Nurse prescribing of medicines in Western European and Anglo-Saxon countries: A survey on forces, conditions and jurisdictional control

Content of medicine prescription and clinical practice training for haematology advanced practice nurses in China: A modified Delphi study

AIM

To explore the scope and form of prescriptions for blood and hematopoietic drugs that future advanced practice nurses (APNs) in the Department of Haematology and to establish a medicine prescription training content in China.

BACKGROUND

Because the increasing number of doctors cannot meet the increasing demand for medical care with the population growth, many countries have begun to explore the medical team structure and practice areas, among which nurse prescribing rights have been the most effective. However, China's higher nursing education system still lacks education and training on nurse prescription.

DESIGN

On the basis of literature research and semi-structured interviews, a set of nursing prescription content, education, training and practice system suitable for Chinese nurses was jointly created.

METHODS

Two rounds of expert consultation between 23 haematology nursing experts and clinical experts determined the training content of blood system drugs and medicine prescriptions. Additionally, on the basis of the 23 experts，13 experts engaged in clinical and education, teaching and training experts were involved. Two rounds of expert consultation with 36 experts identified a general clinical practice training program for advanced practice nurses in China.

RESULTS

Regarding contents and forms of hematopoietic drugs, the study concluded that advanced practice nurses in haematology department can prescribe anti-anemia drugs, anti-coagulant drugs and anti-thrombotic drugs in 2 categories and 16 drugs. Of these, four kinds of drugs should be prescribed in the form of protocol prescription. One kind of drug should be prescribed in the form of extended prescription and 11 drugs should be prescribed in the form of independent/extended or agreed/extended prescription. Regarding training content, the study obtained the training content of nurses' medicine prescriptions in eight clinical circumstances and the medicine prescription training content for common diseases of the blood system. The required specifications and the medicine prescription decision skills of nurses were sorted out according to different prescription types.

CONCLUSIONS

The degrees of expert authority were both higher in consultations. Moreover, the results after consultation were reliable. It was recommended that haematology APNs could prescribe anti-anaemic drugs and anti-coagulation and anti-thrombotic drugs. Furthermore, most drugs should be prescribed in the form of independent/extended or agreed/extended prescriptions. The establishment of a medicine prescription training content for haematology APNs is expected to provide a reference for clinical practice education and training for drug prescriptive authority applicants for blood and hematopoietic system nurses in China.

Nurses' perceived barriers and facilitators to the implementation of nurse prescribing: Delphi study and focus group

AIM

To obtain consensus on barriers and facilitators to nurse prescribing following its recent introduction in Spain.

DESIGN

A three round online Delphi survey and focus group.

METHODS

An exploratory method was used with three consecutive rounds of questionnaires based on anonymity and feedback, and a focus group. The study was carried out with primary care, specialized care, socio-health care and manager nurses.

RESULTS

On the basis of the Delphi study that was conducted, a list of 15 barriers and 18 facilitators of nurse prescribing was obtained. However, no general consensus was found with respect to the prioritization of these barriers/facilitators. The analysis of the results of the focus group confirmed the information obtained from the Delphi study. The main barriers highlighted were dependence on the figure of the physician, insufficient training in pharmacology, a lack of institutional support and the limited list of products that could be prescribed. The key facilitators were academic knowledge and ongoing training and education, independence in the functions and responsibilities of the nursing profession, adaptation to new roles and autonomy in the case of chronic care processes.

CONCLUSION

Nurses were generally positive about the introduction of nurse prescribing. The commitment of nurses to training and their accreditation as prescribers (internal forces) and health policy and nursing management (external forces) play a fundamental role in supporting the basis of nurse prescribing and ensuring that it is developed with the identified support resources, such as staff training and the provision of the materials necessary for its proper implementation, all with the aim of guaranteeing quality healthcare.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Strong models of nurse prescribing are being considered globally to address population needs. The results can help the future implementation of non-medical independent prescribing and provide guidance to the government and society on the interventions that can be used to consolidate it.

IMPACT

What problem did the study address? By 2027, the world's population will receive more than 4.5 trillion doses of medicine each year. However, the WHO estimates a projected shortfall of 10 million health workers by 2030. Inadequacies with traditional physician-led care systems mean that new approaches are imperative to maintain patient access to prescription medicines, with NP being a key element in this regard. In Catalonia (Spain), the accreditation process for nurses as prescribers was implemented in 2021. It is therefore of vital importance to question and consult the nurses themselves, the main promoters of the process, to find out their perceptions and thus be able to take them into consideration in the implementation process. What were the main findings? A total of 15 barriers and 17 facilitators were identified. The main perceived barriers are dependence on the figure of the physician, insufficient training in pharmacology during undergraduate studies and a lack of institutional support. The main perceived facilitators are academic knowledge and ongoing education and training, independence in nursing functions and responsibilities, and adaptation to new roles and tasks. Where and on whom will the research have an impact? These results can contribute to improving NP implementation in Spain and serve as a reference for other countries, especially where NP education and training have only recently been instigated or are in the planning process.

REPORTING METHOD

Standards for reporting qualitative research: a synthesis of recommendations. SRQR.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Task shifting in Dutch nursing practice: A repeated cross-sectional analysis of nurses' experiences

AIM

This study aims firstly to identify shifts in the execution of medical tasks by nurses in the past decade. Secondly, it aims to explore nurses' perspectives on task shifting: how they think task shifting affects the quality of care, the attractiveness of nursing practice and their collaboration with physicians.

DESIGN

A quantitative repeated cross-sectional study.

METHODS

A nationwide survey was conducted among Dutch registered nurses (RNs) working in hospitals and home care, first in 2012 and again in 2022, with sample sizes of 359 and 362, respectively. Analyses were based on descriptive statistics and logistic and linear regressions.

RESULTS

Between 2012 and 2022, there was a significant increase in the execution of only one medical task by nurses, namely prescribing over-the-counter medication. The majority reported in both years that task shifting has positive impact on their professional autonomy and the attractiveness of nursing practice. However, most nurses also reported that task shifting increased their workload (72.7% in 2022) could lead to conflicts in care teams (20.9% in 2022 compared to 14.7% in 2012) and may cause physicians to feel threatened (32.8% in 2022 and 29.9% in 2012). There were no significant changes in nurses' perception of the impact of task shifting on quality of care, the attractiveness of nursing practice and the nurse-physician relationship.

CONCLUSION

There was an increase in the execution of prescribing over-the-counter-medication by nurses between 2012 and 2022. However, both in 2012 and in 2022, as the majority of nurses reported that task shifting increased their workload, there is reason to worry about this negative consequence of task shifting, e.g. with regard to labour market issues. Further research, also among the medical profession, is needed to better understand and address the implications of task shifting for the nursing profession.

IMPLICATIONS FOR THE PROFESSION

Implications for the nursing profession include potential scope expansion with complex tasks, attracting more individuals to nursing careers, although an eye must also be kept on what that means for the workload of nurses and the relationship with physicians.

