Dr Karen Stenner

Aims To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services. Design Qualitative case study. Methods Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted. Results A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID-19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting. Conclusion Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively. Impact Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings. Patient or Public Contribution A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings.

Background: Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights for medicines: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists.

Abstract available from publisher's website.

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% ( =93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% ( =3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety.

Abstract Background Increasing numbers of nurses, pharmacists and allied health professionals across the world have prescribing rights: over 90,000 of the eligible United Kingdom workforce are qualified as non-doctor prescribers. In order to inform future developments, it is important to understand the benefits and impact of prescribing by allied health professionals including physiotherapists and podiatrists. Aim: to compare outcomes of Physiotherapist and Podiatrist Independent Prescriber (PP-IP) patients with those of Physiotherapist and Podiatrist non-prescribers (PP-NPs). Outcome measures included patient satisfaction, ease of access to services, quality of life and cost implications. Design: a quasi-experimental, post-test control group design Methods: Using mixed methods outcomes were compared between 7 sites where care was provided from a PP-IP (3 podiatrist and 4 physiotherapist IPs) and 7 sites from a PP-NP (3 podiatrist and 4 physiotherapist NPs). Patients were followed up for 2 months (2015-2016). Results: 489 patients were recruited: n=243 IP sites, and n=246 NP sites. Independent prescribing was found to be highly acceptable, and equivalent in terms of quality of life (p>0.05) and patient satisfaction (p≤0.05) compared to care provided by NPs. PP-IP care delivery was found to be more resource intensive than NP-PP, with longer consultation duration for IPs (around 6.5 mins), and a higher proportion of physiotherapy patients discussed with medical colleagues (around 9.5 minutes). Conclusion This study provides new knowledge that PP-IPs provide high levels of care. PP-IP care delivery was found to be more resource intensive. Further research is required to explore cost effectiveness. A more focussed exploration within each profession using targeted outcome measures would enable a more robust comparison, inform future developments around the world and help ensure non-doctor prescribing is recognised as an effective way to alleviate shortfalls in the global workforce.

The aim of this study were to compare nurse prescribers and non-prescribers managing people with diabetes in general practice regarding: (a) patient characteristics; (b) activities and processes of care; (c) patient outcomes (self-management, clinical indicators, satisfaction) and (d) resource implications and costs. Over 28,000 nurses in the UK can prescribe the same medicines as doctors provided that it is in their level of experience and competence. Over 30%, mostly in general practice, prescribe medicines for patients with diabetes. A comparative case study. Nurses managing care of people with Type 2 diabetes were recruited in twelve general practices in England; six could prescribe, six could not. Patients, recruited by nurses, were followed up for 6 months (2011–2012). The patient sample comprised 131 in prescriber sites, 83 in non-prescriber sites. Patients of prescribers had been diagnosed and cared for by the nurse longer than those of non-prescribers. There were no differences in reported self-care activities or HbA1c test results between the patients of prescribers and non-prescribers. Mean HbA1c decreased significantly in both groups over 6 months. Patients of prescribers were more satisfied. Consultation duration was longer for prescribers (by average of 7·7 minutes). Non-prescribing nurses sought support from other healthcare professionals more frequently. Most prescribing nurses were on a higher salary band than non-prescribers. Clinical outcomes of patients managed by prescribing and non-prescribing diabetes nurses are similar. Prescribing nurses had longer relationships with their patients and longer consultations, possibly contributing to higher satisfaction with care. Employment costs of prescribing nurses are potentially higher.

