“Providing a complete episode of care”: A survey of registered nurse and registered midwife prescribing behaviours and practices

Abstract

Aims and objectives To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices. Background The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision. Design Cross‐sectional national survey of registered nurse and midwife prescribers. Methods Data were collected through an online survey between April–July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study. Results Respondents estimated that two‐fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations. Conclusion Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing. Relevance to clinical practice Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.

Evidence‐informed implementation of nurse prescribing under supervision: An integrative review

“…Nurse prescribers and non‐medical prescribers perceive that patients benefit from their extended prescribing practice (Armstrong, 2015; Avery et al, 2007b; Casey et al, 2019; Cooper et al, 2008; Elsom et al, 2009) and that patients have confidence in nurse prescribers (Banicek, 2012). The quality of prescribing has been evaluated according to the appropriateness of prescribing decisions made by nurse prescribers compared with other health professions and reported positively in terms of safety and effectiveness in community settings (Hart, 2013) and by district nurses in the UK (Latter et al, 2012).…”

“…A range of organizational factors have been identified as influencing the success of multi‐professional prescribing. Many studies highlight that good managerial governance, colleague support, and trust in working relationships are important influences on nurse and midwife prescribing (Bowskill et al, 2013; Casey et al, 2019; Cooper et al, 2008; Courtenay, Deslandes, et al, 2018; Courtenay, Franklin, et al, 2018; Fisher, 2009; Lennon & Fallon, 2018). Sufficient support from medical colleagues has facilitated collaborative practice with independent nurse prescribers resulting in improved pharmacological knowledge and subsequent clinical practice enhancement (Lim et al, 2015).…”

“…Clear administrative processes and key stakeholder support for independent non‐medical prescribing at the local level between and in organizations influence prescribing practice (Courtenay et al, 2012; Courtenay & Carey, 2008; McHugh et al, 2020). Independent prescribers who receive recognition in terms of financial incentives, adequate clinical supervision and allocation of sufficient time to prescribe safely, are enabled to undertake their prescribing role (Casey et al, 2019; Oldknow & Gillibrand, 2013). However, lack of support from executive and management staff, overly restrictive rules governing prescribing, additional documentation and administrative workloads negatively impact nurse prescribing (Casey et al, 2019; Coull et al, 2013; Courtenay et al, 2012; Courtenay & Carey 2008).…”

A nurse prescriber‐led protocol for anaemia management in established haemodialysis patients: A retrospective study

“…Advances in nursing practice led to changes in the role of the nurse, none more so than the introduction of nurse prescribing, which has taken place in many countries within agreed parameters (Carney, 2016; Casey et al., 2019; Creedon, Byrne, Kennedy, & McCarthy, 2015; Fong, Buckley, Cashin, & Pont, 2017). The nurse prescriber role, aimed at improving outcomes for patients and service provision, includes the expansion of the nurse's scope of practice beyond that which the nurse had at the time of registration (NMBI, 2018).…”

“…The nurse prescriber role, aimed at improving outcomes for patients and service provision, includes the expansion of the nurse's scope of practice beyond that which the nurse had at the time of registration (NMBI, 2018). The scope of practice for nurse prescribers differs between countries either with prescriptive authority permitting nurse prescribers to prescribe independently or only under the supervision of a doctor (Carney, 2016; Casey et al., 2019; Creedon et al., 2015; Fong et al., 2017).…”