IMPACT

Nurse prescribing medicines was more executed in 2022 compared to 2012. Nurses had a predominantly positive perspective on task shifting, but still felt it can cause conflicts in care teams, high workload and physicians feeling threatened. These results can help during implementation of task shifting and in monitoring the perceived effects of task shifting among nurses.

REPORTING METHOD

This study followed the STROBE reporting guideline for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution. This study focussed on the task shifting (perspectives) of nurses.

A text mining and network analysis of topics and trends in major nursing research journals

AIM

This study is set to determine the main topics of the nursing field and to show the changing perspectives over time by analysing the abstracts of several major nursing research journals using text mining methodology.

DESIGN

Text mining and network analysis.

METHODS

Text analysis combines automatic and manual operations to identify patterns in unstructured data. Detailed searches covering 1998-2021 were conducted in PubMed archives to collect articles from six nursing journals: Journal of Advanced Nursing, International Journal of Nursing Studies, Western Journal of Nursing Research, Nursing Research, Journal of Nursing Scholarship and Research in Nursing and Health. This study uses a four-phase text mining and network approach, gathering text data and cleaning, preprocessing, text analysis and advanced analyses. Analyses and data visualization were performed using Endnote, JMP, Microsoft Excel, Tableau and VOSviewer versions. From six journals, 17,581 references in PubMed were combined into one EndNote file. Due to missing abstract information, 2496 references were excluded from the study. The remaining references (n = 15,085) were used for the text mining analyses.

RESULTS

Eighteen subjects were determined into two main groups; research method topics and nursing research topics. The most striking topics are qualitative research, concept analysis, advanced practice in the downtrend, and literature search, statistical analysis, randomized control trials, quantitative research, nurse practice environment, risk assessment and nursing science. According to the network analysis results, nursing satisfaction and burnout and nursing practice environment are highly correlated and represent 10% of the total corpus. This study contributes in various ways to the field of nursing research enhanced by text mining. The study findings shed light on researchers becoming more aware of the latest research status, sub-fields and trends over the years, identifying gaps and planning future research agendas. No patient or public contribution.

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

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.

A hidden gem in multidisciplinary antimicrobial stewardship: a systematic review on bedside nurses' activities in daily practice regarding antibiotic use

Background

Antimicrobial stewardship (AMS), the set of actions to ensure antibiotics are used appropriately, is increasingly targeted at all those involved in the antimicrobial pathway, including nurses. Several healthcare organizations have issued position statements on how bedside nurses can be involved in AMS. However, it remains unclear how nurses, in reality, contribute to appropriate antibiotic use.

Objectives

To systematically search the literature to describe the activities bedside nurses perform regarding antibiotic use in daily clinical practice, in relation to the activities proposed by the aforementioned position statements.

Methods

We searched MEDLINE, Embase, CINAHL and grey literature until March 2021. Studies were included if they described activities regarding antibiotic use performed by bedside nurses. Methodological rigour was assessed by applying the Mixed Method Appraisal Tool.

Results

A total of 118 studies were included. The majority of the proposed nurses' activities were found in daily practice, categorized into assessment of clinical status, collection of specimens, management of antimicrobial medication, prompting review and educating patient and relatives. Nurses may take the lead in these clinical processes and are communicators in all aspects of the antimicrobial pathway. Patient advocacy appears to be a strong driver of bedside nurses' activities.

Conclusions

Nurses' activities are already integrated in the day-to-day nursing practice and are grounded in the essence of nursing, being a patient advocate and showing nursing leadership in safeguarding the antimicrobial treatment process. An essential element of the nursing role is communication with other stakeholders in the patient-centred antimicrobial pathway. Educating, engaging and empowering nurses in this already integrated role, could lead to a solid, impactful nursing contribution to AMS.

Developing modern primary care nursing in North Macedonia

BACKGROUND

Nurses have the potential to make a real impact on the health and well-being of people and populations and contribute to the realisation of delivery of Universal Health Coverage. However, in many parts of the world, the education and practice of nursing and nurses' position in health care and society are restricted by a range of social, cultural, economic and political factors. In North Macedonia, the Ministry of Health in partnership with the WHO Country Office launched a primary healthcare strategy supporting the development of nurses in primary care to fulfil their full scope of service.

AIMS

To present information on the education, practice and position of nursing, in particular primary care nursing, in North Macedonia and to describe the ongoing initiatives to support the further development of nursing.

APPROACH

Background documents reviewed, and visits to healthcare settings, organisations, interviews with individuals and groups and workshops undertaken in 2019-2020.

FINDINGS

Three key areas of development were identified: education of nurses, their service delivery and practice in primary care, and their position in health care and society, all underpinned by the need for workforce planning. The findings formed the basis of a 10-year plan: Making Change Happen: The Nursing and Midwifery Development Roadmap.

DEVELOPMENTS

To support the proposed primary care pilots, during the 2020/2021 COVID-19 pandemic, an on-line modular programme for primary care nurses was developed and delivered with the support of members drawn from The National Working Group for Moving Primary Care Nursing Forward in North Macedonia. Further work is planned to develop initial nurse education and to pilot changes in primary care.

CONCLUSIONS

The launch of the primary healthcare strategy stimulated initiatives to improve the education, position and practice of primary care nursing. The COVID-19 pandemic required flexibility and changes to the original plans.

Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews

Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.

Identifying the Enablers and Barriers to Advance Nurse Prescribing of Medication in Spain According to Experts' Views: A Delphi Study

Nurses play an important role in pharmaceutical care worldwide in detecting clinical changes, communicating and discussing pharmacotherapy with patients, their families, and other healthcare professionals, proposing and implementing drug-related interventions, and ensuring the monitoring of patients and their medication regimens, among others. However, there is no global consensus across countries regarding the prescribing of medication by nurses. In Spain, for example, this topic is currently in transition since the approval of the Royal Decree 1302/2018 of October 22nd, which regulates the indication, use, and authorization for dispensing human-use medication by nurses. Our study aims to identify the enablers and barriers to advancing the nurse prescribing of medication in Spain through the views of experts in the field and according to the latest Royal Decree approved and the steps taken by the different Spanish autonomous communities. A modified qualitative Delphi study with three iterations was performed online through the perspectives of experts from the field of healthcare education, research, practice, management, and policy. Data extracted from the literature review were used to formulate the open-ended questions utilized in the three rounds. The experts involved (n = 15) belonged to different Spanish regions where the Royal Decree is being implemented with different speeds, and had distinct backgrounds and experiences. Our results highlight the importance of prospectively developing additional protocols based on chronic diseases as well as scaling up towards independent nursing prescription, the inclusion of a joint multidisciplinary pharmaceutical care model, the controversial role played by national nursing councils and boards, the variability in the speed of implementation among the autonomous communities, and the lack of nursing training in the field of medication prescription.

