Symposium 1 An exploration of stakeholder views of nurse prescribing
Symposium lead:
Molly Courtenay, Professor of Prescribing and Medicines Management, School of Health and Social Care, University of Reading, Reading, United Kingdom m.courtenay@reading.ac.uk
Symposium chair:
Dr Richard Whittingdon, Reader in Health Sciencies, Health and Community Care Research Unit (HaCCRU) School of Health Sciences, University of Liverpool, Liverpool, UK
Symposia focus:
Developing and enhancing the roles of healthcare professionals is key to modernising the National Health Service (Department of Health (DoH) 1999, DoH 2000). Nurse prescribing is central to this modernisation. Since the introduction of independent prescribing training in 2002 and supplementary training in 2003, over 10,000 nurses have become qualified as Nurse Independent Prescribers/Nurse Supplementary Prescribers. The independent prescribing powers of nurses will extend further later this year following decisions made on the proposals set out by the Home Office(HO) (HO 2007) with regards to the extension of controlled drug prescribing.
This symposium, Chaired by Dr Richard Whittingdon, comprises of 5 papers:
- The benefits of nurse prescribing to service users (Dr Richard Whittingdon)
- The benefits and challenges of mental health nurse prescribing (Eleanor Bradley)
- A study to explore the treatment management of patients with dermatological conditions by nurse independent/nurse supplementary prescribers (Professor Molly Courtenay)
- An exploration of the views of doctors and clinical leads of nurse prescribing in the care of children and young people (Nicola Carey)
- The benefits of nurse prescribing according to nurses prescribing for patients in pain (Karen Stenner)
Papers encompass the views of nurse prescribers, doctors, managers, and patients about the prescription of medicines by nurses. Findings are presented from both primary and secondary care, adult nursing (including the therapeutic areas of dermatology and pain), children and young people, and mental health.
Reference:
- DoH (1999). Making a Difference. Strengthening the Nursing, Midwifery and Health Visiting Contribution to Healthcare. London: DoH
- DoH (2000). The NHS Plan. A Plan for Investment. A Plan for Reform. London
- DoH. Home Office (2007) Public Consultation – Independent Prescribing of Controlled Drugs by Nurse and Pharmacist Independent Prescribers. London: Home Office – extension of CDs ref
Abstract 1:The benefits of nurse prescribing to service users
Dr Richard Whittingdon, Reader in Health Sciencies, Health and Community Care Research Unit (HaCCRU) School of Health Sciences, University of Liverpool, Liverpool, UK
Background:
Service users have traditionally appreciated the extra time they have to spend with nurses (Venning et al 2000) however as consultation times decrease, it remains to be seen how this will impact on service user satisfaction (Williams & Jones 2006), communication and the role of the nurse prescriber in promoting health.
Aim:
To outline some benefits of non-medical prescribing from the perspectives of service users Method Interviews with 11 service users to discuss their experiences of having medication prescribed by a supplementary nurse prescriber. Participants were randomly sampled from a list of service users provided to the research team by nurse prescribers. Nurses asked to provide the list were all participating in a larger study to evaluate nurse prescribing.
Results:
The importance of the first consultation and the way that choices are offered and made were highlighted. Those identified as good prescribers have time, encourage questions, give advice and education, and support people in making their own decisions about their treatment. Mental health clients are particularly vulnerable when it comes to making decisions about their health and hence it is important to know what they find most helpful.
Discussion:
Service users elicit a number of advantages from being prescribed medication by a nurse prescriber, in particular the time to describe the consequences of taking medication, the integration of medication with other types of intervention and any concerns about medicine-taking. The potential for nurse prescribing to be utilised to encourage self-management and self-monitoring warrants further consideration.
Conclusion:
There are certain factors that contribute to a prescribing relationship being beneficial to both client and prescriber. Choices are presented in a myriad of ways, but nurse prescribers are in a position to spend time discussing options with service users in way that is meaningful and could enhance concordance and satisfaction with care.
