Carey N, Stenner K (2011) Does non-medical prescribing make a difference to patients?, Nurs Times 107 (26) pp. 14-16
This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.
Carey N, Stenner K, Courtenay M (2010) Stakeholder views on the impact of nurse prescribing on dermatology services, JOURNAL OF CLINICAL NURSING 19 (3-4) pp. 498-506 WILEY-BLACKWELL PUBLISHING, INC
Stenner K, Courtenay M (2008) The role of inter-professional relationships and support for nurse prescribing in acute and chronic pain, JOURNAL OF ADVANCED NURSING 63 (3) pp. 276-283 WILEY-BLACKWELL
Aim. This paper is a report of a study to explore nurse prescribers' views on the role of inter-professional relationships and other means of support for nurse prescribing for patients in acute and chronic pain. Background. Research indicates that good team relationships are important for supporting nurse prescribing but that poor understanding of the role by other healthcare professionals can act as a barrier. While collaborative working is central to the role of pain nurses, there is a lack of research on the impact of nurse prescribing on inter-professional working or the support needs of these nurses. Method. A qualitative approach was adopted using thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were 26 nurses who prescribed medicines for patients with acute and/or chronic pain. Findings. Nurses' believed that prescribing encouraged collaborative working and sharing of knowledge across professional boundaries and that this helped to broaden understanding of the wider remit of pain management. Collaboration with doctors served a number of functions, including support and continuous learning. Barriers to effective nurse prescribing were a lack of understanding of its role amongst healthcare professionals and inadequate support. Formal support structures, such as regular clinical supervision, were seen as crucial to meeting nurses' ongoing learning. Conclusion. Factors that promote understanding of nurse prescribing and support inter-professional relationships are likely to have a positive impact on the effectiveness of nurse prescribing. A more consistent approach is required within organisations to support nurse prescribing. © 2008 The Authors.
This article aims to explore the views of doctors and nurses, who care for people with diabetes, about the prescribing programme. Interviews with 10 nurse prescribers, nine doctors and three non-nurse prescribers were conducted in nine case study sites across England between October 2007 and September 2008. Prescribing was seen as a natural extension of advanced nursing roles adopted by nurses caring for people with diabetes. Nurses considered it important to obtain sound knowledge in areas in which they intended to prescribe before undertaking the course. Variation across prescribing programmes with regards to the level of work required of students and the way in which courses were run were reported. Most doctors thought it beneficial for nurses to be involved in mentorship, although doctors' continued involvement was considered necessary. Prescribing supports advanced nursing practice in the care of people with diabetes. Nurses considering undertaking the prescribing course need to be aware of the variations across prescribing programmes with regards to the level of work required. There is support for joint mentorship between nurse prescribers and doctors for students undertaking taking the prescribing course.
BACKGROUND: Nurses make a valuable contribution to pain services and have the potential to improve the safety and effectiveness of pain management. A recent addition to the role of the specialist pain nurse in the United Kingdom has been the introduction of prescribing rights, however there is a lack of literature about their role in prescribing pain medication. OBJECTIVE: The aim of this study was to develop a profile of the experience, role and prescribing practice of these nurses. DESIGN: A descriptive questionnaire survey. SETTING: 192 National Health Service public hospital inpatient pain services across the United Kingdom. PARTICIPANTS: 161 qualified nurse prescribers were invited to participate, representing 98% of known nurse prescribers contributing to inpatient pain services. The survey was completed in November 2009 by 137 nurses; a response rate of 85%. RESULTS: Compared with nurse prescribers in the United Kingdom in general, participants were highly qualified and experienced pain specialists. Fifty-six percent had qualified as a prescriber in the past 3 years and 22% reported that plans were underway for more nurses to undertake a nurse prescribing qualification. Although all participants worked in inpatient pain services, 35% also covered chronic pain (outpatient) services and 90% treated more than one pain type. A range of pain medications were prescribed, averaging 19.5 items per week. The role contained a strong educational component and contributed to informing organisational policy on pain management. Prescribing was said to improve nurses' ability to promote evidence-based practice but benefits were limited by legislation on prescribing controlled drugs. CONCLUSIONS: Findings demonstrate that pain nurses are increasingly adopting prescribing as part of their advanced nurse role. This has implications for the development needs of pain nurses in the United Kingdom and the future role development of nurses in other countries.