Introduction Healthcare workforces are currently facing multiple challenges, including aging populations; increasing prevalence of long-term conditions; and shortfall of registered nurses. Employing non-registered support workers is common across many countries to expand service capacity of nursing teams. One task delegated to non-registered support workers is medication administration, which is considered a complex task, with associated risks. This is an important topic given the predicted global increase in patients requiring assistance with medication in community settings. This review explores the evidence on delegation of medication administration from registered nurse to non-registered support workers within community settings to better understand factors that influence the process of delegation and its impact on service delivery and patient care. Methods The review followed key principles of Critical Interpretative Synthesis and was structured around Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines. Literature searches were conducted in MEDLINE, CINAHL, Embase, and ProQuest-British Nursing Index databases. Twenty studies were included. Results Findings are reported under four themes: 1, Regulatory and contextual factors; 2, Individual and team level factors; 3, Outcomes of delegation; and 4, Process of implementation and evaluation. Delegation was found to be a complex phenomenon, influenced by a myriad of interconnecting factors at the macro, meso, micro level. At the macro level, the consistency and clarity of government and state level regulations was found to facilitate or impede delegation of medication administration. Lack of clarity at the macro level, impacted at meso and micro levels, resulting in confusion around what medication administration could be delegated and who held responsibility. At the micro level, central to the interpretation of success was the relationship between the delegator and delegate. This relationship was influenced by personal views, educational and systems factors. Many benefits were reported as an outcome of delegation, including service efficiency and improved patient care. The implementation of delegating medication administration was influenced by regulatory factors, communication, stakeholder engagement, and service champions. Conclusion Delegation of medication administration is a complex process influenced by many interrelating factors. Due to the increased risk associated with medication administration, clear and consistent regulatory and governance frameworks and procedures are crucial. Delegation of medication administration is more acceptable within a framework that adequately supports the process, backed by appropriate policy, skills, training, and supervisory arrangements. There is a need for further research around implementation, clinical outcomes and medication errors associated with delegation of medication administration.

Objective: 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. Methods: 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. Results: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. Conclusion: 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.

Background: Globally, Multidisciplinary Teams (MDTs) are considered the gold standard for diagnosis and treatment of cancer and other conditions, but variability in performance has led to demand for improvement tools. MDT-FIT (Multidisciplinary Team Feedback for Improving Teamwork) is an improvement programme developed iteratively with over 100 MDTs (>= 1100 MDT-members). Complex interventions are often adapted to context, but this is rarely evaluated. We conducted a prospective evaluation of the implementation of MDT-FIT across an entire integrated care system (ICS). Methods: MDT-FIT was implemented within all breast cancer MDTs across an ICS in England (n = 10 MDTs; 275 medical, nursing, and administrative members). ICS managers coordinated the implementation across the three stages of MDT-FIT: set up; assessment (self-report by team members plus independent observational assessment); team-feedback and facilitated discussion to agree actions for improvement. Data were collected using process and systems logs, and interviews with a purposively selected range of participants. Analysis was theoretically grounded in evidence-based frameworks for implementation strategies and outcomes. Results: All 10 MDTs participated in MDT-FIT; 36 interviews were conducted. Data from systems and process logs covered a 9-month period. Adaptations to MDT-FIT by the ICS (e.g., coordination of team participation by ICS rather than individual hospitals; and reducing time protected for coordination) reduced Fidelity and Adoption of MDT-FIT. However, the Acceptability, Appropriateness and Feasibility of MDT-FIT remained high due to embedding implementation strategies in the development of MDT-FIT (e.g., stakeholder engagement, interactive support). Conclusions: This is a unique and comprehensive evaluation of the multi-site implementation of a complex team improvement programme. Findings support the imperative of considering implementation strategies when designing such programmes to minimize potentially negative impacts of adaptations in "real world" settings.

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.

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.

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.

