Independent extended and supplementary nurse prescribing practice in the UK: A national questionnaire survey

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Abstract

Background

Nurses are able to prescribe independently from a list of nearly 250 prescription only medicines for a range of over 100 medical conditions or, from the whole British National Formulary as a supplementary prescriber. There is some evidence available on the prescribing practices of district nurses and health visitors and early independent extended prescribers. Little or no attention has focussed on supplementary nurse prescribing.

Objective

To provide an overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing.

Design of study

National questionnaire survey.

Setting

United Kingdom.

Participants and method

A convenience sample of 868 qualified independent extended/supplementary nurse prescribers self-completed a written questionnaire.

Results

A total of 756 (87%) used independent extended prescribing; 304 (35%) used supplementary prescribing to treat a range of chronic conditions (including asthma, diabetes and hypertension); 710 (82%) nurses worked in primary care. Nurses in general practice reported the largest number of reasons preventing prescribing. Reasons included the inability to computer generate prescriptions and to implement the Clinical Management Plan. Nurses in primary care reported more continuing professional development needs. These needs included update on prescribing policy and the treatment management of conditions. A total of 277 (32%) nurses were unable to access continuing professional development.

Conclusion

Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. These nurses are highly qualified and have many years clinical experience. Supplementary prescribing is used by a minority of nurses. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing. The continuing professional development needs of independent extended/supplementary nurse prescribers are frequently unmet. It will become increasingly important that these needs are met once nurses are able to prescribe the full range of medicines included in the British National Formulary, limited only by their area of competence.

Section snippets

What is already known about this topic?

  • Factors influencing independent prescribing practice include the size and make-up of the practice population, the role of the nurse, interprofessional relationships, informal peer support, access to continuing professional development and the limited choice of medicines available to nurse prescribers.

  • There is evidence of low prescribing rates amongst health visitor and district nurse prescribers. This is in contrast to high prescribing rates reported by some early independent extended

What this paper adds

  • Supplementary prescribing is used by nurses to prescribe medicines for a range of conditions but it is used to a much lesser extent than independent extended prescribing. Implementing the Clinical Management Plan is a barrier preventing the use of this mode of prescribing.

  • The large majority of nurses who access prescribing programmes have more than 10 yr experience as a qualified nurse and academic qualifications at degree level and higher.

  • Qualified independent extended/supplementary nurse

Background

To date, a relatively small number of empirical studies have been conducted to evaluate nurse prescribing. Following a review of the literature, Latter and Courtenay (2004) concluded that the impact and effectiveness of nurse prescribing has largely been a positive development. However, the authors noted that the majority of the studies to date, have largely been confined to the prescribing practices of DNs and HVs. Luker et al., 1997, Luker et al., 1998, for example, in a national evaluation

Aim

To provide a national overview of the prescribing practices of independent extended/supplementary nurse prescribers and the factors that facilitate or inhibit prescribing.

Methodology

A survey design was used, in which participants were asked to self-complete a postal questionnaire. All questions were ‘closed’ in nature. Respondents were asked to tick a box to indicate their responses. Quantitative data was generated from this study.

Questionnaire

A questionnaire booklet was developed for the purpose of this study. Its

Job title

Respondents were asked to indicate their job title. A total of 437 (50.4%) worked in general practice (practice nurses, nurse practitioners), 256 (29.5%) as specialist nurses (clinical nurse specialists, specialist nurse practitioner, nurse clinician), 93 (10.7%) as senior nurses (nurse consultants, senior nurses, charge nurses, sisters, managers) and 82 (9.4%) worked as community nurses (HVs, DNs, children's community nurse specialist).

Part time/full time

The majority of respondents worked full time (580 or

Discussion

Before summarising the key findings and drawing conclusions, two potential limitations of the methodology must be taken into account. Firstly, the sample included all the qualified independent extended/supplementary nurse prescribers registered on the medical reference guide. It was not a random sample. A second potential limitation is that the length of time participants had been prescribing was not taken into account. This may have affected responses. This is unlike previous work (Latter et

Conclusions

Independent extended/supplementary nurse prescribers work predominantly in primary care and do prescribe medicines. Supplementary prescribing is used by a minority of nurses. Barriers to implementing the CMP require further exploration. The large majority of nurses who access prescribing programmes have more than 10 yr experience as a qualified nurse and academic qualifications at degree level and higher. However, once qualified, the CPD needs of these nurses are frequently unmet. This requires

Acknowledgments

This study was undertaken with the help of a research grant provided by Galderma UK.

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