References:
- Venning P, Durie A, Roland M, Roberts C, Leese B (2000). Randomised controlled trial comparing cost-effectiveness of general practitioners and nurse practitioners in primary care. BMJ. 320: 1048-1053
- Williams A & Jones M (2006). Patients' assessments of consulting a nurse practitioner: the time factor Journal of Advanced Nursing 53(2): 188-195
Abstract 2: The benefits of nurse prescribing according to nurses prescribing for patients in pain
Karen Stenner, Research Fellow, University of Reading Molly Courtenay, Professor Medicines Management, University of Reading
Background:
Nurse prescribing is a recent addition to the role of the nurse. However, there is little evidence of its impact according to nurses working in specialist areas such as acute and chronic pain. This is important as there is a continual need for research to inform and shape this role as it expands to different areas of nursing practice./p>
Aim:
To explore the views of nurses working with patients in acute and chronic pain, on the adoption of the role of prescribing on their practice.
Method:
A qualitative study involving semi-structured interviews with a purposive sample of 26 specialist pain nurses. Data was collected between November 2006 and April 2007. A thematic analysis was conducted on the interview data.
Results:
Reported benefits included: faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses themselves benefited from increased job satisfaction, credibility with patients and health professionals and also gained knowledge through prescribing.
Discussion:
The benefits of nurse prescribing for patients in pain are comparable to the benefits reported by nurses in other therapeutic areas. However, our findings provide deeper insight into the mechanisms by which some of these benefits arise, and also highlight slight differences in the views of pain nurses compared to the views of nurse prescribers working in other practice areas. Mechanisms include gaining autonomy over prescribing decisions, having expertise and skill in using controlled drugs, and nurses’ ability to combine prescribing with existing nursing skills such as advanced consultation skills.
Conclusions:
The benefits of nurse prescribing in pain are in line with those predicted (DoH 1999, DoH 2006). The mechanisms underpinning these benefits warrant examination in other therapeutic areas.
References:
- DoH (1999). Review of Prescribing, Supply and Administration of Medicines (Crown report). London
- DoH (2006). Improving patients' access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England. London
Abstract 3: The benefits and challenges of mental health nurse prescribing
Eleanor Bradley, Reader, Health and Social Care, Staffordshire University
Introduction:
Nurses working in mental healthcare should contribute to prescribing due to their ability to form therapeutic relationships with service users (Hemmingway & Flowers 2000). Nurse prescribing should enable these nurses to provide person-centred care whilst strengthening their therapeutic skills (Nolan & Badger 2002). Although nurse prescribing benefits nurses and service users (Latter et al 2005), few studies have focused on mental health nurses.
Aim:
To outline the benefits and challenges faced by mental health nurse prescribers
Method:
Sixty four mental health nurse prescribers were contacted as part of a project to evaluate nurse prescribing. All nurses registered on the prescribing course at 5 universities were asked to participate between 2003 – 2006. A further 15 mental health nurse prescribers identified as either ‘prescribing’ or ‘non-prescribing’ nurses were identified by a prescribing lead in a local Trust and invited to participate a focus group study to audit the progress of prescribing.
Results:
Barriers to mental health nurse prescribing included organizational systems, communication difficulties across primary and secondary care, the movement of qualified prescribers to non-prescribing roles and difficulty implementing the clinical management plans. Facilitative factors included supportive teams that understood non-medical prescribing, good relationships with mentors and a clear prescribing role within the team.
Discussion:
Findings highlight the importance of providing prescribers with ongoing support. Teams must to be prepared, with information about the remit of the role and discussion about re-negotiating roles. Nurse prescribers working across primary and secondary care face particular challenges and could benefit from setting clear boundaries for prescribing practice.
Conclusions:
Prescribers must feel supported by their teams to implement their prescribing qualification. Personal formularies could set the remit for prescribing practice with colleagues and service users. The clinical management plan, although perceived as time-consuming in practice, provides a framework for nurses keen to prescribe independently.
References:
- Hemmingway S, Flowers K. 2000 Nurse prescribing in the field of community mental health nursing Nursing Times, 96 (43),40 - 41
- Nolan P and Badger F. 2002 Promoting Mental Health in Primary Care Nelson Thornes: London.
- Latter S, Maben J, Myall M, Courtenay M, Young A & Dunn N 2004 An Evaluation of Extended Formulary Independent Nurse Prescribing Department of Health: London
Abstract 4: An exploration of the views of doctors and clinical leads of nurse prescribing in the care of children and young people
Nicola Carey, Senior Research Fellow, University of Reading Molly Courtenay, Professor of Prescribing & Medicines Management
Background:
Nurses caring for children have adopted lead roles which frequently involve medicines management (Gibson et al. 2003). Nurse prescribing is emphasised by the National Service Framework for children, young people and maternity services (DoH 2004). Although Inter-professional relationships, team working and support in practice are factors that have been identified as facilitating prescribing practice (Latter et al 2005), little is known about views of the health care team on the adoption of this role by nurses.