Factors Influencing Nurses’ Opinions on the Implementation of Nursing Advice in Poland

In the past five years, nursing practice has changed drastically in Poland. Nurses have received many new competencies in response to the need to provide services to patients. The purpose of the study was to analyze nurses’ opinions on the new rights to provide nursing advice and to identify factors that influence their opinions in this regard. A descriptive cross-sectional study was conducted among 798 nurses who work in various medical facilities. The influence of selected variables on nurses’ opinions on the provision of nursing advice to patients was evaluated using logistic regression. The nurses surveyed had a positive attitude towards new competencies and believed that they were able to independently provide the patient with advice within the scope provided by Polish legislation. Logistic regression showed that the factors that statistically significantly influenced nurses’ opinions on particular types of nursing advice were age (p = 0.038), education (p = 0.000), and the place of work of the respondents; that is, hospital (p = 0.016). More research is needed to demonstrate the effectiveness and quality of the implemented nursing advice and its impact on the functioning of the health system.

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

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 mean scores of the attitudes towards nurse prescribing in nurses, physicians and patients were 40.62 ± 3.68, 37.98 ± 5.92 and 39.38 ± 4.39 respectively (from a range of 10 -50). However, the total mean score of attitudes among nurses was significantly higher than others (P = 0.000) and nurses had more positive attitudes toward prescribing.

Conclusion

The results showed that the participants have a good understanding and attitudes toward nurse prescribing. Nurse prescribing as a new duty and authority can be considered in providing more effective care by specialist nurses. The results of this study can also be used in the future planning of health policy for nurses to have the right to prescribe and ultimately improve the quality of patient care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00888-0.

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.

Expanding nurses' authority - Physicians' and nurses' attitudes

AIM

To examine and compare the attitudes of physicians and registered nurses regarding extending nurses' authority.

DESIGN

This was a comparative quantitative study, which used a questionnaire that examined the attitudes of nurses and physicians regarding expanding nurses' authority.

METHODS

The study comprised a sample of 134 nurses (62.7%) and physicians (37.3%), who filled out the self-report questionnaire that included sociodemographic data and questions designed to examine the participants' attitudes and perceptions on expanding nurses' authority. The general reliability of the questionnaire was Cronbach's α = 0.931. Participants were sampled through the convenience-snowball method.

RESULTS

Differences were found between the attitudes of physicians and nurses to expanding nurses' authority. Nurses tended to be in favor, whereas physicians tended to be against (t(86.29) = 7.713; p < 0.05). Nurses' attitudes are also more positive specifically to procedures related to drug administration (t(132) = 6.894; p < 0.05) and resuscitation (t(132) = 2.974; p < 0.05), compared to physicians.

CONCLUSIONS

Nurses have more positive attitudes toward expanding nurses' authority than physicians do, specifically toward drug administration and resuscitation. Further study is proposed to identify factors which affect the physician-nurse relationship and attitudes on a large scale through a qualitative study.

Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines

Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses' competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017-2019.The largest number of prescription visits made by nurses concerned patients aged 50-70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses' involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients' access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients.

Independent nurse medication provision: A mixed method study assessing impact on patients' experience, processes, and costs in sexual health clinics

BACKGROUND

Local services in the United Kingdom National Health Service enable autonomous provision of medication by nurses, supporting individual nurses to gain prescribing qualifications or by introducing local patient group directions.

AIM

To compare nurse prescribing and patient group directions about clinic processes, patients' experiences, and costs from the perspectives of providers, nurses, and patients.

DESIGN

Mixed methods, comparative case study in five urban sexual health services in the United Kingdom.

METHODS

Data were collected from nurse prescribers, patient group direction users and their patients July 2015 to December 2016. Nurse questionnaires explored training (funding and methods). Nurses recorded consultation durations and support from other professionals in clinical diaries. Patient notes were reviewed to explore medication provision, appropriateness and safety; errors were judged by an expert panel. Patients completed satisfaction questionnaires about consultations and information about medications.

RESULTS

Twenty-eight nurse prescribers and 67 patient group directions users took part; records of 1682 consultations were reviewed, with 1357 medications prescribed and 98.5% therapeutically appropriate. Most medication decisions were deemed safe (96.0% nurse prescribers, 98.7% patient group directions, Fisher's Exact Test p = .55). Errors were predominantly minor (55.6% nurse prescribers, 62.4% patient group directions) and related to documentation omissions (78.0%); no patients were harmed. Consultation durations and unplanned re-consultations were similar for both groups. Nurse prescribers sought assistance from colleagues less frequently (chi-squared = 46.748, df = 1, p < .001) but spent longer discussing cases. Nurse prescribing training required more resources from providers and nurses, compared with patient group directions. Nurse prescribers were on higher salary bands. Patient satisfaction was high in both groups (>96%).

CONCLUSIONS

Nurse medication provision by both nurse prescribers and patient group direction users is safe and associated with high patient satisfaction; effects on clinic processes and costs are similar. Undertaking the prescribing qualification involves independent study but may bring longer-term career progression to nurses.

Evidence-informed implementation of nurse prescribing under supervision: An integrative review

AIM

To explore evidence reporting facilitators and barriers to implementation of nurse prescribing and provide practical recommendations for evidence-informed implementation and adoption of nurse prescribing under a supervision model.

BACKGROUND

As demand for access to quality health care services increases, health professional roles are expanding to meet population needs. Nurse prescribing has been effective in some countries and is being considered globally to address growing health care demand. Successful implementation of health service models requires careful planning and consideration. No existing reviews have examined implementation factors in the literature.

DESIGN

Integrative review.

DATA SOURCES

CINAHL, MEDLINE, PubMed and EMBASE databases were searched from inception to 15 April 2020.

REVIEW METHODS

This integrative review is guided by Whittemore and Knafl and adheres to PRISMA reporting guidelines. The sustainability of innovation framework was used to synthesize data concerning implementation and sustainability factors (i.e. innovation, organizational, political, workforce and financial) for nurse prescribing.

RESULTS

A total of 39 articles were reviewed with literature predominantly reporting findings related to non-medical and nurse prescribing under various models. Variable evidence was found to inform nurse prescribing across five implementation and sustainability factors identifying several areas that require in-depth consideration. Very little evidence is available on nurse prescribing under supervision.

CONCLUSION

Introduction of service reform is often costly. This review highlights gaps in the literature and raises areas for consideration prior to implementation of this new service delivery model. The introduction of nurse prescribing must be planned and informed by available evidence to support effective adoption, practice and patient outcomes.

IMPACT

There are significant gaps in evidence related to nurse prescribing under a supervision model. Based on the evidence synthesized in this review, this paper provides practical recommendations for health service providers, managers, clinicians, educators and researchers to support implementation and adoption of nurse prescribing.

