Education programmes preparing independent prescribers in Scotland: An evaluation
Introduction
The process for nurse prescribing in the UK started with the Cumberlege report. It recommended that a limited list be available for nurses to prescribe in their nursing care (DHSS, 1986) to end primary care nurses wasting time waiting for prescriptions from doctors when patient care had already been planned. Education for prescribing was delivered to community nurses by integrating it within their District/Community Nursing course. Initially prescribing was solely for nurses with a primary care qualification who prescribed from a very limited list. With the subsequent extension of nursing roles and the reduction in doctor's hours, prescribing rights have since been expanded across all areas of nursing, midwifery, health visiting and some allied health professions and is called non-medical prescribing (NMP).
Nurse prescribing is one of the most significant developments in the delivery of patient care in the UK over the last century (Harrison, 2003). Prescribing activity by nurses and midwives provides opportunities for a range of potential benefits including continuity of patient care, greater and quicker access of patients to treatments which may or may not involve some sort of prescription, more rapid treatments with patient safety benefits, enhanced and greater use of nurse's and midwive's skills, greater health service cost effectiveness and the release of GP and hospital doctor's time for other activities (Carey and Stenner, 2011, Earle et al., 2011, Courtenay and Carey, 2007, Courtenay et al., 2009, Kelly et al., 2010, Snowden, 2006).
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Review of Literature
During the research, there was no empirical research literature available to the team that could be found that explored the preparation of nurse prescribers (Banning, 2004).The large review of nurse and pharmacist prescribing in England did not research the educational preparation of nurse prescribing per se (Latter et al., 2011), so this study provides a new unique perspective on preparation for prescribing which is of international interest to countries as yet to embark on extending nurses
Background
The number, scale and scope of the work of nurse prescribers in Scotland have been developing rapidly since 1997 when nurse prescribing was limited to a small number of medications, appliances, reagents, and dressing products. Nurse prescriber numbers in Scotland have increased exponentially from a low base of a few hundred nurse prescribers ten years ago to over three thousand in 2010 (ISD Scotland, 2010). Prescribing legislation has also changed over time. In 1997 the education programme for
Aims
The aim of this study was to evaluate approaches to nurse prescribing training and their fitness for purpose as preparation for prescribing practice. The scope of the evaluation was comprehensive, surveying all seven programmes that commenced in Scotland in the first half of 2005. One university offered the programme at two locations and another at three locations. This made a total of ten centres throughout Scotland, each of which was included in the evaluation on an equal basis.
There were
The Population Investigated
A total of 192 nurses, midwives and health visitors began nurse prescribing programmes at ten different centres providing such training in Scotland during the period between January and May 2005.
The participation rate in the questionnaire survey was 97% (n = 186) and 47% of these were subsequently involved in the focus-groups.
Professional Affiliation
The sample consisted almost entirely of nurses (94%, n = 171) but there were also a few Health Visitors (3%, n = 6) and Midwives (3%, n = 5) and some participants who were both a
Focus-groups
Focus-groups with students on all seven programmes offered in Scotland indicated that the programmes significantly increased professional expertise and standing. The benefits of the programme were described as greater professional confidence, empowerment to provide better patient care, an expansion of their role as nurses and improved working relations with other professionals including General Medical Practitioners (GPs) and pharmacists.
These benefits were judged to arise from the
Interviews
Interviews with all programme leaders revealed a consensus that the generic structure model should be retained. The rationale is that it supports collaboration between nursing disciplines, especially between hospitals and community services, and prepares nurses to deal with co-morbidity and interactions with drugs other than those they are prescribing. The generic structure was also valued because it enabled networking with nurses from different specialties and provided the broad education in
Discussion
Most nurse prescribers undertook prescribing programmes from personal choice because of expected benefits for a) patient care and b) more efficient use of time. The students doing prescribing training are mostly highly experienced, mature professionals, who undertake lifelong learning to maintain and enhance their knowledge and skills. There were mixed views on some training programmes, some students felt that they adequately prepared them for prescribing in practice and others perceived ‘gaps’
Conclusion
Educational provision for preparation of nurse prescribers in Scotland has largely met the needs of those preparing to extend their role in practice. Employers play a key role in facilitating the preparation of nurse prescribers from practical provision such as arrangement of medical supervisors to supply of prescribing pads but also in creating the environment for prescribing to occur following qualification, and support for time to study (Watterson et al., 2009).
The harmonisation of
Role of the Funding Source
This particular study formed part of a larger project evaluating the extension of independent nurse prescribing in Scotland (Watterson et al., 2009) funded by the Social Research Department of the Scottish Government who identified the objectives of the research prior to funding being allocated.
Disclosure Statement
No conflicts of interest declared.
Acknowledgement
The authors would like to acknowledge the contribution of Lesley Doyle formerly Research Fellow, Institute of Education at the University of Stirling to the research project.
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