Aims:
To explore the views of doctors and clinical leads on the role of nurses prescribing medicines for children and young people within a specialist children’s hospital NHS trust.
Methods:
A qualitative study involving semi-structured interviews with a purposive sample of 11 doctors, and 3 clinical leads. Data was collected between October 2006 and July 2007. A thematic analysis was conducted on the interview data.
Results:
Doctors and clinical leads were generally supportive of nurse prescribing and reported a number of benefits. However, the impact of this new role on service delivery was limited by several factors including the structure and organisation of the hospital, the small number of nurse prescribers, a lack of support and knowledge, and reluctance by some doctors to relinquish control.
Discussion:
Preliminary evidence that doctors and clinical leads support nurse prescribing for children in the hospital setting is provided. However, a low level of awareness and understanding of the nurse prescribing role by doctors and clinical leads hindered its development and impact on service delivery.
Conclusion:
A good understanding of nurse prescribing by members of the health care team is essential if this role is to be optimised for children and young people in the hospital setting. Only then can appropriate workforce planning arrangement, structures and support be put in place to support nurses adopting this role.
References:
- DoH (2004) National Service Framework for Children, Young People and Maternity Services: Medicines for Children and Young People, Department of Health, London
- Gibson, F., Kahir, K.,Pike, S. (2003) Nurse Prescribing: children's nurses' views, Paediatric Nursing, 15, (1), 20-25
- Latter, S., Maben, J., Myall, M., Courtenay, M., Young, A.,Dunn, N. (2005) An evaluation of extended formulary independent nurse prescribing. Final Report, Policy Research Programme Department of Health & University of Southampton
Abstract 5: A study to explore the treatment management of patients with dermatological conditions by nurse independent/nurse supplementary prescribers
Molly Courtenay, Professor of Prescribing & Medicines Management Nicola Carey, Senior Research Fellow, University of Reading
Background:
Most nurse prescribers in primary care prescribe for skin condition (Courtenay et al 2006). Inconsistencies exist with regards to nurses’ specialist dermatology knowledge and nurses’ lack confidence to prescribe for some skin conditions. Some information about medicines is not routinely given to patients by nurse prescribers (Latter et al 2005)
Aim:
To explore the treatment management of patients with dermatological conditions by Nurse Independent/Nurse Supplementary prescribers.
Design & methods:
The study comprised of a national survey and case studies in which nurses prescribed medicines for skin conditions. Methods used at case study sites (n=10) included interviews with healthcare professionals, video-taped observations, and patient questionnaires. Data presented will be that from patient questionnaires (n=165). Data was analysed using SPSS: included descriptive statistics, Chi-square and non-parametric tests. Data was collected between July 2006 and September 2007.
Results:
Data collected was categorical and in the form of 6 point Likert-type scales. Ease of access, consultation waiting times, and continuity of service were rated as either good or excellent by the majority of participants. Ratings of ten aspects of communication of the nurse/patient consultation were either very good or excellent. Over 50% of patients reported they were more able to cope with their illness and understand their treatment. Nearly 75% of the sample felt more able to apply topical therapies.
Discussion:
Nurse prescribing has a number of potential benefits which include easier access and increased choice in accessing medicines (DoH 2006). Participants (80%) in this study rated access to nurses as good or excellent and reported that nurses explained their treatment and involved them in decision making.
Conclusion:
Nurse prescribing has effectively increased patient choice with regards to accessing medicines for skin conditions. Nurses share decision making about treatment management with the patient and this should result in more effective use of medicines.
References:
- Courtenay, M. & Carey, N (2006). Preparing nurses to prescribe medicines for patients with dermatological conditions. Journal of Advanced Nursing. 55(6) 698-707
- DoH (2006). Improving patients' access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England. London: DoH
- Latter, S., Maben, J., Myall, M., Courtenay, M., Young, A.,Dunn, N. (2005) An evaluation of extended formulary independent nurse prescribing. Final Report, Policy Research Programme Department of Health & University of Southampton