Introduction

It is almost ten years since the first nurses in the UK started to prescribe. However there have been reports that some nurses are not making use of their prescribing rights with around a quarter of trained prescribers not regularly prescribing in one study (1). The aim of this paper is to identify barriers that either prevent nurses prescribing or make it more difficult.

Method

Semi-structured interviews were undertaken with 22 community nurse prescribers (11 district nurses [DN], 10 health visitors [HV] and one practice nurse [PN]) from five Primary Care Trusts (PCT) in England. This was a purposive sample selected to include nurses prescribing frequently, infrequently (less than once per week) and those not prescribing regularly. The prescribing lead (PL) in each PCT was also interviewed. Transcriptions of the interviews were analysed using the framework method. A questionnaire was developed following the interviews to ascertain the relative importance of barriers. The questionnaire was sent to the PL in each PCT in three strategic health authorities (29 PLs returned the questionnaire giving a response rate of 69.0%).

Results and Discussion

Operational procedures were considered a barrier by prescribers and a majority of the PLs. It was apparent during the interviews that procedures varied between PCTs. The procedures in PCTs with higher levels of prescribing tended to more flexible and the procedures in the PCTs with lower levels of prescribing tended to be rigid and cumbersome. Lack of prescriber confidence was also a barrier and there have been reports that community nurse prescribers lack support (1). It has been reported that the reason nurses consulted pharmacists was to obtain information on to how to prescribe rather than what to prescribe (2). HVs and PNs were more likely than DNs to consider the formulary to be limited although most indicated that they would like more training if the formulary was to be extended. There were prescribers occupying managerial roles with no patient contact in a majority of Trusts but the numbers involved were low (average 3.8%) indicating that this is unlikely to represent a major problem.

Conclusion

PCTs should develop formal support structures to address the needs of not only its nurse prescribers but also its pharmacist prescribers and they should also collaborate with other PCTs to allow good practice to be shared between trusts.

References

1. Luker K, McHugh G, (2002) Nurse prescribing from the community nurse's perspective, International Journal of Pharmacy Practice 10: 273-80
2. Hall J, Cantrill JA, Noyce P, Nurse prescribers and community pharmacists International Journal of Pharmacy Practice, 2003: (suppl):R64