The prescribing needs of community practitioner nurse prescribers: A qualitative investigation using the theoretical domains framework and COM‐B

Abstract

Aim With a number of qualified community practitioner nurse prescribers (CPNPs) not prescribing, this research aimed to understand what influences this behaviour. Design A qualitative research design. Methods Semi‐structured interviews, based on the theoretical domains framework (TDF) were conducted with 20 CPNPs. Data collection took place between March‐July 2018 and continued until data saturation was reached. Results Nine themes inductively explained prescribing behaviour: 1) ‘Knowledge and experience’; 2) ‘Consultation and communication skills’; 3) ‘Professional confidence and identity’; 4) ‘Wanting the best outcome’; 5) ‘NHS versus patient cost’; 6) ‘Emotion‐led decisions’; 7) ‘Time allocation’; 8) ‘Formulary access’ and 9) ‘Supporting environment for patient‐centred care’. Themes were then deductively mapped to the TDF and COM‐B. Conclusion There is an ongoing need to support community practitioner nurse prescribers’ ‘Capability’ to prescribe in terms of knowledge and aquired skills; ‘Opportunity’ to make prescribing easier, such as access to a wider and up to date nurse formulary alongside effective clinical support; and ‘Motivation’ to feel confident in prescribing behaviour, highlighting positive patient outcomes while reducing perceived issues such as cost and non‐adherence. Impact Findings show that Capability, Opportunity and Motivation all influence the decision to prescribe. Those responsible for professional regulation and training should ensure community practitioner nurse prescribers have access to the relevant knowledge, skills and formulary to facilitate their prescribing behaviour. Professional confidence and identity as a prescriber should be encouraged, with acknowledgment of influences such as cost and emotion. An environment that allows for patient‐centred care and the best outcome should be supported, this may mean increasing time allocated to consultations.

Factors influencing the prescribing behaviour of independent prescriber optometrists: a qualitative study using the Theoretical Domains Framework

“…The determinants of behaviour we identified align with previous findings from studies of nurse prescribers. The importance of strong interpersonal communication skills reported in this study resonate with findings from previous studies of nurse prescribers 24,36 . We described the important influence of relationships with other healthcare professionals, which is also consistent with that found by previous studies of nurse prescribers 37,47,48 .…”

Influences on antibiotic prescribing by non-medical prescribers for respiratory tract infections: a systematic review using the theoretical domains framework

“…The identity as an NMP was highlighted as an important influence, and the importance of doing the right thing by way of the patient and the health care system has been found as a strong influence, both in this review and elsewhere 31,40 . In the UK at least, this, in part, can be linked to the national antibiotic guardianship initiative.…”

Development and Validation of the Nurse Prescribing Self-Efficacy Scale

“…In addition, the known-group analysis showed that the NP-SES could find statistically significant differences between the three groups of nurses with different levels of experience who participated in the study. The more experienced nurses are, the more confident they are to prescribe (Chater et al, 2019; Lim et al, 2018; Solomons et al, 2019). Nevertheless, when we compared self-efficacy in supplementary prescribing and evidence-based practice between groups, we only found statistically significant differences between the group of nursing graduates (with no professional experience) and the group of nurses with more than 10 years’ experience.…”

“…Nurse prescribing has been linked not only to positive patient outcomes (Kooienga & Wilkinson, 2017; Lim et al, 2017) but also to improved nurse-related outcomes (Carey et al, 2014; Hopia et al, 2017) and better results for health care services in general (Courtenay et al, 2017; Galiana-Camacho et al, 2018). However, the international literature suggests that nurses often encounter barriers to adequate prescribing (Chater et al, 2019; Graham-Clarke et al, 2018; Stewart et al, 2017). In this regard, numerous studies highlight that low self-efficacy could hamper nurses’ ability to prescribe (Lim et al, 2018; Maddox et al, 2016; Solomons et al, 2019).…”