Mental health nurse prescribing: psychiatrists’ concerns

How is mental health nurse prescribing viewed by psychiatrists and nurses, given the slower than expected uptake of nurse prescribing by mental health nurses, and the suggestion that psychiatrists’ behaviour is a barrier for implementation? It seems that a majority of both groups are now in favour of mental health nurse prescribing but with more psychiatrists expressing concerns, according to a recent study.

This study, the first large in-depth attempt to explore and compare these attitudes and perspectives of mental health nurses and psychiatrists, used a specially created questionnaire returned by 82 psychiatrists and 119 mental health nurses, after random selection of recipients from staff lists in two large metal health trusts. So, importantly, it was not a sample of those undertaking nurse prescribing or involved with it necessarily, although a rather low response rate may be explained by the suggestion that many recipients had no knowledge of, or interest in, nurse prescribing, perhaps leading to some bias in respondents.

Although psychiatrists and mental health nurses were overall in favour of mental health nurse prescribing, psychiatrists had particular concerns about aspects of clinical and legal responsibility, and the appropriate setting for use, with nurses being much more positive about the notions of mental health nurses prescribing in acute inpatient wards and of nurses prescribing medication (including intravenous medication in emergency situations) for rapid tranquilisation. Interestingly, about half the participants from both groups thought mental health nurse prescribing would cause conflict in clinical teams, 61% of psychiatrists thought it would make services more complex, and nearly half of the psychiatrists disagreed with the assertion that it has an increasingly favourable evidence base.

The authors argue that some of the findings may be explained by a perceived change in power balance.

Patel MX et al. Attitudes regarding mental health nurse prescribing among psychiatrists and nurses: A cross-sectional questionnaire study. Int J Nurs Stud 2009;Â 46(11): 1467-1474