Benefits and challenges of nurse prescribing

Abstract

The level of reported prescribing by health visitors and district nurses in this study indicates that they are not acting as substitute prescribers for general practitioners of the products in the limited formulary. Implementation of a major role change such as nurse prescribing requires a number of conditions, including adequate education/preparation, a formulary that meets practitioners' needs, and acceptance by the practitioners themselves.

Determinants of the implementation of a new practice in hormonal contraception by Quebec nurses

“…In line with other reports, organizational innovativeness was identified as a leading factor in voluntary decision-making and implementation (Greenhalgh et al, 2004;Oppewal, et al, 2006;Robert et al, 2011;Rogers, 2003;van Achterberg et al, 2008;While & Biggs, 2004). The aspects of organizational innovativeness included low centralized decision-making and ''organizational slack'' -availability of premises, nurse and physician availability, access to pharmaceutical drug samples (useful for counseling), absence of professional isolation and technical support (results not shown).…”

“…The more decentralized the decision-making and the greater the organizational slack, the more likely nurses were to implement this new practice and to be efficient. External openness or inter-organizational networking also had an influence on the implementation in our study like in other settings (Greenhalgh et al, 2004;Oppewal, et al, 2006;Robert et al, 2011;Rogers, 2003;van Achterberg et al, 2008;While & Biggs, 2004).…”

“…Additional analyses (not shown) indicated that such nurses lacked interpersonal contacts to obtain information on the new practice and would implement it only when others would do it. Such behaviour may have something to do with a certain level of anxiety or lack of confidence in performing the new tasks, as suggested in other studies (While & Biggs, 2004). In the case of nurses who favoured electronic contact to receive additional information and implemented the new practice less intensively, additional analysis (not shown) pointed to a role for management responsibilities in addition to their clinical involvement.…”

“…In the present study, the observation that 57.3% of respondents have implemented the new practice of starting women on hormonal contraception, within two years of their training in hormonal contraception, is an encouraging result. Comparable or better results have been attained with nurses in settings across a broad range of practices (Bowen, Stanton, & Manno, 2012;Montufar, Morales, Vernon, Brambila, & Solorzano, 2005;Oppewal, Lamanna, & Lee Glenn, 2006;van der Weide & Smits, 2004;While & Biggs, 2004). Implementation strategies are expected to be more successful when they match relevant determinants, are linked with relevant theoretical insights, and are supported by evidence for either the theory or the effectiveness of the strategy itself (van Achterberg et al, 2008).…”

“…First, although our sample size of this study was respectable, the response rate (27%) was limited and may have been influenced by the fact that the study was launched around Christmas, a time when nurses were busy with flu immunization or were on vacation. Notably, in studies with larger sample sizes (Oppewal et al, 2006;Pestka, et al, 2010;Westrick, Watcharadamrongkun, Mount, & Breland, 2009), the response rate was lower than in studies with small sample size (van der Weide & Smits, 2004;While & Biggs, 2004;). E-mail lists do not enable tracking of nurses who change organizations and sample selection bias due to recall errors and social desirability bias may also have been influential.…”