Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature

Abstract

BackgroundA growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor.MethodsA comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods.ResultsOne hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians.ConclusionsDifferences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights.

Stakeholders’ views on granting prescribing authority to pharmacists in Nigeria: a qualitative study

“…Prescribing to patients was the exclusive role of doctors and dentists, until the introduction of non-medical prescribing (NMP) in some countries which allowed non-medical professionals including nurses and pharmacists to prescribe medicines [2,3]. A number of countries have legislated for NMP including the United States of America (USA), United Kingdom (UK), Australia, New Zealand, Canada, Sweden, Republic of Ireland, South Africa, Botswana, Kenya and Uganda [4].…”

Medication prescription by nurses and the case of the Brazil: What can we learn from international research?

“…At the same time, national studies of supplementary prescribing (Bissell et al, 2008) mental health nurse prescribing (Norman et al, 2010) and independent prescribing in Ireland (Naughton et al, 2013) all showed largely positive findings, and so helped build support and confidence for nurse prescribing in the UK. Studies demonstrate that the prescription of medication by nurses is safe and competent, has led to better access and quality of care for patients, improvements in the abilities and experience of nurses, increased professional recognition, the legitimation of responsible autonomous practice and enabled better team working between the various healthcare professionals (Latter et al, 2012;Kroezen et al, 2011;Bhanbhro et al, 2011). Kroezen et al (2011) state that patient support and grassroots legislative constituency are crucial in battles over prescribing rights and these UK national studies all consistently reported patient support for nurse prescribing.…”

“…Studies demonstrate that the prescription of medication by nurses is safe and competent, has led to better access and quality of care for patients, improvements in the abilities and experience of nurses, increased professional recognition, the legitimation of responsible autonomous practice and enabled better team working between the various healthcare professionals (Latter et al, 2012;Kroezen et al, 2011;Bhanbhro et al, 2011). Kroezen et al (2011) state that patient support and grassroots legislative constituency are crucial in battles over prescribing rights and these UK national studies all consistently reported patient support for nurse prescribing. In Brazil there is no research that has evaluated the impact, quality or safety of the prescription of medication by nurses in primary health care, and this is now urgently required in order to collate evidence that may help win support and legitimacy for taking it forward.…”

“…For the International Council of Nursing (ICN), these actions are innovative elements that contribute to advanced nursing practice (ICN, 2011). The term prescription by nurses encompasses a diversity of practices within which we can highlight three models: the independent or substitute prescriber, the semi-autonomous or complementary prescriber, and the group protocol (Patient Group Directions) (Consejo General de Enfermería, 2006;Kroezen et al, 2011). Among the countries where prescription and the requisition of clinical examinations by nurses is already consolidated, the United Kingdom (UK), Sweden, United States, Canada, Australia, New Zealand, South Africa and Ireland stand out (Van Ruth et al, 2008;Krozen et al, 2012;Latter et al, 2010).…”

“…Whilst improvement in care for patients and better use of nurses' skills has ostensibly driven the expansion of prescribing in countries such as the UK, in Brazil, like other countries such as Canada and Australia, forces external to the nursing profession have motivated the introduction of prescription by nurses. These include reduction of health care expenditure, efficient use of time and resources (Van Ruth et al, 2008;Consejo General de Enfermería, 2006), reduction of doctors' workload, resolution of the problem of lack of doctors and to assist with coverage of patients in remote areas (Kroezen et al, 2011).…”