Mental health nurse independent prescribing: what are nurse prescribers' views of the barriers to implementation?

Abstract

This paper reports a pilot study exploring mental health nurse prescribers' perceptions of barriers to prescribing independently but also includes perceptions of barriers to supplementary prescribing. Current prescribing practice as experienced by mental health nurses suggests a need to identify and highlight these barriers. A mixed methodology explanatory sequential study was carried out over 3 months in Scotland in 2008 as part of a Master's degree. A questionnaire was completed by 33 mental health nurse prescribers. A focus group was conducted with 12 mental health nurse prescribers. Participants' views exposed a number of barriers to prescribing previously unidentified in a review of the relevant literature, and concurred with some previously documented barriers. Sixty per cent of mental health nurse prescribers in the study were not prescribing. Barriers identified in the study included concern about how prescribing impacts on the therapeutic relationship, role conflict, lack of support, inappropriateness of prescriber training, remuneration, qualifying to prescribing time, supervision, prescribing policies, clinical governance and nurse management. Nurse prescribing involves increased accountability and responsibility which is not currently recognized in job status or pay banding. Mental health nurse prescribing has the potential to enhance service provision, but until barriers to prescribing have been identified and addressed as part of the process of organizational change, nurse prescribing cannot achieve its maximum potential.

Nonmedical prescribing: where are we now?

“…Other factors influencing the practical element of prescribing include time since qualifying [Ross and Kettles, 2012], training [Ross and Kettles, 2012;Boreham et al 2013], good grounding in knowledge [Green et al 2009;Stewart et al 2013;Hurst and Marks-Maran, 2011;Meade et al 2011;Gumber et al 2012], continuous practice [Dobel-Ober et al 2013;Green et al 2009;Stewart et al 2013], multidisciplinary support [Green et al 2009] and the use of formularies or guidelines [Dobel-Ober et al 2013].…”

Determinants of personal resilience in the workplace: nurse prescribing in an African work context

“…Research in advanced economies suggest that targeted resiliency training can contribute to develop the resilience of nurses to work place stress and vulnerabilities (Carnevale and Smith, 2013) and enable them to pursue legitimate and professional standards of nurse prescribing (Ross and Kettles 2012;Gillespie, Chaboyer, and Wallis 2007). This can be achieved by incorporating the determinants of personal resilience in the national nursing curriculum, continuing professional development and specialised resiliency workshops (CIPD 2011) and certified by The National Order of Nurses, Midwives and Health Technicians.…”

“…It is seen as particularly significant in addressing the increasing demand for healthcare and shortage of doctors (Ross and Kettles 2012). The expanding role of nurses beyond providing comfort and ensuring a clean and healthy healthcare environment for patients is globally recognised.…”

“…A resilient individual is willing to not only take risks, but to be able to persevere in the face of such risks and this shapes their retention behaviours in a job. The concept of resilience has been shown to be an important resource that can be used by nurses to deal with major constraints and to adapt to adversity in their working environment (Ross and Kettles 2012). Dealing with constraints includes negotiating competency, professionalism and risks, which is crucial to the effectiveness of nurses (Cant, Watts, and Ruston 2011) At the organisational level, HRD plans and procedures affect employee resilience.…”

“…Nurses are no longer restricted to the role of administering doctors' diagnoses and prescriptions (Latter 2008 Gallagher et al 2006) its guidelines affect the effectiveness of nurse prescribing in specific hospitals. HRD provides highly specialised nursing education, extensive clinical experience beyond basic nursing training and a well-resourced healthcare infrastructure as seen in advanced economies such as USA, Sweden, Australia, New Zealand, Canada and the UK, (Ross and Kettles 2012;Gallagher et al 2006;Groves 2012). This expertise required for 6 nurse prescribing in advanced economies is largely inadequate in developing countries such as those in Africa (Kinfu et al 2009) where nurse prescribing is seen as an unavoidable solution to high disease incidence and shortage of medical doctors (Shumbusho et al 2009).…”