This study aimed to explore the prescriptions issued to patients with diabetes by nurse independent and nurse supplementary prescribers working in general practice. A total of 19 prescriptions were collected and assessed from four case-study sites based in general practice between October 2007 and September 2008. Prescriptions were collected from patients with diabetes whose consultations were video recorded for the purposes of research. Prescriptions were consistently issued on an appropriate computer-generated prescription form, written legibly in ink, used the correct terminology, generic prescribing and contained an accurate/appropriate product dose and preparation. They were less consistent in stating the number of days, quantity of medicine to be supplied, and providing clear and accurate instructions on frequency and timing of treatment. Nurses in general practice are using computer based repeat prescribing systems to issue prescriptions to patients for the management of diabetes and its common complications, such as hypertension, hyperlipidaemia and cardiovascular disease. Whilst nurse prescribers were generally compliant with good practice in prescription writing, they need to ensure that they include ongoing information with respect to the number of days of treatment, quantity of medicine to be supplied, and clear and accurate instructions regarding the frequency and timing of medicines.
Courtenay M, Carey N, Stenner KL (2009) Dermatology patients' views on nurse prescribing, Dermatological Nursing 8 (2) pp. 38-44
In the United Kingdom, non-medical prescribing (NMP) has been identified as one way to improve healthcare quality and efficiency. Healthcare organisations are charged with overseeing the clinical governance of NMP and guidance recommends the identification of a lead director to be responsible for its implementation. While over twelve million items are prescribed each year by the 50,000 qualified NMPs its uptake is inconsistent. Several studies have explored the barriers to NMP at a practice level, however little is known about the role the NMP lead and the implementation of NMP from an organisational perspective. The aim of this research was to explore the role of the organisational NMP lead across a range of practice settings within one Strategic Health Authority (SHA) and consider the development of NMP from a multi-organisational perspective.
Stenner K, Iacovou N (2006) Evaluating the impact on practice of a west of Berkshire protected learning time initiative in primary care, Education for Primary Care 17 (4) pp. 371-378
Despite the popularity of half-day protected learning time events within primary care, there are few published evaluations and little evidence of their impact on practice. This paper describes the main findings of an exploratory evaluation of such an initiative in the west of Berkshire. The initiative was found to be effective in terms of working to meet its main aims of enhancing practice and developing a learning culture. Many examples of impact on practice were reported and there was agreement among participants over effectiveness in relation to improving awareness of services, enhancing understanding of illness and improving treatments or procedure. Questions are raised about the balance of meeting the diverse needs of different staff groups whilst encouraging a multi-professional learning environment. © 2006 Radcliffe Publishing Limited.
Courtenay M, Carey N, Stenner KL (2009) Nurse prescribing in dermatology, Dermatology Nursing 8 (1) pp. 24-30
Stenner K, Carey N, Courtenay M (2012) Prescribing for pain - how do nurses contribute? A national questionnaire survey., J Clin Nurs
Aims and objectives.? To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Background.? Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. Design.? A descriptive questionnaire survey. Method.? An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Results.? Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Conclusion.? Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. Relevance to clinical practice.? The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits.
Carey N, Stenner K, Courtenay M (2014) An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England., BMC Health Serv Res 14 (1)
There is a need to reduce symptoms, exacerbations and improve quality of life for patients with respiratory diseases. Across the world, increasing numbers of nurses are adopting the prescribing role and can potentially enhance service provision. Evidence suggests improved quality of care and efficiencies occur when nurses adopt the prescribing role. No evidence is available on the views of nurse prescribers who care for respiratory patients. The aim was to explore how nurse prescribing is being used for patients with respiratory conditions in different care settings across one strategic health authority, and whether this has benefited patients, healthcare professionals and the National Health Service.
