Issues affecting the growth of independent prescribing

To investigate factors that have influenced A&E departments, minor injury units (MIUs) and walk-in centres (WICs) on whether or not to send nurse practitioners on extended nurse prescribing courses. Also, to examine the extent to which nurses who have completed an extended course are independently prescribing in their everyday practice.

A pilot study was undertaken in 20 randomly selected units, and following minor changes the main study was carried out by sending a questionnaire with a stamped addressed envelope to all nurse managers in 307 units. The response rate was 62 per cent (n=192).

The study found that 71 per cent (n=20) of WICs, 30 per cent (n=33) of A&E departments and 20 per cent (n=11) of MIUs have sent nurses on extended nurse prescribing courses. The most striking result was that 44 per cent (n=28) of nurses were still not prescribing even after completing the course. Patient Group Directions (PGDs) are the most common method for nurse practitioners to obtain medication for patients and 81 per cent (n=52) of nurses who have completed the course would continue to work under PGDs to supplement the formulary.

It was surprising and worrying to find that less than half (n=28, 44 per cent) of nurse prescribers do not prescribe after completing the course. The reasons for this are unclear but could include: inappropriate selection of staff and problems accessing prescription pads, lack of peer supervision and inadequate knowledge of pharmacology. More studies are needed to understand the reasons and to help ensure government targets on increasing the numbers of nurse prescribers are met.