District nurse and independent prescribing

September 27, 2010 by admin 

What is the experience of district nurses who are independent prescribers? This study explored this issue using interviews with eight district nurses practising as nurse independent prescribers in the west of Scotland. It found that their experiences were largely positive but identified a particular problem - which may be less of an issue for practice nurses - to do with  administration and particularly duplicate record keeping (nursing and medical notes). This was of great concern and involved all sorts of difficulties to do with different locations, paperless systems and computer access. It is possible that the cumbersome systems were causing some nurses to limit their prescribing, although the authors point out that they were also relatively inexperienced as prescribers and lacked confidence (five expressed a lack of confidence in their prescribing ability).

Support - both organisational and peer - was a major issue too, with nurses reporting a lack of support from the time they qualified as prescribers: even when support mechanisms existed, they may be insufficient or inconsistent. As well as confidence and support, education and ongoing development, and nursing relationships and roles were identified as influences on prescribing practice. Other difficulties included an increase in workload associated with prescribing, partly because of the administrative issues, and a lack of remuneration and recognition.

Benefits identified by the nurses included saving time, a more seamless service for patients, and increased autonomy and job satisfaction, which supported the development of the district nursing role.

Downer F and Shepherd CK. District nurses prescribing as nurse independent prescribers. Br J Community Nursing 2010; 15(7): 348-352.

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Changing prescribing practice for district nurses

April 10, 2009 by admin 

Ineffective current therapy and awareness of a new product were identified as the two major drivers for changes in the prescribing patterns of district nurses in this small study.

For those district nurses that did change their habits, pharmaceutical company reps and other nurses had the greatest influence on product selection. The experience of the nurse then had the greatest influence on whether the new product continued to be prescribed. The authors argue that this heavy reliance on the industry for information about prescribing, although apparently mirrored in medical prescribing, is a concern, especially as evidence-based practice was not mentioned. They suggest that perhaps organizations promoting cost effective prescribing for nurses should visit nurse prescribers, taking a leaf from the industry’s book. As colleagues also influence prescribing habits, a cascade system could be used.

Hall J, Noyce P and Cantrill J. Why do district nurse prescribers alter their prescribing patterns? Br J Comm Nursing 2008; 13(11): 507-513.

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