Stenner K, Carey N, Courtenay M (2009) Nurse prescribing in dermatology: doctors' and non-prescribing nurses' views, JOURNAL OF ADVANCED NURSING 65 (4) pp. 851-859 WILEY-BLACKWELL PUBLISHING, INC
Stenner K, Carey N, Courtenay M (2010) Implementing nurse prescribing: a case study in diabetes, JOURNAL OF ADVANCED NURSING 66 (3) pp. 522-531 WILEY-BLACKWELL PUBLISHING, INC
Keene J, Stenner K, Connor M, Fenley S (2007) A case-study of substitute opiate prescribing for drug-using offenders, DRUGS-EDUCATION PREVENTION AND POLICY 14 (5) pp. 443-456 TAYLOR & FRANCIS LTD
Courtenay M, Stenner KL, Carey N (2009) An exploration of the practices of nurse prescribers who care for people with diabetes: a case study, Journal of Nursing and Healthcare of Chronic Illness 1 (4) pp. 311-320
Aim. To explore the practices of nurse prescribers who care for people with diabetes.
Background. The use of medicines is an important component of the care of patients with diabetes. However, education and support is equally important to the successful management of this group. These are areas of care in which nurses have traditionally been involved. Evidence suggests that combining nursing skills with prescribing may result in shared decision-making and increased medicines concordance.
Design and methods. A collective case study of nine practice settings across England in which nurses prescribed medicines for people with diabetes. Data comprised of semi structured interviews (n = 31), patient questionnaires (n = 131) and video-taped observations of nurse consultations (n = 35). Data analysis included thematic analysis and descriptive statistics. Data were collected between October 2007?September 2008.
Results. Nurses demonstrated good communication skills, which they integrated with the ability to prescribe. Questionnaire and video data confirmed an exchange of information between nurse and patient about aspects of self-care and medicines management. Additional benefits included improved efficiency, supported by patient satisfaction with access and waiting times. Nurses were inconsistent in explaining the risks and benefits of treatments and side-effects and exploring the use of non-prescribed herbal or over-the-counter medicine.
Conclusion. The care nurses are able to provide to people with diabetes is optimised through prescribing. Further evidence is required to evaluate nurse prescribing from the patient?s perspective. Our findings will be of interest to those keen to develop the prescribing role for nurses involved in diabetes service delivery.
Relevance to clinical practice. Prescribing is a valuable development through which nurses are able to encourage self-care and work towards shared-decision making with patients in a way that supports national guidance on the care of people with diabetes.
Carey N, Stenner K, Courtenay M (2009) Adopting the prescribing role in practice: exploring nurses' views in a specialist children's hospital., Paediatr Nurs 21 (9) pp. 25-29
BACKGROUND: Recent United Kingdom government policy emphasises that prescribing by nurses can improve access to medicines. However, the views of nurses prescribing for children have not been explored. AIM: To explore the views of children's nurses working in a specialist hospital on the adoption of the prescribing role in their practice. METHOD: A longitudinal, qualitative approach was adopted using thematic analysis on semi-structured interview data collected during 2006 and 2007. Participants were seven children's nurses who were qualified nurse prescribers. FINDINGS: Nurse prescribing was reported to improve efficiency, allow nurses to complete episodes of care and improve communication with patients. This was believed to enhance quality of care and job satisfaction for nurses. CONCLUSION: Children's nurses' capacity to prescribe medicines contributes to healthcare policy. Further research is recommended to substantiate these findings.
Stenner KL, Courtenay M (2007) A qualitative study on the impact of legislation on the prescribing of controlled drugs by nurses, Nurse Prescribing 5 (6) pp. 257-262
This qualitative research explores the views of 26 qualified Nurse Independent and Nurse Supplementary Prescribers on the adoption of the role of prescribing for patients in pain, and how the legislation on prescribing controlled drugs has had an impact on practice. This level of prescribing, and the impact of legislation have varied according to the context in which the nurses worked. Practice was affected in the hospital setting where there was confusion over definitions of pain types. Nurses working with chronic pain patients in outpatient settings tended to make recommendations rather than prescribe medication. The findings of this study inevitably have implications for the Home Office consultation on the prescription of controlled drugs by Nurse Independent Prescribers.