The NUPHAC-EU Framework for Nurses' Role in Interprofessional Pharmaceutical Care: Cross-Sectional Evaluation in Europe

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses’ responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses’ level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86–97%), patient education (85–96%), medication safety (83–95%), monitoring adherence (82–97%), care coordination (82–95%), and drug monitoring (78–96%). The most prevalent level of responsibility was ‘with shared responsibility’. Prescription management tasks were considered to be nurses’ responsibility by 48–81% of the professionals. All contextual factors were indicated as being relevant for nurses’ role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.

Time for change? A qualitative exploration of the educational preparation and subsequent continuing professional development needs of nurse and midwife prescribers

AIM/OBJECTIVE

The aim of this study was to explore nurse and midwife prescribers' perception of their educational preparation for the role and identify continuing professional development (CPD) requirements to generate practitioner-based knowledge with the potential to inform education and research, policy and practice.

BACKGROUND

Educational preparation for the nurse and midwife prescribing role has remained relatively unchanged since its introduction and follows a model whereby practitioners engage in theoretical learning and learning situated within the clinical environment, facilitated by a dedicated medical mentor. No significant examination of this preparation has been undertaken in Ireland since 2009.

DESIGN

This was a qualitative study, guided by elements associated with hermeneutic phenomenology.

METHODS

Following research ethics approval and informed consent, 16 participants from 2 maternity hospitals participated in one-to-one audio recorded semi-structured interviews.

RESULTS

Participants experience of the education programme varied with some acknowledging the importance of a broad pharmacological module whereas others believed it to be irrelevant given their prescribing scope was in many instances quiet narrow. The experience of being mentored by a medical doctor ranged from a positive learning experience to one which did not contribute to learning. Barriers to engaging with CPD were identified along with advancements in the practice arena which identify additional CPD requirements.

CONCLUSIONS

This study has generated practitioner-based knowledge which provides direction for future developments in the educational preparation of nurse and midwife prescribers, particularly around pharmacology and mentorship and outlines specific CPD requirements for practitioners.

Polish Nurses' Opinions on the Expansion of Their Competences-Cross-Sectional Study

The development of medical science creates new challenges for nurses to acquire new skills. Thanks to legal changes in Poland, nurses have gained the opportunity to independently provide health services in many areas, including consultations for patients. The aim of the survey is to analyze nurses' opinions on the expansion of competences in their profession. This is a cross-sectional, descriptive study conducted among 798 nurses using the survey technique. The majority (65.48%) of the respondents believed that they were adequately prepared to take up new competences. Most of the respondents believed that the new competence would improve the efficiency of the healthcare system in Poland (71.06%) and facilitate patients' access to health services (65.29%). According to the nurses, the scope of nursing advice will mainly concern the promotion of health education, wound treatment and prescribing medications. Age, seniority and education level significantly influenced the nurses' opinions on the scope of nursing advice. The Mann-Whitney test and the Kruskal-Wallis test were used. A correlation between two quantitative variables was assessed with the Spearman's rho coefficient. The significance level of p < 0.05 was assumed. The extension of the professional competences of nurses will increase the prestige of the profession and is another step toward introducing the role of Advanced Practice Nurse in Poland.

The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation

AIM

The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers-the people most able to provide relevant insights and information.

BACKGROUND

Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries.

DESIGN

A qualitative study was undertaken.

METHODS

Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant-comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes.

RESULTS

Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence-based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements.

CONCLUSION

Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost-effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse- or midwife-led outpatient clinics.

A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: A mixed methods study

BACKGROUND

United Kingdom legislation allows nurses to autonomously provide medications as independent nurse prescribers or using patient group directions. Evidence of medication safety and appropriateness is limited. We compared nurse prescribers and patient group direction users in terms of prevalence, types and severity of medication provision errors.

METHODS

Objectives: Compare safety and appropriateness of medication provision between nurse prescribers and patient group direction users.

DESIGN

MIXED METHODS: clinical notes review and nurse-patient consultation observations.

SETTING

Five United Kingdom sexual health services.

SELECTION CRITERIA

'Clinical notes review' included a random selection of nurse-patient consultations July-December 2015, 743 consultations managed by nurse prescribers and 939 consultations by patient group direction users. 'Observation study' involved 15 nurse prescriber and 15 patient group direction user nurse-patient medication consultations. Patients aged under 16 or non-English speaking were excluded.

MEASUREMENTS

Medication safety/appropriateness was compared between nurse prescribers and patient group direction users. Medication provision errors were categorised and assigned severity ratings. The Medication Appropriateness Index and the Prescribing Framework were used to assess medication provision.

RESULTS

Of 1682 clinical notes (nurse prescribers=743, 44%; patient group directions=939, 56%), 879 involved the provision of 1357 medications (nurse prescribers=399, 54%; patient group directions=480, 51%). The overall error rate was 8.5% (1844 errors from a potential 21,738 errors), predominantly related to documentation omissions. Nurse prescribers were more likely to make an error compared to patient group directions users (error rates 9% versus 8%, respectively; p=0.001); most were 'minor' (nurse prescribers=489, 56%; patient group directions=602, 62%). Both nurse prescribers and patient group direction users made safe medication decisions (n=1640 of 1682 patient care episodes, 98%); however, patient group directions users worked outside patient group directions restrictions in 39 (8%) of consultations. In 101 consultations, medication was indicated but not documented as offered/provided. From 30 observed consultations assessed against the Prescribing Framework, nurse prescribers' and patient group directions users' clinical practice were comparable (maximum score 46: nurse prescribers=44.7; patient group direction=45.4, p=0.41).

CONCLUSION

Sexual health nurse prescribers and patient group direction users provided safe and therapeutically appropriate medication. Improvements in clinical documentation are recommended. Moreover, patient group directions users should be encouraged to adhere to patient group directions' governance restrictions, such as through regular training, audits and staff updates.

The Implementation Process of Nurse Prescribing in Poland-A Descriptive Study

The study aimed to investigate the situation of nurse prescribing, introduced in Poland in 2016, by analyzing the opinions of nurses, expected to be influential on nurses' actual practices, in response to legislative change to enable nurses to prescribe and comparing this with actual nurse prescribing behaviours during the early years of the legislation. The paper fills a knowledge gap and provides baseline data analysis for subsequent research. Nurses' opinions were collected during the period they were preparing themselves for prescribing. That data was compared with data on the character and extent of nurses' actual prescribing practices over the first two years of implementation. The study showed the number of nurse prescriptions increased. Comparing the first and second years of nurse prescribing, the number of nurse independent prescriptions more than doubled. Over the same period, the number of nurse supplementary prescriptions increased almost six-fold. The implementation of nurse prescribing has increased the scope of nursing care, especially in the treatment of the infections, pain and chronic conditions in the elderly.

