Evaluation of the expansion of nurse prescribing in Scotland

The expansion of nurse prescribing in Scotland has had many benefits: in some settings, it could be rolled out further if some of the remaining obstacles are overcome, best practice information could be exchanged more readily, and communication and support networks facilitated further. These are among the conclusions of a report on the expansion of nurse prescribing in Scotland, published by Scottish Government Social Research.

The research explored nurse prescribing in practice using interviews and meetings with stakeholders, surveys of the public, questionnaires sent to nurse prescribers, and case studies; it also examined nurse prescribing education, again using a variety of methods.

Patient care has improved as a result of nurse prescribing, particularly in specialist areas and areas of particular competence., with benefits including improved access to treatment and team working, according to the results. There was a high level of agreement between patents, the public, nurse prescribers, doctors and other healthcare professionals, and health managers about the benefits for patients that this programme has introduced. For maximum effectiveness, however, some remaining obstacles need to be overcome, and implementation has been patchy, both geographically and professionally.

The expansion of nurse prescribing has also had a positive impact professionally in several ways including higher professional satisfaction and development, although these were contingent on continuing professional development (CPD), support and resources. There was some anxiety among nurses about their roles becoming overly medicalised: they felt traditional nursing roles should be maintained as prescribing develops.

On the educational front, the prescribing course was felt to be ‘fit for purpose’ and although nurses had expected the pharmacology element to be more focussed on the drugs they themselves would be prescribing, the evaluation concluded that the generic nature of the course should be retained. It suggested that two mentors should be used in future: a clinical mentor and a nurse prescriber who will therefore have experience of the course.

As far as safety is concerned, no prescribing incident or problems were reported that affected patient safety although all the stakeholder groups, health professionals and managers agreed that effective education, supervision and auditing are needed. More research may be needed to establish how extensive and effective clinical governance of nurse prescribing is.

A range of challenges were identified, including delays in getting prescription pads, increased workloads, patchy implementation, the need for CPD and support and for effective networks to share good practice and resolve problems, and some fragmented approaches to policy and leadership. The report ends with a list of recommendations to help overcome some of these challenges.