Carey N, Stenner KL, Courtenay M (2010) How nurse prescribing is being used in diabetes services: views of nurses and team members, Journal of Nursing and Healthcare of Chronic Illness 2 (1) pp. 13-21 Wiley-Blackwell
Aim. To explore the views of nurses, doctors, non-nurse prescribers and administrative staff on how nurse prescribing is being used in diabetes services.
Background. Nurse-led services enhance care and improve outcomes for patients with diabetes. Research indicates that care delivered by nurse prescribers can improve efficiency and support new ways of working. There is no evidence reported that explores nurses and team member views on how nurse prescribing is being used in diabetes services.
Method. A collective case study of nine practice settings across England in which nurses prescribed medicines for patients with diabetes. A thematic analysis of semi-structured interview data collected during 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, doctors and non-prescribing nurses.
Findings. Nurse prescribing was reported to enhance and support a variety of models of diabetes care. It enabled nurses to work more independently and provide a more streamlined service. Maintaining a team approach ensured that nurses continued to learn and maintained good relationships with doctors.
Conclusion. Nurse prescribing is being successfully used to support and develop more streamlined services for patients with diabetes. Individual and organisational factors, as well as the interpretation of policy initiatives are reported to influence how prescribing is used in practice. Understanding the implications of these forces is important if the full potential of this new and developing role is to be realised.
Relevance to clinical practice. Nurses have an important role to play in the medicines management of patients with diabetes. Nurse prescribing supports and enhances established diabetes services. Prescribing allows nurses to develop diabetes services around the needs of the individual and introduce new ways of working such as the single review process.
To explore the practice of nurses who prescribe medication for patients with skin conditions.
Carey N, Stenner KL, Courtenay M (2009) Views on implementing nurse prescribing in a specialist children's hospital, Nurse Prescribing 7 (5) pp. 205-2010
This study aimed to explore the views of health care professionals on the implementation of nurse prescribing in a specialist children's hospital. An intrinsic case study approach was taken using thematic analysis on semi-structured interview data collected during 2006 and 2007. Participants were seven children's nurses who were qualified nurse prescribers, 11 doctors and three clinical leads in one specialist children's hospital. Nurses varied in their actual and desired levels of autonomy, and this was reflected in the way that prescribing was used in practice. Some nurses tended to treat existing patients, had less assessment and diagnostic skills and felt little need for support. The original selection of nurses focused around the needs and wishes of individuals, but was quickly superseded by the adoption of a more strategic approach. Nurses' expectations of prescribing may influence the extent to which they use their prescribing qualification and their subsequent support needs. Adopting a strategic approach to workforce planning and preparation should help ensure that the full potential of nurse prescribing is realized.
Stenner K, Carey N, Courtenay M (2012) Prescribing for pain - how do nurses contribute? A national questionnaire survey, Journal of Clinical Nursing 21 (23-24) pp. 3335-3345
Aims and objectives. To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Background. Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. Design. A descriptive questionnaire survey. Method. An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Results. Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Conclusion. Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. Relevance to clinical practice. The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits. © 2012 Blackwell Publishing Ltd.
Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA.
