharmacists and physicians (who acted as their training mentors) at least 12 months after pharmacists had qualified as supplementary prescribers.

Methods

The setting was primary and secondary healthcare sectors in Northern Ireland. Pharmacists and mentors who had participated in a pre-training study were invited to take part. All pharmacists (n= 47) were invited to participate in focus groups, while mentors (n= 35) were asked to participate in face-to-face semi-structured interviews. The research took place between May 2005 and September 2007. All discussions and interviews were audiotaped, transcribed and analysed using constant comparison.

Key findings

Nine pharmacist focus groups were convened (number per group ranging from three to six; total n= 40) and 31 semi-structured interviews with mentors were conducted. The six main themes that emerged were optimal practice setting, professional progression for prescribing pharmacists, outcomes for prescribing pharmacists, mentors and patients, relationships, barriers to implementation and the future of pharmacist prescribing. Where practised, pharmacist prescribing had been accepted, worked best for chronic disease management, was perceived to have reduced doctors' workload and improved continuity of care for patients. However, three-quarters of pharmacists qualified to practise as supplementary prescribers were not actively prescribing, largely due to logistical and organisational barriers rather than inter-professional tensions. Independent prescribing was seen as contentious by mentors, particularly because of the diagnostic element.

Conclusions

Supplementary prescribing has been successful where it has been implemented but a number of barriers remain which are preventing the wider acceptance of this practice innovation.

Benefits and challenges of prescribing training and implementation: perceptions and early experiences of RPSGB prescribers

Objective To investigate the challenges experienced by pharmacists in delivering supplementary prescribing (SP) services, to explore their perceptions of benefits of SP and to obtain feedback on both SP training and implementation.

Method A postal questionnaire focusing on prescribing training, early experiences of prescribing and general demographics was sent in September to November 2005 to all SP pharmacists (n = 488) in Great Britain after excluding a pilot sample (n = 30). The biggest benefits and challenges of SP, and reasons for not practising SP, were identified. Responses to a general open question were content analysed for major themes.

Key findings A total of 401 responses (82.2%) was received; 195 (48.6%) had started practising SP of which 154 (79%) had written at least one prescription. This paper focuses primarily on perceived benefits and challenges to the implementation of SP, and the responses to the open question. Better patient management (n = 58; 29.7%) was identified as the main benefit of SP and inadequate funding (n = 27; 13.8%) as the biggest challenge in delivering SP service. The main reasons for not commencing SP were: no organisational recognition of SP (n = 37; 18%); lack of funding (n = 33; 16%); non-availability of prescription pads (n = 22; 10.7%), and change of jobs (n = 18; 8.7%). The comments to the open question (n = 145; 36.2%) were regarding: SP training; perceived benefits of SP; and barriers to SP. Respondents highlighted the need for greater emphasis on clinical skills development as part of the SP course.

Conclusion Despite optimism among SP pharmacists, the need for support in terms of infrastructure and integration into the healthcare team has been identified. Our findings also inform the need for modifications in the structure, content and delivery of the prescribing course for pharmacists. Greater publicity of pharmacists' roles in medication management, support from the medical profession and healthcare organisations, and high standards by early practitioners are warranted for the success of SP by pharmacists.

How do district nurses choose which products to prescribe?

The aim of this study was to explore the influences on product selection by district nurses when they start to prescribe a product for the first time. Representatives from the pharmaceutical industry had the biggest impact on the prescribing of new products followed by the nurses' colleagues with specialists being viewed more positively than non-specialists. The primary care trust and patients appeared to have little impact on product selection. The challenge for primary and secondary care trusts is to promote safe cost-effective, evidence-based prescribing and to maximize consistency across the primary - secondary care interface. NHS organizations wishing to influence prescribing must convince prescribers that they are interested in more than just reducing costs and they could do well to take a lead from the pharmaceutical industry when they try to get their messages across to prescribers.