Non-medical prescribers: prescribing within practice

Since its inception in Ireland in 2007, the Nurse Prescribing Programme has prepared registered nurses and midwives to prescribe from a limited formulary in their area of clinical speciality. However, registration numbers have declined in recent years, prompting changes to the registration processes. This article present the findings of a study conducted on the prescribing behaviours, practices and confidence of registered nurse/midwife prescribers following these changes, reporting the findings from the qualitative arm of a larger mixed-method study. Interviews with participants (n=6) explored their prescribing behaviours, practices and confidence. The findings suggest that organisational and professional factors influence prescribing. Scope of practice and expert decision-making is seen to influence engagement with treatment. Interprofessional cooperation continues to develop in making prescribing decisions. There is a clear need for interprofessional education to increase cooperation between health professionals in making prescribing decisions and including national competencies for all prescribers.

Nurse prescribing of medicines in 13 European countries

BACKGROUND

Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe have adopted laws on nurse prescribing.

METHODS

Cross-country comparative analysis of reforms on nurse prescribing, based on an expert survey (TaskShift2Nurses Survey) and an OECD study. Country experts provided country-specific information, which was complemented with the peer-reviewed and grey literature. The analysis was based on policy and thematic analyses.

RESULTS

In Europe, as of 2019, a total of 13 countries have adopted laws on nurse prescribing, of which 12 apply nationwide (Cyprus, Denmark, Estonia, Finland, France, Ireland, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom (UK)) and one regionally, to the Canton Vaud (Switzerland). Eight countries adopted laws since 2010. The extent of prescribing rights ranged from nearly all medicines within nurses' specialisations (Ireland for nurse prescribers, Netherlands for nurse specialists, UK for independent nurse prescribers) to a limited set of medicines (Cyprus, Denmark, Estonia, Finland, France, Norway, Poland, Spain, Sweden). All countries have regulatory and minimum educational requirements in place to ensure patient safety; the majority require some form of physician oversight.

CONCLUSIONS

The role of nurses has expanded in Europe over the last decade, as demonstrated by the adoption of new laws on prescribing rights.

The eligibility criteria, training content, and scope of practice for prescriptive authority for midwives: a modified Delphi study†

Objective

To investigate the necessary eligibility criteria for prescriptive authority for midwives, gather suggestions from experts on training content for prescriptive authority for midwives, and explore the scope of practice of their prescriptive authority in certain circumstances. The results of this study could serve as a reference for the development of policies on prescriptive authority for midwives.

Methods

Based on a literature search and semistructured interviews, a modified Delphi method was first used to conduct 2 rounds of expert consultation on eligibility criteria and training content for prescriptive authority for midwives. This stage included nursing experts (20) and medical experts (16) engaged in midwifery in many tertiary Grade A hospitals in China. Subsequently, consultation on the scope of practice of prescriptive authority for midwives was conducted with nursing experts (18) and medical experts (14) engaged in midwifery in many tertiary Grade A hospitals in China. The suggestions from the experts were analyzed using statistical methods to confirm the eligibility criteria for prescriptive authority, training content, circumstances, scope of practice for prescriptive authority, and the prescription forms.

Results

Among the consulted experts, 70.59% (the highest acceptance rate) considered an undergraduate degree to be the minimum educational requirement for midwives to be eligible for prescriptive authority, 85.29% (the highest acceptance rate) considered the supervisor nurse to be the minimum technical position experience necessary for midwives to be eligible for having prescriptive authority, and 50% (the highest acceptance rate) considered 5 years to be the minimum number of years of experience in the specialty for midwives to be eligible for prescriptive authority. The applicants should at least be practicing at Grade C hospitals, which was the consensus among 91.18% of the consulted experts. Among the consulted experts, 100%, 100%, 97.06%, 94.12%, and 94.12% agreed that the applicants should have knowledge in pharmacology, laws and ethics, nursing, diagnostics, and midwifery, respectively. The consulted experts confirmed 22 related course topics and identified 6 specific circumstances in which the midwives could partially practice prescriptive authority, including uterine atony, excessive uterine contraction, postpartum hemorrhage, premature rupture of fetal membranes, normal labor, and neonatal asphyxia. Under these 6 circumstances, the consulted experts commonly agreed that there were 20 medication prescriptions and 13 auxiliary examination prescriptions that could be prescribed by midwives. Of these prescriptions, 51.5% were independent prescriptions, 30.3% were protocol prescriptions, and the remaining 18.2% were both independent and protocol prescriptions.

Conclusions

Midwives who have an undergraduate degree, supervisor nurse position, and 5 years of practice in Grade C hospitals are considered eligible to apply for prescriptive authority. Partial prescriptive authority could be granted after regulated training in fundamental theories and practices, which could improve the independence and professionalism of midwifery.

Preparing pre-registration nurses to be 'prescriber ready': Aspirational or an achievable reality?

The Nursing and Midwifery Council (NMC), the professional body for U.K. registered nurses, midwives and nursing associates has recently proposed future nurses should be 'prescriber ready', in a move to ensure the nursing workforce can prescribe medicines soon after registration (NMC, 2018a). Considering this, the educational preparation requirements for future nurses requires consideration, particularly where it is incumbent on the University, or NMC Approved Educational Institution (AEI), to prepare nurses with sufficient knowledge and skills to enter an NMC approved non-medical prescribing programme from the point of registration. This paper explores the new NMC educational and practice standards for nurses and the potential infrastructures required of the AEI where there is a responsibility under the NMC to develop a new, more progressive generation of 'prescriber ready' nurse. Excitingly, Universities and nurse educators are now tasked with ensuring future nurses can safely demonstrate an amalgam of nursing care, fusing traditional nursing expertise with skills which once remained the exclusive responsibility of the doctor, thus creating a new generation of hybrid practitioners.

What are the motivating and hindering factors for health professionals to undertake new roles in hospitals? A study among physicians, nurses and managers looking at breast cancer and acute myocardial infarction care in nine countries

BACKGROUND

Many European countries experience health workforce skill-mix changes due to population ageing, multimorbidity and medical technology. Yet, there is limited cross-country research in hospitals.

METHODS

Cross-sectional, observational study on staff role changes and contributing factors in nine European countries. Survey of physicians, nurses and managers (n = 1524) in 112 hospitals treating patients with breast cancer or acute myocardial infarction. Group differences were analysed across country clusters (skill-mix reform countries [England, Scotland and the Netherlands] versus no reform countries [Czech Republic, Germany, Italy, Norway, Poland and Turkey]) and stratified by physicians, nurses and managers, using Chi-squared, Mann-Whitney U and Kruskal Wallis tests.

RESULTS

Nurses in countries with major skill-mix reforms reported more frequently being motivated to undertake a new role (66.5%) and having the opportunity to do so (52.4%), compared to nurses in countries with no reforms (39.2%; 24.8%; p < .001 each). Physicians and nurses considered intrinsic motivating factors (personal satisfaction, use of qualifications) more motivating than extrinsic factors (salary, career opportunities). Reported barriers were workforce shortages, facilitators were professional and management support. Managers' recruitment decisions on choice of staff were mainly influenced by skills, competences and experience of staff.

CONCLUSION

Managers need to know the motivational factors of their employees and enabling versus hindering factors within their organisations to govern change effectively.