Courtenay M, Carey N, Stenner K, Lawton S, Peters J (2010) Patients' views of nurse prescribing: effects on care, concordance and medicine taking, BRITISH JOURNAL OF DERMATOLOGY 164 (2) pp. 396-401 WILEY-BLACKWELL
Stenner KL, Carey N, Courtenay M (2010) How nurse prescribing influences the nursing role, Nurse Prescribing 8 (1) pp. 29-34
Because role change can be disruptive, the introduction of nurse prescribing could potentially lead to confusion and conflict over role boundaries and definitions. This article considers how adopting prescribing has influenced the role of nurse prescribers who treat and manage patients with diabetes. Interviews with 10 nurse prescribers, nine doctors and three non-prescribing nurses were collected as part of a case study of nine UK sites where nurses prescribed medicines for patients with diabetes. We found that nurses resisted the 'medicalization' of their role. They strove to ensure that their consultations continued to follow a 'nursing model' which involved holistic assessment, health promotion and patient-centred care. There were perceived differences in the level of decision-making between doctors and nurse prescribers. To conclude, nurses adopted prescribing while maintaining a nursing approach to practice. For specialist nurses, this expanded role included higher levels of decision-making more traditionally associated with doctors.
Stenner K, Courtenay M (2008) Benefits of nurse prescribing for patients in pain: nurses' views, JOURNAL OF ADVANCED NURSING 63 (1) pp. 27-35 WILEY-BLACKWELL
Courtenay M, Stenner K, Carey N (2010) The views of patients with diabetes about nurse prescribing, DIABETIC MEDICINE 27 (9) pp. 1049-1054 WILEY-BLACKWELL
Courtenay M, Carey N, Stenner K (2009) Nurse prescriber-patient consultations: a case study in dermatology, JOURNAL OF ADVANCED NURSING 65 (6) pp. 1207-1217 WILEY-BLACKWELL PUBLISHING, INC
The fact that health inequalities disproportionately affect the minority ethnic population is not new and projections are that the minority ethnic population will continue to increase. The importance of early intervention and the key role that health visitors can play in attempting to reduce health inequalities is well documented as is the requirement for health providers to establish culturally sensitive services. To date, much of the research has focused on the perspectives of healthcare professionals caring for minority ethnic clients in hospital-based settings and little is known about the perspectives of minority ethnic clients regarding the health visiting service (HVS). The aim of this study was to explore the perspectives of South Asians regarding their experiences with the HVS. The study was conducted in a small town in the South of England between March and June 2013. A qualitative study using a grounded theory approach was used to capture the perspectives of this group regarding their interactions with the HVS. The sample consisted of 15 participants and data were collected through audio-recorded semi-structured interviews and analysed using constant comparative approach. Three key categories were identified: 'understanding the health visitor's role', 'sensitivity of services' and 'the significance of family'. While clients valued one-to-one support from health visitors, there was some evidence of poor communication and ethnocentric tendencies within the service. It was found that South Asian clients distinguish between health and parenting advice, being more likely to accept health advice from their health visitor and more likely to accept parenting advice from their family. The findings, although limited in their generalisability, offer important insights into how South Asians perceive the service and will equip health visitors with a better understanding of how best to improve the experience of South Asian clients accessing the health visiting.
Making best use of existing skills to increase service capacity is a global challenge. The aim was to systematically review physiotherapy and podiatrist prescribing and medicines management activity, including evidence of impact on patient care, levels of knowledge and attitudes towards extended medicines role.
A search of MEDLINE, CINAHL, and Cochrane databases, using terms to identify prescribing and medicines management across a range of roles, was conducted from January 1985 to May 2016 for physiotherapy, and January 1968 to May 2016 for podiatry. Hand searching of citations and databases from professional organisations was undertaken. Data were extracted and analysed descriptively, and quality appraised by 2 reviewers using the mixed methods appraisal tool.
1316 papers were identified, and 21 included in the review. No studies were identified that reported prescribing and no studies specific to podiatry met the inclusion criteria. Physiotherapists were highly involved in administering medicines, providing medicines advice, and recommending new medicines. Patient satisfaction, cost and outcomes were equivalent when comparing physiotherapist-led injection therapy to traditional care. Pharmacology knowledge was variable and unmet training needs identified.
Medicines management practices were identified in physiotherapy and positive outcomes of extended scope physiotherapy. There was a lack of evidence regarding podiatric practice. Review of educational preparation for medicines management is recommended along with evaluation of medicines management practice.