The integration of nurse prescribing: case studies in primary and secondary care

Bowskill, Dianne (2009) The integration of nurse prescribing: case studies in primary and secondary care. DHSci thesis, University of Nottingham.

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Nurse independent and supplementary prescribers have legal authority to prescribe all licensed and unlicensed medicines with some minor restriction to prescribing controlled drugs. These prescribing rights are similar to those of doctors. To be effective, the integration of nurse prescribing must be consistent with the legal framework for nurse prescribing and, be acceptable to the nurse, employer, patient and healthcare team. There is little known about how prescribing is integrated in practice but agreements are potentially important to the organisation of professional work and may ultimately affect patient safety.

These case studies set out to investigate how nurse prescribers integrate prescribing in primary and secondary care. Each case, a nurse prescriber,had completed the independent and supplementary prescribing course at one university between September 2004 and January 2007. Of the 26 cases recruited 13 had been qualified to prescribe for between 7 and 13 months, and 13 for 14 and 26 months. Data collected through semistructured interviews, field notes and attribute data was drawn together in case summaries. Data analysis showed effective integration to be dependent upon professional relationships and prescribing role agreements.

Prescribers outlined three approaches to integrate prescribing. These were; prescribing as the opportunity presents, prescribing for specific conditions and prescribing for individuals. Prescribing as the opportunity presents reflects medical models of prescribing. Condition specific and individual approaches restrict prescribing to specific medical condition(s)or individual patients. These nurse prescribers preferred to use Independent prescribing. Reflecting this, prescribers showed higher levels of dependence on doctors than previously reported. This was most common in the first year of prescribing. Relationships between nurse prescribers and the team were important. New nurse prescribers raised unexpected issues in some intraprofessional relationships. However, it was the inter-professional relationship between nurse and doctor that determined integration. The nurse must believe, trust exists and is reciprocal to integrate prescribing in practice. Where there was an absence of trust or a concern of mistrust the nurse would not integrate prescribing.

Item Type: Thesis (University of Nottingham only) (DHSci)
Supervisors: James, V.C.
Timmons, S.
Keywords: Nurse prescribers, Professional relationships, Prescribing education, Team relationships
Subjects: QS-QZ Preclinical sciences (NLM Classification) > QV Pharmacology
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Nursing
Item ID: 11036
Depositing User: EP, Services
Date Deposited: 01 Mar 2010 13:33
Last Modified: 15 Dec 2017 01:54

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