Nurse prescribing, policy, practice and evidence base

There are now over 30,000 nurses across the UK who are qualified to prescribe from the Nurse Prescribing Formulary (NPF) for community practitioners. Training to prescribe from this formulary is now available to community staff nurses. Increasing numbers of community nurses are extending their prescribing skills by adopting independent and supplementary prescribing. Over 14,000 nurses across the UK are qualified to prescribe using these modes of prescribing. The benefits of nurse prescribing exceed those anticipated by the Government. However, there is some misunderstanding by doctors about the prescribing role. Doctors have concerns about nurses encroaching on medical territory, nurses' clinical skill base, and the possibility that nurses will prescribe outside of their area of competence. If doctors have an established relationship with a nurse prior to the adoption of prescribing, and have experienced some of the tangible benefits of this role, this helps to readdress these concerns. The increasing numbers of community nurses adopting and extending their role in the prescription of medicines is an indication that healthcare reforms, shifting care into the community, means that nurses are frequently the first point of contact from whom patients access their medicines. If the benefits of nurse prescribing are to be maximized and nurses are to feel supported in this role, there is a need to educate doctors about the professional limitations of nurse prescribing.

Why do district nurse prescribers alter their prescribing patterns?

This paper describes how district nurses decide what products to start prescribing and explores the reasons why prescribing patterns change. It is based on semi-structured interviews with fourteen nurses from one primary care trust. The first products prescribed immediately following qualification depended on the route taken to becoming a prescriber. These were either the same products they had been using before qualifying as a prescriber or if prescribing was included with their district nurse training then it was the same products that their mentor prescribed. The two drivers for changes in prescribing patterns were patients, whose current therapy was ineffective, and products, where patients were selected to try new products on. Representatives from the pharmaceutical industry and fellow nurses had the greatest influence on product selection for those prescribers that changed their prescribing. The nurse's own experience had the greatest impact on the decision to continue prescribing a new product.

The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain

AIM

This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain.

BACKGROUND

Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses.

METHOD

A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain.

FINDINGS

Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning.

CONCLUSION

Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing.

Exploring the views of nurse prescribing among Macmillan nurses

Nurse prescribing is a key government initiative which aims to enhance patient care. The aim of this study was to investigate the prescribing practice of specialist nurses working in cancer and palliative care and to explore the benefits of and barriers to uptake of nurse prescribing training. A national postal survey of 2252 Macmillan nurses was undertaken using a structured questionnaire with open-ended questions. Data were analyzed using thematic content analysis for 1575 respondents (70% response rate). Only 13% (203) had undergone prescribing training and of these 105 provided responses to the open questions concerning training and of the 87% (1372) who had not undergone the training, 423 provided details on barriers to nurse prescribing training. The data presented in this paper draw from this data. The findings indicate that those who prescribed gave the prospect of improving care as the main reason for undertaking nurse prescribing training. The main reasons why these specialist nurses did not undertake training were: resource issues particularly with respect to backfill while training, lack of medical support and mentorship, concerns about the relevance of prescribing as a nursing role and prioritizing other courses. If nurse prescribing is to be more widely available for cancer and palliative care patients it is important in both primary and secondary care to address the resource and support issues.

Supplementary nurse prescribing for patients with skin conditions: a national questionnaire survey

AIM

To examine the prescribing practices of supplementary nurse prescribers (working in both primary and secondary care) who prescribe medicines for patients with skin conditions and the factors that facilitate or inhibit this mode of prescribing.

BACKGROUND

Nurses work in a variety of roles, with varying levels of expertise, are involved in the treatment management of a broad range of skin diseases. Skin conditions are those for which independent nurse prescribers prescribe most frequently. The role of the nurse, limitations of the formulary and inter-professional relationships influence the prescribing practices of these nurses. There is no evidence currently available examining the impact and activity of supplementary nurse prescribing for patients with skin conditions.

METHODS

A convenient sample of 580 nurses who prescribed for skin conditions and were qualified supplementary nurse prescriber, self-completed a written questionnaire.

RESULTS

Five hundred and twenty (89.7%) nurses were based in primary care and worked in general practice. Four hundred and thirty-six (75%) held a degree level qualification or higher, 41 (7%) had specialist dermatology training and 512 (88.3%) had more than 10 years postregistration nursing experience. Supplementary prescribing was used by a minority of nurses. Nurses who had specialist dermatology training used this mode of prescribing most frequently. Doctor and pharmacists lack of understanding of supplementary prescribing, lack of peer support and clinical management plans prevented the implementation of this mode of prescribing.

