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An Evaluation of the Expansion of Nurse Prescribing in Scotland

DescriptionNurse prescribers in Scotland can now prescribe a range of controlled drugs for specific medical conditions. This research project which is summarised below provides an evaluation of the extension of nurse prescribing following the introduction of new legislation in 2001.
ISBN978 07559 76591
Official Print Publication DateSeptember 2009
Website Publication DateSeptember 25, 2009

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Andrew Watterson, Fiona Turner, Alison Coull, Ian Murray
Department of Nursing and Midwifery, University of Stirling
Nick Boreham Institute of Education, University of Stirling
Scottish Government Social Research
2009

ISBN 978 0 7559 7659 1(Web only publication)

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Acknowledgements

We would like to acknowledge the contribution that a number of people and organisations made to the report, including Information Services Division ( ISD) and our survey company, in terms of providing information and advice. We would like to thank all those nurse prescribers, health professionals, stakeholders and others who gave up their time to talk to us. Our in-house and lay steering group proved invaluable: Mike Wilson for University of Stirling provided statistical support and analysis for us during the preparation of the report. Fraser Boxall, a service user member of the research advisory group, Sarah Annesley University of Stirling, Nicola Ring University of Stirling, and Sheena Williamson University of Stirling provided excellent ideas and constructive observations. Our Research Advisory Group proved very supportive and our clerical and administrative team were remarkably patient and efficient.

CONTENTS

GLOSSARY

EXECUTIVE SUMMARY
FINDINGS: NURSE PRESCRIBING IN PRACTICE
FINDINGS: NURSE PRESCRIBING EDUCATION
CONCLUSIONS

CHAPTER ONE: INTRODUCTION
INTRODUCTION
OVERVIEW OF LEGISLATION
NURSE PRESCRIBING NUMBERS IN SCOTLAND
REPORT OVERVIEW

CHAPTER TWO: RESEARCH ON NURSE PRESCRIBING
RESEARCH ON NURSE PRESCRIBERS
RESEARCH ON PATIENT VIEWS
SCOTTISH NURSE PRESCRIBING LITERATURE
CONCLUSIONS

CHAPTER THREE: METHODS
INTRODUCTION
METHODS USED TO EVALUATED NURSE PRESCRIBING IN PRACTICE
EVALUATION OF NURSE PRESCRIBER EDUCATION
ETHICAL AND GOVERNANCE ISSUES

CHAPTER FOUR: NURSE PERSPECTIVES ON NURSE PRESCRIBING
INTRODUCTION
PROFILE OF NURSE PRESCRIBERS
CURRENT PRACTICE
FACTORS INFLUENCING DECISION TO BECOME A NURSE PRESCRIBER
SATISFACTION AND IMPACT ON ROLE
PERCEPTION OF BENEFITS OF NURSE PRESCRIBING TO PATIENTS
LOCATION OF TRAINING
FACTORS AFFECTING PRESCRIBING WORK
FUTURE PRACTICE AND DEVELOPMENTS
SUMMARY AND CONCLUSIONS

CHAPTER FIVE: STAKEHOLDER PERSPECTIVES
INTRODUCTION
VIEWS FROM GENERAL SHAREHOLDERS
VIEWS FROM HEALTHY STAKE
STAKEHOLDER VIEWS FROM CASE STUDIES
SUMMARY AND CONCLUSIONS

CHAPTER SIX: NURSE PRESCRIBING EDUCATION
INTRODUCTION
DESCRIPTION OF THE NURSE PRESCRIBING COURSES
THE COURSE PROVIDERS' PERSPECTIVE OF THE NURSE PRESCRIBING COURSES
THE COURSE MEMBERS' PERSPECTIVE
SUMMARY AND CONCLUSIONS

CHAPTER SEVEN: PATIENT PERSPECTIVES OF NURSE PRESCRIBING
INTRODUCTION
STAKEHOLDER PERSPECTIVES ON PATIENT BENEFITS OF NURSE PRESCRIBING
INITIAL STAKEHOLDER INTERVIEWS
PATIENT PERSPECTIVES ON NURSE PRESCRIBING
SUMMARY AND CONCLUSIONS

CHAPTER EIGHT: NURSE PRESCRIBING IMPACT ON HEALTH SERVICE
INTRODUCTION
IMPACT ON WORKLOADS
NURSE AND MEDICAL STAFF VIEWS OF NURSE PRESCRIBING
PROMOTERS AND BARRIERS TO CHANGE
SUMMARY AND CONCLUSIONS

CHAPTER NINE: PUBLIC HEALTH AND PATIENT SAFETY IN NURSE PRESCRIBING
INTRODUCTION
LITERATURE REVIEW
SAFEGUARDS FOR PUBLIC HEALTH AND PATIENT SAFETY IN NURSE PRESCRIBING WITH PARTICULAR REFERENCE TO MICROBIAL SAFETY
MICROBIAL DISEASE MANAGEMENT
STAKEHOLDER PERSPECTIVES
CASE STUDY FINDINGS
CONCLUSION

