Practice nurses and prescribing

July 25, 2010 by admin 

What is the experience of prescribing for practice nurses, how do they feel about it, and what has its impact been on their role? These were some of the issues explored in a small, qualitative study using semi-structured interviews with eight prescribing practice nurses. Their experiences were mainly positive, but some tensions with medical colleagues in particular remain.

Many or all  of the nurses felt that there were benefits for patient care through prescribing, that there were misunderstandings among practice staff about their role, that it is both ‘imperative and intuitive’ to follow appropriate guidance, that their role had changed as a result of prescribing, and that they were unwilling to prescribe outside their competence or boundaries. Some felt that workload had increased. It emerged during the interviews that minor illness is increasingly being incorporated into the role of these nurses. Although some GPs welcomed the change and were supportive, others were less happy about it and lacked understanding about the nurse prescriber’s role and competency.

The authors make some recommendations: all staff working with prescribing nurses should get full explanations of the circumstances in which they can prescribe; after the initial mentoring period, doctors or experienced nurse prescribers should provide a further period of mentoring and supervision, to further mutual respect and understanding; and a continued learning or system of monitoring could be introduced to help nurse prescribers demonstrate their credibility - as nurses’ roles extend, something like the GP performance monitoring system may become more appropriate. Clearly, as the authors point out, this is a small study and further work is needed.

Daughtry J. and Hayter M. A qualitative study of practice nurses’ prescribing experiences. Practice Nursing 2010; 21(6): 310-314.

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Remaining barriers to prescribing for practice nurses

February 25, 2010 by admin 

Many services in primary care are now led by practice nurses working at an advanced level but not prescribing, either independently or as supplementary prescribers. What are the barriers as perceived by these nurses? Age, salary, support and training all emerged as factors in this questionnaire survey of practise nurses in one English county where prescriber numbers are low.

The authors make recommendations to improve the situation, including some central funding for course fees and expenses for practice nurses, study time and mentoring systems, a funded post of professional lead for practice nurses in each Primary Care Trust (PCT), a clear career pathway for practice nursing, and realistic financial incentives for professional development.

Of the 251 practice nurses in the county, 151 responded to the survey, most of whom were mature and experienced. About one-third will be reaching retirement age within 15 years, so GPs and PCTs will need to provide incentives to recruit and retain practice nurses.

More than 90% were managing at least one chronic condition but of these only 17% held a prescribing qualification and nearly half did not hold or intend to study for the prescribing qualification. Similarly, 37% of those providing first contact care for minor illnesses did not hold or intend to study for the prescribing qualification. The intention to train was strongly related to age, as might be expected.

Other factors included lack of support, time factors, anxiety about prescribing or the course, and lack of interest or opposition by GPs. There was a widespread view that respondents would receive little or no financial reward for doing the course. The authors point out that few GPs have adopted Agenda for Change, which would ensure parity with NHS colleagues. 

Kelly A, Neale J and Rollings R. Barriers to extended nurse prescribing among practice nurses. Community Practitioner 2010; 83(1): 21-24.

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