Aim. To explore stakeholder views on the impact of nurse prescribing on dermatology services. Background. Nurse led care enhances the services that dermatology patients receive. Research indicates that care delivered by nurse prescribers can improve efficiency and access to medicines. There is no evidence exploring the impact of nurse prescribing on the configuration of dermatology services. Design. Case study. Method. A collective case study of 10 practice settings across England where nurses prescribed medicines for dermatology patients. A thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were qualified nurse prescribers, administrative staff, doctors and non-nurse prescribers. Findings. Nurse prescribing was reported to support and facilitate the modernisation of dermatology services. It enabled nurses to make effective use of their knowledge and skills, overcome delays in treatment and provide faster access to medicines. However several organisational issues restricted the success of the initiative. Conclusion. Nurse prescribing is successfully being used to support and deliver a range of services to dermatology patients. Stakeholders reported that both patients and staff had benefited by the adoption of this role by nurses. However issues over support and access to CPD and capacity of the workforce were identified as potential barriers which could affect the contribution of nurse prescribing to dermatology patients. Relevance to clinical practice. Nurse prescribing contributes to the services provided to dermatology patients; Nurse supplementary prescribing contributes to the ability of dermatology nurse specialists to work in teams and prescribe complex medicines; Provision of adequate support and strategic planning are essential if the impact of nurse prescribing is to be fully realised; © 2009 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.

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.

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.

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.

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.

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.

Background: There is a drive to improve the quality of service provision for patients with diabetes and to enable better self-management of this condition. The adoption of prescribing by nurses is increasing worldwide and can potentially enhance service provision. Evidence suggests that patients prefer services where their lifestyle factors and opinions are considered by healthcare professionals within a partnership approach. Few studies have explored patients’ views about their consultations with a nurse prescriber. Objective: To explore the views patients with diabetes have about their consultations with nurse prescribers and any impact this may have on their medications management. Design: A qualitative study involving semi-structured interviews and thematic analysis. Setting: Six primary care sites in which nurses prescribed medications for patients with diabetes in England. Data was collected in 2009. Participants: Interviews took place with 41 patients with diabetes from the case loads of 7 nurse prescribers. Results: Findings are reported under three themes; the nurse consultation style, benefits of the nurse prescriber consultation and views on involvement and decision-making. Key aspects of the nurse consultation style were a non-hurried approach, care and rapport, approachability, continuity, and providing clear information based on specialist knowledge. Many benefits were described, including improved access to appropriate advice and medication, greater understanding and ability to self-manage, ability to address problems and improved confidence, trust and wellbeing. While patients were happy with the amount of information received and involvement they had decisions about their treatment, there was some controversy over the consistency of information provided on side-effects of treatment. Conclusions: The study provides new knowledge about what patients with diabetes value and benefit from in respect to care provided by nurse prescribers. Continuity of relationship, flexibility over consultation length, nurses’ interpersonal skills and specialist diabetes knowledge were identified as crucial to good quality care. Patients require that nurse prescribers are skilled in providing a person-centred approach and have access to specialist training. The level of information and involvement offered to patients should reflect patients’ requirements.

Aims To explore the views of patients with diabetes about nurse prescribing and the perceived advantages and disadvantages. Methods Patients were recruited from the case-loads of seven nurse prescribers in six National Health Service sites in England. Sites reflected the key settings in which nurses typically prescribe for patients with diabetes within primary care. Forty-one interviews were undertaken by trained qualitative researchers. Interviews addressed opinions and experiences of nurse prescribing; audiotapes were transcribed, coded, and themes identified. Results Patients were confident in nurse prescribing. Distinctions were made between the role of the nurse and that of the doctor, and views varied with regard to the extent patients felt nurses should work autonomously. Confidence in nurse prescribing was inspired by nurses’ specialist knowledge and experience, a mutual trusting relationship, a thorough consultation, and experience of the benefits of nurse prescribing. Communication between nurses and doctors about patient care, awareness by nurses of their area of competence, training and experience, specialist diabetes knowledge and access to training updates were considered important for safe prescribing. Patterns of attendance had changed in some cases, with patients tending to see doctors less often. Access to medicines was improved for patients during non-routine/emergency situations. Conclusions Nurse prescribing is acceptable to patients and can increase the efficiency of diabetes service in primary care. Workforce planners need to include the services of nurse prescribers alongside those of doctors.