CHAPTER TEN: CONCLUSIONS AND RECOMMENDATIONS
INTRODUCTION
FINDINGS: NURSE PRESCRIBING IN PRACTICE
FINDINGS: NURSE PRESCRIBING EDUCATION
NURSE PRESCRIBING POSITIVES AND CHALLENGES
THE POSITIVES
THE CHALLENGES
RECOMMENDATIONS AND SUGGESTIONS FOR FUTHER RESEARCH

REFERENCES

ANNEX 1 NATIONAL QUESTIONNAIRE
ANNEX 2
OMNIBUS QUESTIONS - FIRST AND SECOND SURVEYS
ANNEX 3
INITIAL QUESTIONNAIRE ADMINISTERED TO COURSE MEMBERS
ANNEX 4
SAMPLE PARTICIPANT INFORMATION SHEET/ CONSENT FORM
ANNEX 5
NURSE PRESCRIBERS' COURSE CONSENT FORM
ANNEX 6
INTERVIEW SCHEDULE FOR COURSE LEADERS AND LECTURERS
ANNEX 7
CASE STUDIES INFORMATION SHEET (NURSE PRESCRIBERS)
ANNEX 8
NURSE PRESCRIBING LOG INSTRUCTIONS
ANNEX 9
NURSE PRESCRIBING LOG
ANNEX 10
INFORMATION SHEET FOR ACTIVITY QUESTIONNAIRE
ANNEX 11
NURSE PRESCRIBER'S ACTIVITY QUESTIONNAIRE
ANNEX 12
NURSE PRESCRIBER INTERVIEW SCHEDULE
ANNEX 13
INTERVIEW QUESTIONS PROFESSIONAL GROUPS
ANNEX 14
PATIENT INTERVIEW QUESTIONS
ANNEX 15
CASE STUDY CRITERIA MATRICES
ANNEX 16
CASE STUDY SETTINGS & PARTICIPANTS
ANNEX 17
NURSE PRESCRIBING STAKEHOLDER GROUPS - POLICY AND NHS

LIST OF TABLES AND CHARTS
TABLE 1.1 THE INCREASE IN NURSE PRESCRIBING IN SCOTLAND
TABLE 1.2
NURSE PRESCRIBING - NUMBER OF PRESCRIBED ITEMS (ISD, 2007)
TABLE 3.2 INTERVIEWEE CATEGORIES AND NUMBERS
TABLE 4.1
NURSE PRESCRIBER AGE PROFILE 2005
TABLE 4.2 PRESCRIBER CATEGORY
TABLE 4.3
LEVEL OF PRESCRIBING BY NURSE PRESCRIBERS
TABLE 4.4 MOTIVATION TO UNDERTAKE TRAINING AND BECOME A PRESCRIBER
TABLE 4.5 IMPACT OF BECOMING A NURSE PRESCRIBER
TABLE 4.6
NURSE PRESCRIBER VIEWS OF BENEFITS TO PATIENTS
TABLE 4.7 WHERE NURSES COMPLETED NURSE PRESCRIBING TRAINING
TABLE 4.8 EFFECTIVENESS OF TRAINING FOR A VARIETY OF AREAS*
TABLE 4.9 FACTORS AFFECTING PRESCRIBING WORK*
TABLE 4.10
DESIRED FUTURE DEVELOPMENTS IN NURSE PRESCRIBING
TABLE 6.1 RATIOS OF ON-SITE/OFF-SITE STUDY
TABLE 6.2 THE COURSE MEMBERS' PROFESSIONAL AFFILIATIONS
TABLE 6.3 HEALTHCARE SETTINGS COURSE MEMBERS WERE PRACTISING
TABLE 6.4 GEOGRAPHICAL AREAS COURSE MEMBERS PRACTISED
TABLE 6.5 AGE DISTRIBUTION OF NURSES TRAINING AS NURSE PRESCRIBERS*
TABLE 6.6 HIGHEST NON-PROFESSIONAL ACADEMIC QUALIFICATION*
TABLE 6.7 COMPLEMENTARY COURSES BEING TAKEN
TABLE 6.8 PROTECTED STUDY TIME
TABLE 6.9 SUMMARY OF POSITIVE THEMES
TABLE 6.10 SUMMARY OF NEGATIVE THEMES
TABLE 7.1 AWARENESS OF NURSE PRESCRIBING BY SOCIOECONOMIC GROUP
TABLE 7.2 LOCATION IN WHICH PATIENT HAD RECEIVED NURSE PRESCRIPTION*
TABLE 7.3 PATIENT SATISFACTION WITH NURSE PRESCRIBING*
TABLE 7.4 COMPARISON OF NURSE/DOCTOR PRESCRIBING*
TABLE 7.5 NURSE PRESCRIBING VERSUS GP PRESCRIBING*
TABLE 8.1 PRESCRIPTIONS ISSUED BY NURSE PRESCRIBERS PER WEEK
CHART 8.1 AVERAGE NUMBER OF PRESCRIPTIONS WRITTEN IN A WEEK
TABLE 8.2 WORKING PATTERN OF NURSE PRESCRIBERS IN 2 NHS BOARDS

The views expressed in this report are those of the researcher and
do not necessarily represent those of the Department or Scottish Ministers.

This report is available on the Scottish Government Social Research website only
www.scotland.gov.uk/socialresearch.