National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants

OBJECTIVE

To evaluate the effects of granting legal full practice authority (FPA) to nurse practitioners (NP) and physician assistants (PA) regarding the performance of specified reserved medical procedures and to support governmental decision-making.

DESIGN

Nationwide mixed methods design with triangulation of quantitative (Pre-post test design) and qualitative data (expert interviews and focus groups).

METHODS

Surveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross-compliance requirements (adherence with protocols, competence). Interviews focused on competence, knowledge, skills, responsibilities, routine behaviour, NP/PA role, acceptance, organisational structure, collaboration, consultation, NP/PA positioning, adherence with protocols and resources. Data collection took place between 2011 and 2015.

RESULTS

Quantitative data included 1251 NPs, 798 PAs and 504 physicians. Besides, expert interviews with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 healthcare providers) were held.After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Utilisation of FPA was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross-compliance requirements were mostly fulfilled.

CONCLUSIONS

Informal practice was legalised. The opportunities to independently perform catheterisations, injections, prescribing, punctures and small surgical procedures were highly used. Care processes were organised more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to continue with FPA.

Clinical and cost-effectiveness of non-medical prescribing: A systematic review of randomised controlled trials

Objective

To evaluate the clinical and cost-effectiveness of non-medical prescribing (NMP).

Design

Systematic review. Two reviewers independently completed searches, eligibility assessment and assessment of risk of bias.

Data sources

Pre-defined search terms/combinations were utilised to search electronic databases. In addition, hand searches of reference lists, key journals and grey literature were employed alongside consultation with authors/experts.

Eligibility criteria for included studies

Randomised controlled trials (RCTs) evaluating clinical or cost-effectiveness of NMP. Measurements reported on one or more outcome(s) of: pain, function, disability, health, social impact, patient-safety, costs-analysis, quality adjusted life years (QALYs), patient satisfaction, clinician perception of clinical and functional outcomes.

Results

Three RCTs from two countries were included (n = 932 participants) across primary and tertiary care settings. One RCT was assessed as low risk of bias, one as high risk of bias and one as unclear risk of bias. All RCTs evaluated clinical effectiveness with one also evaluating cost-effectiveness. Clinical effectiveness was evaluated using a range of safety and patient-reported outcome measures. Participants demonstrated significant improvement in outcomes when receiving NMP compared to treatment as usual (TAU) in all RCTs. An associated cost analysis showed NMP to be more expensive than TAU (regression coefficient p = 0.0000), however experimental groups generated increased QALYs compared to TAU.

Conclusion

Limited evidence with overall unclear risk of bias exists evaluating clinical and cost-effectiveness of NMP across all professions and clinical settings. GRADE assessment revealed moderate quality evidence. Evidence suggests that NMP is safe and can provide beneficial clinical outcomes. Benefits to the health economy remain unclear, with the cost-effectiveness of NMP assessed by a single pilot RCT of low risk of bias. Adequately powered low risk of bias RCTs evaluating clinical and cost effectiveness are required to evaluate NMP across clinical specialities, professions and settings.

Registration

PROSPERO (CRD42015017212).

Nurse and midwifery prescribing in Ireland: A scope-of-practice development for worldwide consideration

For 10 years, select Irish nurses and midwives who pass a rigorous 6 month theory and practical program can prescribe medications and other medicinal products. Given the need for timely, accessible, and affordable health-care services in all countries, this nursing/midwifery education and practice development is worthy of examination. Irish nurse/midwife prescribing occurred following long-term deliberative nursing profession advocacy, nursing education planning, nursing administration and practice planning, interdisciplinary health-care team support and complementary efforts, and government action. A review of documents, research, and other articles was undertaken to examine this development process and report evaluative information for consideration by other countries seeking to improve their health-care systems. Nurse/midwife prescribing was accomplished successfully in Ireland, with the steps taken there to initiate and establish nurse/midwife prescribing of value internationally.

Interventions to improve working conditions of nursing staff in acute care hospitals: Scoping review

AIM

To conduct a scoping review to examine and map the interventions proposed for the improvement of the working conditions of nursing staff in acute care hospitals.

BACKGROUND

The Registered Nurse Forecasting (RN4CAST) project and other studies have determined the impact that the nursing staff has on the quality of care. The nursing staff's higher levels of burnout, job dissatisfaction and negative perception of the quality of care provided caused worse health outcomes.

METHODS

A scoping review was carried out. By searching in SCOPUS, PubMed, CINAHL, Cochrane, Dialnet and in the grey literature, 705 potentially relevant papers were identified. The final analysis included 21 papers and three grey documents.

RESULTS

The studies analysed proposed interventions at the macro-management, meso-management and micro-management levels, although the interventions at the macro- and meso-levels produce better staff outcomes.

CONCLUSIONS

The findings of this review can be applied to management at different levels: measures to improve the patient-nurse ratio at the macro-management level, the horizontal hierarchies at the meso-management level, the mind-body techniques at the micro-management level.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and leaders should implement interventions at different organisational levels to improve the working conditions of the nursing staff and other health outcomes.

The necessity and possibility of implementation of nurse prescribing in China: An international perspective

BACKGROUND

The number of countries where nurses are legally permitted to prescribe has grown rapidly due to a variety of external and internal forces. Despite its international popularity, nurse prescribing has not yet been implemented in China widely.

OBJECTIVE

The intent of this paper is to review the current international literature regarding nurse prescribing so as to explore the necessity and possibility of implementation of nurse prescribing in China and classify the research gap.

METHODS

Eight electronic databases including Embase, SpringerLink, EBSCO, CINAHL, Medline, Wiley, Science Direct, CochraneLibrary were electronically searched to identify related peer-review articles published in the English language only from 2007 to 2017. Relative references found from the identified studies were traced back to ensure that potentially eligible articles were included.

RESULTS

Thirty-three publications which met the inclusion criteria were included in this literature review. The literature shows that not only could nurse prescribing provide quicker service, improvements in quality, but also could make better utilization of the nurses' professional skills and increase nurses' autonomy. Moreover, the barriers of nurse prescribing are explored to identify the factors that may facilitate the success of its implementation.

CONCLUSION

The review advises that nurses' views towards nurse prescribing have played a significant role in the success of nurse prescribing. While no literature regarding Chinese nurses' attitudes towards nurse prescribing could be identified, it is imperative to examine their attitudes on it. This would help Chinese healthcare policymakers ascertain the necessity of the introduction of nurse prescribing and provide them with valuable information for service planning.

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.

Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review

QUESTION

What are the factors that affect the implementation or utilisation of independent non-medical prescribing (iNMP)?

DESIGN

Mixed-methods systematic review. Two reviewers independently completed searches, eligibility and quality assessments.

DATA SOURCES

Pre-defined search terms were utilised to search electronic databases. Reference lists, key journals and grey literature were searched alongside consultation with authors/experts.