With the demand for medication continually growing, Nicola Carey and Karen Stenner discusses how non-medical prescribing can ease the burden; showcasing a new online toolkit ‘Preparing to Prescribe’, that will aid the future training of prescribers

Background  Skin disease can have a huge impact on quality of life for patients and their families. Nurses have an important role in the delivery of specialist dermatology services, and prescribing enhances the care they provide. The views of dermatology patients about nurse prescribing are unknown. Objectives  To explore the views of dermatology patients about nurse prescribing, and its impact on medicines management and concordance. Methods  Semistructured interviews were undertaken with a consecutive sample of 42 patients with acne, psoriasis or eczema who attended the clinics of seven dermatology specialist nurse prescribers. Primary and secondary care clinics were included to reflect settings in which nurses typically prescribe for patients within specialist dermatology services in England. Interviews addressed the effects of nurse prescribing on care, the patient’s medicine regimen, involvement in treatment decisions and concordance, and influences on medicine taking. Results  Patients believed that nurse prescribing improved access to, and efficiency of, dermatology services. Great value was placed on telephone contact with nurses, and local access. Information exchange and involvement in treatment decisions ensured that treatment plans were appropriate and motivated adherence. Nurses’ specialist knowledge, interactive and caring consultation style, and continuity of care improved confidence in the nurse and treatment concordance. Conclusions  Nurse prescribing can increase the efficiency of dermatology services. Patients experienced active involvement in decisions about their treatment which in turn contributed to concordance and adherence to treatment regimens. This study has important implications for maximizing resource use and improving access to and quality of care in dermatology specialist services.

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.

This study aimed to explore the experiences of men from African and African Caribbean heritage on transition to fatherhood and support received. Semi-structured interviews were undertaken with eight black fathers living in the south east of England. Four themes were identified: preparation for fatherhood; experiences post birth; influences on ideas about fatherhood; and reflections on transition and suggestions for support for future fathers. While some fathers benefited from formal support, others did not attend antenatal classes and there was uncertainty around healthcare roles identified during the men's experiences post birth. Findings highlight the importance of extended family and friends in providing advice and the importance of culture in forming the identity of African fathers.

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.

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.

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.

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.

Title. Nurse prescriber-patient consultations: a case study in dermatology. Aim. This paper is a report of a study exploring the content and processes in consultations between nurse prescribers and patients with dermatological conditions. Background. Communication skills, consultation time, information and follow-up are central to the treatment and management of patients with dermatological conditions. The contribution nurses make to the care of these patients has great potential. Method. A multiple case study was conducted with 10 practice settings across England in which nurses prescribed medicines for patients with dermatological conditions. Data were collected between June 2006 and September 2007 using semi-structured interviews (n = 40), patient questionnaires (n = 165/200) and videotaped observations of nurse consultations (n = 40). Data analysis included thematic analysis, descriptive statistics, chi-square and non-parametric tests. Findings. Nurses believed that their holistic approach to assessment, combined with their prescribing knowledge, improved prescribing decisions. Listening and explanation of treatments were aspects of nurse communication that were rated highly by patients. Listening and dealing sensitively with emotions were also aspects of the videotaped consultations that were rated highly by assessors. Nurses were less consistent in providing information about medicines. Conclusion. Triangulated data from this study suggest that nurse prescribing enhances the care of patients with dermatological conditions through improved prescribing decisions. If patients are to be more involved in this decision-making, nurses must give them more information about their medicines. The benefits of prescribing were most evident in the practices of dermatology specialist nurses. Further evidence is required to identify whether prescribing by specialist nurses offers similar benefits in other therapeutic areas. © 2009 Blackwell Publishing Ltd.

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

Aim. This paper is a report of a study to explore nurses' views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. Background. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Method. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Findings. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. Conclusion. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings. © 2008 The Authors.

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.

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 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.

To explore the practice of nurses who prescribe medication for patients with skin conditions.