District nurse and independent prescribing

What is the experience of district nurses who are independent prescribers? This study explored this issue using interviews with eight district nurses practising as nurse independent prescribers in the west of Scotland. It found that their experiences were largely positive but identified a particular problem – which may be less of an issue for practice nurses – to do with administration and particularly duplicate record keeping (nursing and medical notes). This was of great concern and involved all sorts of difficulties to do with different locations, paperless systems and computer access. It is possible that the cumbersome systems were causing some nurses to limit their prescribing, although the authors point out that they were also relatively inexperienced as prescribers and lacked confidence (five expressed a lack of confidence in their prescribing ability).

Support – both organisational and peer – was a major issue too, with nurses reporting a lack of support from the time they qualified as prescribers: even when support mechanisms existed, they may be insufficient or inconsistent. As well as confidence and support, education and ongoing development, and nursing relationships and roles were identified as influences on prescribing practice. Other difficulties included an increase in workload associated with prescribing, partly because of the administrative issues, and a lack of remuneration and recognition.

Benefits identified by the nurses included saving time, a more seamless service for patients, and increased autonomy and job satisfaction, which supported the development of the district nursing role.

Downer F and Shepherd CK. District nurses prescribing as nurse independent prescribers. Br J Community Nursing 2010; 15(7): 348-352.