While acknowledging that Registered Nurse (RN) prescribing offers an opportunity to potentially improve patient access to medicines and enhance healthcare system efficiency, many nurse practitioners remain equally concerned about how it will be implemented, possible role ambiguity, and patient safety, a recent study has revealed.
The survey of 229 Australian nurse practitioners, about 10% of the NP workforce, set out to gauge views on the Nursing and Midwifery Board of Australia’s (NMBA) proposed RN-prescribing standard. According to the NMBA, the proposed RN-prescribing model will enable RNs with an endorsement for scheduled medicines to prescribe within their level of competence and scope of practice in partnership with an authorised prescriber, such as a doctor or nurse practitioner.
Researchers wanted to understand the views of NPs because, as authorised prescribers, they will play a major role in supporting partnership nurse prescribing and ensuring its successful adoption.
The majority of NPs (76.2%) agreed that prescribing would optimise RN knowledge, skills and capability, as well as increase access to nurse-led models of care (75.1%) and improve healthcare system capacity (68%). Nearly 90% of NPs felt the highest-rated enabling factor for introducing RN prescribing was the availability of appropriate mentors.
In terms of workforce preparation, 55.8% of NPs felt a minimum of five years of prior clinical nursing experience should be required to undertake a nurse prescribing course, while 23.6% thought 10 or more years should be the minimum. Most NPs surveyed (62%) deemed universities, or universities in collaboration with health services, best-placed to develop and deliver educational programs for RN prescribing.
When analysing nurse practitioner views on RN prescribing, the study identified three themes – the lived experience of nurse practitioners, concern about the impact on the nurse practitioner role, and fear of patient harm.
According to the study, NP participants reflected on the organisational and legislative challenges they have faced trying to practice to their full scope. While there is support for the introduction of nurse prescribing, many worry the same challenges they experienced in progressing their roles may be repeated with the introduction of RN prescribing. Others suggested outside influences that continue to impact the ability of NPs to work to their full scope may also pose similar challenges for RNs.
“Nurse practitioners are already legislated to be able to prescribe but due to Government obstacles…nurse practitioners are not able to work to their full scope of practice. This illustrates that the problems are not to do with who the prescriber is, but the medical model the Australian legislators refuse to move away from,” one participant said.
“I think the medical profession will need to be on board for this to progress, look at how restrictive their views have been on Nurse Practitioner practice, without Medical Association support, this will never happen,” another participant said.
Meanwhile, many NPs who took part in the study expressed other concerns, including that an increased scope of practice for RNs to prescribe could lead to erosion of the nurse practitioner role. If RNs have increased scope, it could reduce nurse practitioners’ credibility and would risk diluting the NP role and endorsed title, some reported.
Further, some participants were concerned about the potential overlap of roles and responsibilities, which might impact the NP role within multidisciplinary teams. While others said that RN prescribing could cause confusion among health practitioners, patients and the public.
Fear of patient harm was another theme to emerge from the study.
“Whilst I feel this is a positive move, I do not feel that the existing knowledge, skills and capability of RNs is acceptable without further education and strict protocols or guidelines to ensure safe use of medicines.”
Researchers state that successful implementation of RN prescribing in Australia will require collaboration, support, and building trust between all healthcare practitioners. While nurse practitioners’ views on the proposed expanded scope of practice for RNs were conflicted, RNs are well-placed to undertake nurse prescribing providing it is introduced alongside supportive education and legislation.
“The introduction of RN prescribing under a partnership model has the potential to increase access to medicines and facilitate innovate models of care to improve healthcare access for Australian communities,” authors wrote.
“Previous research findings suggest that RNs are prepared to undertake this expanded practice, and this study indicates that nurse practitioners acknowledge the advantages of RN prescribing. Future implementation efforts should acknowledge concerns of nurse practitioners and engage them in facilitating future success of nurse prescribing.”