CONCLUSIONS

Supplementary prescribing is used by a minority of nurses to treat skin conditions. A number of factors prevent nurses from using this mode of prescribing including lack of specialist training and lack of support in practice.

RELEVANCE TO CLINICAL PRACTICE

Specialist dermatology training, an understanding of supplementary prescribing by the members of the healthcare team, and support in practice are required if supplementary prescribing is to be implemented effectively for the treatment of skin conditions.

Prescribing by specialist nurses in cancer and palliative care: results of a national survey

BACKGROUND

This study investigates Macmillan nurses' views on nurse prescribing in cancer and palliative care and explores perceived motivators and barriers to training for and the implementation of this extended nursing role.

METHOD

National postal survey of 2252 Macmillan nurses in the UK.

RESULTS

A response rate of 70% (1575) was achieved. Eleven percent (168 of 1575) of Macmillan nurses surveyed were trained as extended formulary independent nurse prescribers. Half (88 of 168) of the Macmillan nurses who could prescribe from the extended formulary were prescribing, representing just 6% (88 of 1575) of the sample. Training deficits highlighted included poor organization and insufficient length, depth and specificity of courses (to meet the needs of nurses working in palliative care) and a lack of medical mentorship. Among Macmillan nurses who had not undergone extended formulary independent nurse prescribing training, 25% (335) perceived that prescribing was not part of their specialist nursing role. A further 40% (538) expressed reluctance to undergo training.

CONCLUSIONS

A clear lack of enthusiasm amongst specialist nurses in cancer and palliative care to undertake prescribing training was identified. It is noteworthy that half of the Macmillan nurses trained as extended formulary independent nurse prescribers were not prescribing. Since government targets for nurse prescribing are not yet being met, these findings raise important questions concerning whether extended nurse prescribing is likely to be a successful initiative in cancer and palliative care.

Pharmacists’ changing views of their supplementary prescribing authority

OBJECTIVE

To investigate the views and experiences of pharmacists in England before and after they registered as supplementary prescribers.

METHOD

Eight pharmacists were recruited from training courses; seven from secondary care and one from primary care and interviewed during training and again after registration. In the first interviews, topics included previous experience, views on current roles, responsibilities and accountability for prescribing and how these might change. In the second interviews, the pharmacists discussed how these had actually changed after gaining supplementary prescribing authority, how their role worked in practice and how they saw it developing in the future.

MAIN OUTCOME MEASURE

Descriptions of anticipated and actual changes in their roles, responsibilities and accountability before and after registration as supplementary prescribers

RESULTS

The pharmacists anticipated that training would legitimise their current 'informal' prescribing practices, with increased legal responsibility and accountability, but experienced many procedural delays in implementing their new role. Pharmacists who were already heavily involved with prescribing were more likely to work as prescribers, but not necessarily within the clinical management plan framework. The desire to maintain the efficiency of their existing clinical services impacted negatively on the pharmacists' ability or willingness to prescribe in this legally approved manner.

CONCLUSION

Clear and realistic expectations need to be set by the pharmacists as to what is achievable and greater attention needs to be paid to minimising delays between the end of training and the beginning of practice, to minimise reduction in motivation and redeployment of staff.

Independent extended and supplementary nurse prescribing practice in the UK: a national questionnaire survey

BACKGROUND

Nurses are able to prescribe independently from a list of nearly 250 prescription only medicines for a range of over 100 medical conditions or, from the whole British National Formulary as a supplementary prescriber. There is some evidence available on the prescribing practices of district nurses and health visitors and early independent extended prescribers. Little or no attention has focussed on supplementary nurse prescribing.

OBJECTIVE

To provide an overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing.

DESIGN OF STUDY

National questionnaire survey.

SETTING

United Kingdom.

PARTICIPANTS AND METHOD

A convenience sample of 868 qualified independent extended/supplementary nurse prescribers self-completed a written questionnaire.

