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Implications for nursing practice
▪ Nurse prescribing roles can be successfully implemented within acute healthcare services, but effective workforce planning is required to engage the whole team.
▪ Nurse prescribers have the potential to enhance patient satisfaction with medication information in acute settings. The impact of this on concordance and adherence requires further study.
Implications for nursing research
▪ The impact of increased satisfaction on concordance and adherence rates requires further study.
▪ The findings suggest that further research is necessary with Black and Minority Ethnic populations, with a particular focus on concerns about prescribed medication.
The aim of this study was to outline the differences that prescribing roles make to team working to investigate how independent prescribers employ their roles in an acute hospital environment and what difference this can make with respect to impact of the prescribing role.
In the UK, nurse prescribing was introduced to community nurses in the early 1990s then rolled out to all suitably qualified nurses a decade later. There has been relatively little research to date focusing on the roles of nurse prescribers in acute hospital settings.
A single-case design was utilised with a purposively sampled acute care hospital, with three units of analysis – a renal outpatients clinic, hypertension clinic and renal satellite unit. These were purposively selected because doctors and nurses based within them were early implementers of nurse prescribing. A number of propositions were tested, developed from an analysis of policy and professional literature, and a null hypothesis (that there were no differences between the roles of medical and nurse prescribers) was tested.
Multiple data collection methods were utilised: semistructured interviews, non-participant observations of patient–prescriber consultations and a patient survey. Team members were purposively sampled for interview, including prescribers (n=3), colleagues (n=7) and senior hospital staff (n=8). Nurse prescribers (n=2) were interviewed at the beginning of the study and 9 months later.
Two nurses and two doctors were purposively selected for the observations, and 52 patient–prescriber consultations were observed. A structured observation sheet was devised to assess prescribe competence and the ability to manage the patients' medicine needs.
A convenience sample of 122 patients attending hypertension and renal clinics completed the questionnaire. Validated rating scales incorporated within the questionnaire included the Beliefs about Medicines Questionnaire and the Satisfaction with Information about Medicines Scale.
Qualitative data were analysed using a deductive approach to organise the data. Quantitative data were analysed using descriptive statistics.
This article finds that nurse prescribing in acute care settings can be implemented successfully under certain conditions. All team members were able to see that there had been benefits to the introduction of nurse prescribing and on patient care, team working and the ability to maximise the nursing role.
Patients who consulted a nurse prescriber had high rates of satisfaction with the information provided about their medication. However, almost half needed further convincing as to the value of taking medication.
There were no differences between nurses or doctors with respect to prescribing approach, the number and types of items prescribed and the length of appointments.
The findings of this study are important for the continued roll-out of nurse prescribing across UK. However, the services selected for study were purposively sampled as ‘exemplars’ for nurse prescribing and are therefore not ‘representative’. Nurse prescribers were active prescribers and had demonstrated some success with respect to the implementation of their roles. This study provides information about how to successfully implement nurse prescribing.1 ,2
Although published in 2010, the data were collected between 2005 and 2006. There have been a number of changes since then with respect to nurse prescribing, changes to the legislation and the role of the independent nurse prescriber, increasing numbers of nurse prescribers and potential for achieving a ‘critical mass’. Although based on an exemplar, this study provides little guidance with respect to the ‘ideal’ number of nurse prescribers to be based within a clinic, or an acute hospital more widely, information which would have been helpful for those planning prescribing elsewhere.
Of note was the ability of nurse prescribers to enhance patient satisfaction with medication information without any increase in time spent with patients. Previous research has suggested that a key source of patient satisfaction with nurse prescribers has been their ability to communicate effectively with patients about their medication and encourage questioning about medication.3 However, it is acknowledged within the study that the move of more complex patients to medical prescribers will have a consequent impact on length of consultation, and also, possibly, satisfaction with information received. This is an area for future research, alongside the impact of nurse prescribing on concordance or adherence rates.
Competing interests None.
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