Nurse prescribing in low‐resource settings: professional considerations

Abstract

Where there is a need for nurses to extend their role in the ordering of medicines and other treatments, the responsibilities, training, rights and roles of these nurses need to be clearly defined and recognized at all levels of the health service. There is a need for rigorous evaluations incorporating health, social and economic outcomes of nurse-prescribing interventions, in addition to close monitoring of legislative and regulatory changes related to nursing roles.

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

“…Nurse prescribing has long been identified in government policies as a complementary solution to the challenges caused by the high incidence of disease burden and severe shortage of well-trained doctors (Miles, Seitio, and McGilvery 2006). However, the working conditions of nurses remain fraught with major constraints that require nurses to be resilient to be able to cope and sustain nurse prescribing.…”

“…As the quotations on Table 2 indicate, nurse prescribing takes place across all the categories of health facilities. There was a general consensus among interviewees in support of previous This is where the issue of illegality (Miles, Seitio, and McGilvery 2006) and the need to negotiate competency, professionalism and risk comes in (Cant, Watts, and Ruston 2011), with private and faith-based hospitals seen as having relatively better human resourced and self-regulated procedures compared to public hospitals. This suggests that nurses also have to use their own initiatives to define the boundaries of their nurse prescribing practices.…”

“…Apart from specialist training, many other resource-related factors also constrain nurse prescribing -long standing resources and infrastructure constraints, changing demographic and epidemiology of diseases, lack of legal protection due to inconsistent legislation and clinical guidelines for nurse prescribing (Groves 2012;Miles, Seitio, and McGilvery 2006). Professionals responsible for HRD need research that will help them better understand how to motivate and retain employees (Alkire and Avey 2013;Carnevale and Smith 2013) in adverse and risky work contexts (CIPD 2011).…”

“…Although resilience has been widely applied to improve nurse prescribing in developed countries (Gillespie, Chaboyer, and Wallis 2007), there is a dearth of research on Africa where nurse prescribing is very widespread (Groves 2012). Analysing the determinants of resilience in a hospital adds to our understanding, not only of work contexts that are witnessing an expanding role for professionals (Miles, Seitio, and McGilvery 2006;Scholes 2008) but also the HRD interventions that can enhance the personal resiliency of employees working in such contexts. A critical review of the work context for nurse prescribing in African hospitals and the resilience literature is used to provide a conceptual framework for our study.…”

“…Nurse prescribing, a practice in which nurses 3 diagnose and prescribe (Latter 2008) is widely accepted as a solution to the severe shortage of doctors in developing countries despite nurses not having an equivalent training as doctors to do so (Stark, Nair, and Omi 1999;Miles, Seitio, and McGilvery 2006;Shumbusho et al 2009). In addition to the challenges of taking on professional roles that are traditional allotted to doctors, nurse prescribing in developing countries take place in a risky and vulnerable work environment due to poor working conditions, staff shortages, limited training, professional/ethical dilemmas and high workload (Kinfu et al 2009;Miles, Seitio, and McGilvery 2006). Without proper coping mechanism, such vulnerabilities can manifest into low levels of motivation, ineffectiveness and consequently negative health outcomes for patients (Scholes 2008).…”