RESULTS

A total of 756 (87%) used independent extended prescribing; 304 (35%) used supplementary prescribing to treat a range of chronic conditions (including asthma, diabetes and hypertension); 710 (82%) nurses worked in primary care. Nurses in general practice reported the largest number of reasons preventing prescribing. Reasons included the inability to computer generate prescriptions and to implement the Clinical Management Plan. Nurses in primary care reported more continuing professional development needs. These needs included update on prescribing policy and the treatment management of conditions. A total of 277 (32%) nurses were unable to access continuing professional development.

CONCLUSION

Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. These nurses are highly qualified and have many years clinical experience. Supplementary prescribing is used by a minority of nurses. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing. The continuing professional development needs of independent extended/supplementary nurse prescribers are frequently unmet. It will become increasingly important that these needs are met once nurses are able to prescribe the full range of medicines included in the British National Formulary, limited only by their area of competence.

Why don't trained community nurse prescribers prescribe?

AIMS AND OBJECTIVES

(i) To identify barriers that could either prevent community nurses from prescribing altogether or reduce the number of times that a nurse might prescribe. (ii) To determine how wide spread the barriers identified above were.

BACKGROUND

Many community nurses who are trained to prescribe are either not prescribing at all or not routinely doing so.

METHOD

(i) Qualitative semi-structured interviews with nurses prescribers and Trust prescribing leads. (ii) Postal questionnaires sent to the nurse prescribing leads in each Primary Care Trust across three strategic health authorities in England.

RESULTS

Several barriers were identified in this study. Those that (i) prevented prescribing included roles with no patient contact, prescription pads not issued, opposition from general practitioners and lack of confidence; (ii) prevented some prescribing included lack of time in clinics, inability to prescribe for patients registered with another Trust, security concerns, lack of access to patient medical records and the use of alternative methods of supply; (iii) made prescribing more difficult included keeping records, informing general practitioner of items prescribed, delivering prescribed items to housebound patients and situations requiring items from more than one prescriber.

CONCLUSION

Many barriers have been identified that have the potential to reduce the impact of nurse prescribing on patient care. Trusts should monitor the prescribing of their nurse prescribers, target appropriate support and encouragement to address problems with prescriber confidence, develop strategies to integrate their nurse prescribers into the healthcare team to improve access to patient's medical notes, and improve the efficiency of the prescribing process.

RELEVANCE TO CLINICAL PRACTICE

There is a danger that the anticipated benefits to patient care resulting from the introduction of nurse prescribing may not materialize if the barriers identified in this study are not addressed.

Supplementary prescribing for nurses

The three classifications of nurses that can prescribe are community nurses, extended nurse prescribers and supplementary prescribers. Supplementary prescribers can prescribe almost any medicine provided it has been specified in the clinical management plan. Supplementary prescribing is likely to benefit those patients with uncomplicated chronic conditions and is open to all registered nurses who have completed the appropriate training. Both nurses and their managers should be aware of potential pressures on clinical decision-making and appropriate support and encouragement should be provided.

Interdisciplinary working between community pharmacists and community nurses: the views of community pharmacists

Changing roles within primary care have been heralded by the implementation of nurse prescribing and the need to maximize skills within the existing workforce. This paper describes the views of community pharmacists regarding nurse prescribing and interdisciplinary working in primary care. Limited contact was reported between community pharmacists and prescribing nurses which contrasted with the reported frequency of contact with other health professionals. The community pharmacists reported positive views regarding teamworking and nurse prescribing which it is suggested provides a readiness to develop interdisciplinary working which hitherto had foundered on lack of contact and in consequence insufficient understanding of roles and a shared view of primary care.

Nurse prescribing, nurse education and related research in the United Kingdom: a review of the literature

This literature review aims to explore nurse education and the impact this has had on preparing nurses to become nurse prescribers and nurse prescribing research. Research about the initial nurse prescribing education and training programme indicated that although patients were content with nurses prescribing medication, nurses lacked confidence in applied pharmacology and therapeutics and hence, required additional scientific education. With the implementation of extended nurse prescribing, it is conjectural to assume that nurses have been prepared more effectively until results from the national evaluation are available. One can suggest that pre-registration nurses should receive a comprehensive scientific foundation in applied pharmacology and therapeutics and professional knowledge in order to prepare them for post graduate education and training in medication management.