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9.6.3 An evaluation of the new role of nurse prescriber within an acute care NHS Trust (143)

Kathryn Jones, Deputy Director of Nursing/ Director of Clinical Studies, Nursing Directorate, St Marys NHS Trust, London, United Kingdom kn.jones@virgin.net

Abstract:

Background:

As little is known about nurse prescribing within acute care, one acute hospital Trust was used as a case study to evaluate the implementation of nine new nurse prescriber roles.

Aims:

To identify the background and intended purpose of nurse prescribing roles; to explore the experiences of prescribers and teams; to test the null hypotheses that there were no differences in the roles of medical and nurse prescribers.

Methods:

Single-case embedded design (Yin 2003), three clinical services as units of analysis. Semi-structured staff interviews (n=18), non-participant observation of patient-prescriber consultations (n=52), patient survey (n=122) using validated rating scales. Qualitative analysis (Ritchie and Spencer 1994), differential and inferential statistics.

Results:

Nurse prescribing found to be for patient benefit through service delivery improvements and using staff skills differently. Nurses and colleagues positive about the new roles and service changes and their impact on patient care. No differences were found between the ways in which doctors and nurses performed prescribing roles, but there was a statistically significant difference between the satisfaction ratings of patients who had seen a nurse as compared to those seen by a doctor.

Discussion:

Nurse prescribing was successful because a shared vision directed the operational infrastructures needed for the implementation of the new roles. Also, the ‘fit’ of the roles into existing team structures helped to embed nurse prescribing. But, overall the nurses were crucial to the success of the implementation through their enthusiasm, drive and desire to succeed.

Conclusion:

Replication studies within other acute hospital settings are now recommended to extend understanding of the influences on the implementation of new roles and to enable comparisons to be made with the more established body of knowledge relating to nurse prescribing in primary care.

Recommended reading list:

  • Ritchie J and Spencer L (1994) Qualitative data analysis for applied policy research. In Bryman A and Burgess R (Eds) Analyzing qualitative data. London: Routledge pp173-194
  • Yin RK (2003) Case study research design and methods. 3rd edition. (Applied social research methods series volume 5). California USA: Sage Publications Inc

Source of Funding: N/A

Amount in Funding: N/A

Biography:

I work as Deputy Director of Nursing/ Director of Clinical Studies at St Mary’s NHS trust in London, an acute hospital with 550 beds, 1500 nurses delivering both secondary and tertiary care services. The role focuses on education and training, practice development and research and is jointly funded by Thames Valley University. My particular interest is in working with staff to explore new roles and ways of working that will benefit patient care, through service delivery changes and by using staff skills differently. This study has been submitted towards Doctorate in Healthcare at King's College London, and is currently awaiting viva.