ELIGIBILITY CRITERIA FOR INCLUDED STUDIES

Qualitative and quantitative studies investigating independent prescribing by any non-medical professional group. Study participants included any stakeholders involved in actual or proposed iNMP. Measurements reported on data describing stakeholders' perceptions and experiences of the barriers to/facilitators of iNMP.

RESULTS

A total of 43 qualitative and seven quantitative studies from three countries (n=12, 117 participants) were included. Quality scores varied from 9 to 35 (Quality Assessment Tool for Studies with Diverse Designs, 0 to 48). Qualitative data were synthesised into four themes (and subthemes): systems (government and political, organisational, formulary); education and support (non-medical prescribing (NMP) courses/continuous professional development (CPD)); personal and professional (medical profession, NMP professions, service users); and financial factors. Quantitative data corroborated the qualitative themes. Integration of the qualitative themes and quantitative data enabled the development of a NMP implementation framework.

CONCLUSION

Barriers to and facilitators of the implementation and utilisation of iNMP are evident, demonstrating multifactorial and context-specific variables within four explicit themes. Professional bodies, politicians, policy and healthcare managers and clinicians could use the resulting NMP implementation framework to ensure the safe and successful implementation and utilisation of NMP. Clinical physiotherapists and other clinicians should consider whether these variables have been adequately addressed prior to adopting NMP into their clinical practice.

REGISTRATION

PROSPERO CRD42015017212. [Noblet T, Marriott J, Graham-Clarke E, Rushton A (2017) Barriers to and facilitators of independent non-medical prescribing in clinical practice: a mixed-methods systematic review. Journal of Physiotherapy 63: 221-234].

Nurse prescribing in Spain: The law and the curriculum

In this cross-sectional study, we explored course content related to pharmacology and/or healthcare products and supplies in all nursing degree programs in Spain. Changes in nurse-prescribing legislation in Spain require that nurses take a certification course before prescribing over-the-counter products and medications. Using a cross-sectional descriptive study, between July and September 2014, the degree programs of all centers that offer a degree in nursing in Spain were examined, selecting those with course information available online. All centers offered at least one pharmacology course. One-third of the required courses had content related to pharmacology and healthcare products/supplies. The analysis showed that the course content and training received during the current nursing degree program provides the knowledge and skills needed to prescribe healthcare products/supplies and medications that do not now require a doctor's prescription, without the need for additional training and certification. It is essential that government regulation of nursing education be aligned with nursing competencies, curriculum standards, clinical practice, and evidence-based research to provide the maximum level of confidence for nursing professionals and their patients.

The views of non-medical prescribing students and medical mentors on interprofessional competency assessment - A qualitative exploration

BACKGROUND

The United Kingdom (UK) is one of the least restrictive countries in terms of scope of prescribing practice for non-medical prescribers and is a rapidly expanding group of professionals. In the United Kingdom nurse prescribers are assessed in practice by Designated Medical Practitioners (DMP) (doctors) which is a unique approach. In light of proposals to permit nurses to assess each other the benefits and challenges associated with current approach to interprofessional assessment warranted further exploration.

OBJECTIVE

The aim was to explore interprofessional competency assessment with nurse non-medical prescribing students and their DMPs.

DESIGN

A descriptive qualitative research design was undertaken using semi-structured interviews and focus groups.

SETTING

The study was completed in a Scottish University that provides non-medical prescribing education to nurses, midwives and allied health professionals.

PARTICIPANTS AND METHODS

Students (n=6) participated in two focus groups at the start and end of their supervised learning and assessment in practice. DMPs (n=6) participated in semi structured telephone interviews on completion of supervision. Utilising Clark's theory of interprofessional education, a thematic analysis was conducted.

FINDINGS

Professional identity influenced interpretation of prescribing competence with regards assessment and scope of practice. Students and DMPs learned with, from and about each other, and provided a platform for two-way learning and mutual professional respect. The interprofessional learning experience developed relationships and provided ratification for the prescribing role post qualification.

CONCLUSIONS

Further exploration with key stakeholders and service users is recommended, prior to any changes to the designated professional group assigned to assessing non-medical prescribing competence.

Physician associates in primary health care in England: A challenge to professional boundaries?

Like other health care systems, the National Health Service (NHS) in England has looked to new staffing configurations faced with medical staff shortages and rising costs. One solution has been to employ physician associates (PAs). PAs are trained in the medical model to assess, diagnose and commence treatment under the supervision of a physician. This paper explores the perceived effects on professional boundaries and relationships of introducing this completely new professional group. It draws on data from a study, completed in 2014, which examined the contribution of PAs working in general practice. Data were gathered at macro, meso and micro levels of the health care system. At the macro and meso level data were from policy documents, interviews with civil servants, senior members of national medical and nursing organisations, as well as regional level NHS managers (n = 25). At the micro level data came from interviews with General Practitioners, nurse practitioners and practice staff (n = 30) as well as observation of clinical and professional meetings. Analysis was both inductive and also framed by the existing theories of a dynamic system of professions. It is argued that professional boundaries become malleable and subject to negotiation at the micro level of service delivery. Stratification within professional groups created differing responses between those working at macro, meso and micro levels of the system; from acceptance to hostility in the face of a new and potentially competing, occupational group. Overarching this state agency was the requirement to underpin legislatively the shifts in jurisdictional boundaries, such as prescribing required for vertical substitution for some of the work of doctors.

Investigating the roles and training of paediatric research nurses working across Europe: a questionnaire-based survey

BACKGROUND

The key role played by research nurses in coordinating clinical trials in a paediatric setting has developed in line with increasing complexities of trial design. A questionnaire-based survey was conducted to investigate the training of research nurses involved in paediatric trials across Europe, to identify potential training needs and compare roles across specialties and countries.

METHODS

A structured, cross-sectional questionnaire survey was used, with the aim of describing and quantifying research nurse experiences. The questionnaire was designed to cover four main areas of interest: demographics, training, clinical trial experience and research nurse roles/activities.

RESULTS

The questionnaire was completed by 341 respondents across 45 different specialties in 20 European countries. A higher percentage of research nurses within 3 years of taking up post were dissatisfied with the level of training received (16%), as compared with those in post for 3-6 years (8%) and >6 years (6%). There was a trend towards a higher percentage of respondents receiving self-funded training in mainland Europe, with reported values of 15%-20%, as compared with <5% in the UK and Ireland. Only 3% of research nurses prescribed investigational medicinal products in a clinical trial setting, with contrasting roles observed between countries.

CONCLUSIONS

While high levels of training satisfaction were observed, 67% of respondents felt they would benefit from additional training in line with frequently changing practices. Currently, low levels of nurse prescribing are observed in a paediatric clinical trial setting across Europe. Appropriate research nurse training programmes should be promoted through national networks across Europe.

