Non-medical prescribers in substance misuse services in England and Scotland: a mapping exercise

Psychiatric Ment Health Nurs

2016

Introduction This paper reports the latest in a series of national surveys of nurse prescribing in mental health organizations in England. Aim To describe and understand changes and trends in the use of nurse prescribing nationally. Methods Postal survey to all 53 National Health Service Mental Health Trusts (publicly funded provider organizations); 75% responded (n = 40). Results Numbers of nurse prescribers (NPs) have grown significantly in the last 6 years, although remain a small percentage of the total Mental Health Nursing workforce. Most NPs are in community services, particularly community mental health teams and drug/alcohol services. Independent prescribing has now become the most common form of NP, replacing supplementary prescribing. Discussion Overall growth in numbers of NPs has continued, but remains marked by large variance in numbers between organizations. The study evidences that the particular form of nurse prescribing will influence its applicability in different clinical settings and that sustained increase over time in NP numbers is feasible at a national level, even with local variation in uptake. Implications for practice Nurse prescribing has become well embedded in many organizations although large-scale adoption may be hindered by the lack of a definitive evidence base as to outcomes compared with those from medical prescribing.

Section: Discussionmentioning

confidence: 99%

National survey of nurse prescribing in mental health services; a follow‐up 6 years on

Dobel-Ober¹,

Psychiatric Ment Health Nurs

2016

“…The variation in numbers of prescribers and of NCs is within the context of a lack of mental health‐specific empirical evidence on the impact of both of these roles on patient and staff outcomes. However, economic arguments in support of advanced practice roles appear to greatly increase their uptake, demonstrated by the increase in nurse prescribers in substance misuse services (Mundt‐Leach & Hill, ).…”

Section: Discussionmentioning

confidence: 99%

The nurse consultant in mental health services: A national, mixed methods study of an advanced practice role

Psychiatric Ment Health Nurs

Nolan

Khoo

et al. 2019

Accessible summary What is known on the subject? Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities. Studies of nurse consultants in the United Kingdom have largely been non‐empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. What this paper adds to existing knowledge? The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change. A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. What are the implications for practice? Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors. The continued absence of robust evidence as to the clinical/cost‐effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint. Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. AbstractIntroductionThe nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders.AimsThe main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts.MethodWe used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross‐sectional survey of post holder characteristics and semi‐structured interviews with directors of nursing.ResultsOf 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0–12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work.DiscussionNurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers.Implications for ...

“…This paper reports and analyses selected data from five surveys of nurse prescribing in mental health services in England, in 2004 (Gray et al, 2005), 2005(Dobel-Ober et al, 2010), 2014(Dobel-Ober & Brimblecombe, 2016 and 2019.…”

Section: Scope Of Nurse Prescribingmentioning

confidence: 99%

“…A national survey of nurse prescribers in Wales identified only 8 mental health nurses (MHNs) from 321 respondents (Courtenay et al, 2017), whereas Latter et al (2011) reported that 5.5% of mental health inpatient wards/units and 47.7% of community mental health units in England had a qualified nurse prescriber. A survey of substance misuse services in England and Scotland identified 324 nurse prescribers, some of whom were employed outside the National Health Service (NHS) (Mundt‐Leach & Hill, 2014). In relation to advanced practice type roles, a national survey of MHN consultants in England identified 35.7% of respondents as NPs (Brimblecombe et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

The development of nurse prescribing in mental health services: Outcomes from five national surveys 2004–2019

Dobel-Ober

2022

J Nursing Management

Aim This study aimed to explore data from national surveys of nurse prescribing in England's National Health Service mental health services. Background Nurse prescribing is increasing worldwide. Reports describing long‐term developments after implementation are rare. Methods Five surveys were distributed to all mental health organisations between 2004 and 2019. Results Response rates increased from 54% (n = 45/83) in 2004 to 79% (n = 42/53) in 2019. The estimated proportion of mental health nurses who were prescribers increased to 4.3% by 2019. Distribution between clinical practice areas did not change significantly over time, with the largest numbers in community mental health teams. The proportion of nurse prescribers actively prescribing increased from 76.4% in 2014 to 87.8% in 2019. Independent prescribing became the predominant approach, with supplementary prescribing rarely used as the sole model within organisations. The scale of implementation varied markedly between organisations. Conclusions Although nurse prescribing in mental health services has grown over time, growth has slowed and is variable at local level. Implications for Nursing Management Organisations considering the introduction or growth of nurse prescribing should note the evidenced preference for an independent prescribing model to date and consider how to avoid unwarranted variation in nurse prescriber role distribution.