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Essential Factors That Support National Implementation of Designated Registered Nurse Prescribing: A Systems-Thinking

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Summary

Implementing designated registered nurse prescribing in Australia requires a systems-thinking approach. Successful adoption depends on recognizing interdependencies and dynamic factors for whole-of-system support.

Keywords:
Australiadelivery of health carehealth servicesmedicationnursepatient careprescribingregistered nursestakeholder participationsystems analysis

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Area of Science:

  • Health Services Research
  • Nursing Practice
  • Health Policy

Background:

  • Designated registered nurse prescribing has the potential to improve patient access to medicines and care.
  • Implementation in Australia requires understanding enablers and barriers from multidisciplinary stakeholders.
  • A systems-thinking approach is crucial for navigating complex health system interdependencies.

Purpose of the Study:

  • To explore perceptions of enablers and barriers to implementing designated registered nurse prescribing in Australia.
  • To utilize a systems-thinking approach to understand stakeholder views on implementation.
  • To generate systems-level recommendations for successful adoption.

Main Methods:

  • A two-phase explorative study using a systems-thinking lens.
  • Phase 1: Deductive content analysis of interviews and focus groups (n=45) with diverse healthcare professionals across Australia.
  • Phase 2: Inductive analysis of a face-to-face workshop (n=28) and observer notes, refined through reflexive dialogue.

Main Results:

  • Successful adoption is contingent upon interrelated system components, identified through stakeholder perspectives.
  • Key dynamic elements include context-specific service models, stakeholder engagement, financial support, clear communication, and workforce readiness.
  • Overarching themes for successful implementation: The Standard—just one piece of the puzzle; Harnessing collective capability; Shared wisdom for success.

Conclusions:

  • National implementation requires consistent yet context-responsive reforms, acknowledging system interdependencies.
  • A systems-thinking approach highlights the need for whole-of-system strategies, avoiding rapid, unplanned implementation.
  • Sustainable adoption depends on recognizing the dynamic nature of healthcare system interdependencies.