Deprescribing in older adults: a new concept for nurses in administering medicines and as prescribers of medicine

Deprescribing is a new and emerging theme in the care of older adults living with multimorbidities including frailty. Deprescribing requires a comprehensive review of risk and benefits of a medication in the context of the quality of remaining life and patient and family priorities and preferences. Nursing to date has not engaged with this issue, yet in their roles administering medicines and prescribing medicines they are a fundamental part of the pathway in deprescribing decisions and in supporting patients to make such decisions. In administering medicines, nurses are in a position to observe the degree of difficulty or burden experienced by patients due to polypharmacy or side effects of medicines. While as prescribers for adults with multimorbidities, active review of the risk and benefits of all medicines using evidence-based instruments is part of prescribing responsibility. This article is calling for a critical examination of nurses' roles in deprescribing and in supporting patients to make informed choices about their treatment. There is a need to articulate the role of nursing in this emerging area of medicines management and contribute to a multidisciplinary discourse on deprescribing. Equally professional standards and continuous professional development for nurses as prescribers and administrators of medicines needs to reflect the complexity of an older population. A deprescribing ethos challenges nurses to actively elicit patients' experiences of medicines burden, while nurse prescribers should recognise that appropriate deprescribing is as much a part of their role as appropriate prescribing.

Influences on prescribing decision-making among non-medical prescribers in the United Kingdom: systematic review

BACKGROUND

Suitably qualified non-medical healthcare professionals may now prescribe medicines. Prescribing decision-making can be complex and challenging; a number of influences have been identified among medical prescribers but little appears to be known about influences among non-medical prescribers (NMPs).

OBJECTIVE

To critically appraise, synthesize and present evidence on the influences on prescribing decision-making among supplementary and independent NMPs in the UK.

METHODS

The systematic review included all studies between 2003 and June 2013. Included studies researched the prescribing decision-making of supplementary and independent NMPs practising in the UK; all primary and secondary study designs were considered. Studies were assessed for quality and data extracted independently by two researchers, and findings synthesized using a narrative approach.

RESULTS

Following duplicates exclusion, 886 titles, 349 abstracts and 40 full studies were screened. Thirty-seven were excluded leaving three for quality assessment and data extraction. While all studies reported aspects of prescribing decision-making, this was not the primary research aim for any. Studies were carried out in primary care almost exclusively among nurse prescribers (n = 67). Complex influences were evident such as experience in the role, the use of evidence-based guidelines and peer support and encouragement from doctors; these helped participants to feel more knowledgeable and confident about their prescribing decisions. Opposing influences included prioritization of experience and concern about complications over evidence base, and peer conflict.

CONCLUSION

While there is a limited evidence base on NMPs' prescribing decision-making, it appears that this is complex with NMPs influenced by many and often opposing factors.

National survey of nurse prescribing in mental health services; a follow-up 6 years on

WHAT IS KNOWN ON THE SUBJECT?: Nurse prescribing allows nurses, after specific training, to prescribe medications under certain conditions. This article describes the third in a series of surveys of mental health services in England to understand how nurse prescribing is being used across the country. While there is research evidence that shows nurse prescribing to be as safe as prescribing by doctors and that service users typically find it at least as acceptable, there is a lack of detailed evidence about current forms of nurse prescribing practice specifically in mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The survey found that the number of nurse prescribers has increased over the last few years. Nurse prescribers are increasingly prescribing in a form ('independent prescribing') that makes them independently responsible for prescribing decisions without working to a plan laid out by a doctor. Mental health organisations are increasingly planning in a systematic way how to identify, train and ensure good practice in nurse prescribing. This study demonstrates that growth in numbers of nurse prescribers can take place over an extended time period. The study demonstrates that the exact model of nurse prescribing will influence its applicability in different types of service. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurse prescribing is becoming increasingly common in mental health services, changing roles for nurses and the experience of services for service users. However, there is great variation between organisations in this regard. Research is needed regarding the outcomes and any risks of independent nurse prescribing specifically in mental health compared to medical prescribing.

ABSTRACT

Introduction This paper reports the latest in a series of national surveys of nurse prescribing in mental health organizations in England. Aim To describe and understand changes and trends in the use of nurse prescribing nationally. Methods Postal survey to all 53 National Health Service Mental Health Trusts (publicly funded provider organizations); 75% responded (n = 40). Results Numbers of nurse prescribers (NPs) have grown significantly in the last 6 years, although remain a small percentage of the total Mental Health Nursing workforce. Most NPs are in community services, particularly community mental health teams and drug/alcohol services. Independent prescribing has now become the most common form of NP, replacing supplementary prescribing. Discussion Overall growth in numbers of NPs has continued, but remains marked by large variance in numbers between organizations. The study evidences that the particular form of nurse prescribing will influence its applicability in different clinical settings and that sustained increase over time in NP numbers is feasible at a national level, even with local variation in uptake. Implications for practice Nurse prescribing has become well embedded in many organizations although large-scale adoption may be hindered by the lack of a definitive evidence base as to outcomes compared with those from medical prescribing.

Nurse prescribing in Poland: Opinions expressed by primary care doctors, nurses, and patients

The aim of this study was to identify and examine the differences in opinions held by health care professionals and the general public concerning the right to administer and prescribe medication which has been awarded to nurses and midwives in Poland.The study was conducted from December 1, 2014 to July 1, 2015, in randomly selected primary health care clinics, among 2227 individuals, including 849 subjects representing medical personnel of primary health care and 1378 patients receiving primary care services. The study used 2 versions of a questionnaire. The relationships were examined with χ test for independence and Kruskal-Wallis test.Health professionals do not believe the new rights awarded to nurses and midwives will reduce the waiting time for medical consultations (P < 0.001). Nurses' qualifications for the new tasks were most highly rated by patients, whereas the least favorable opinion was expressed by doctors (P < 0.001).To introduce nurse prescribing it is necessary to develop a suitable strategy enabling implementation of the government's initiative and facilitating the process of taking up the new task by nurses.

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.

Non-medical prescribing assessment - An evaluation of a nationally agreed multi method approach

In the United Kingdom, legislation permits nurses and allied health professionals to prescribe for patients within their care. Preparation for this role includes learning, teaching and assessment that is embedded in practice, supervised by a designated medical practitioner (DMP) and evidenced in a reflective learning in practice portfolio.

AIM

The objectives were to explore; (1) which assessment in the practice portfolio was ranked most valuable in terms of achieving safe, effective prescribing practice and, (2) whether a practice based assessment (SDEP) was an acceptable alternative to an Observed Simulated Clinical Examination (OSCE).

METHODS

Online surveys were conducted and follow up semi structured telephone interviews were conducted across 5 universities in Scotland with students, DMPs and line managers.

RESULTS

Students ranked the learning log most valuable and DMPs and line managers ranked the SDEP most valuable. Survey and follow up interviews suggested that the portfolio provided the opportunity to develop prescribing skills and knowledge relevant to their specific clinical speciality. There was agreement amongst all participants that clinical assessment in the practice portfolio effectively enable non-medical prescribing students to evidence prescribing competence.

SUMMARY

The novel use of the SDEP and reflective summary offers a viable alternative to an OSCE and was viewed as one of the most valued components of the assessment strategy.