Since legislation was passed in 1992 to pave the way for nurse prescribing, the development of this initiative has been a key part of Department of Health (DoH) policy. The roll-out of nurse prescribing has progressed particularly quickly since 1999, with the initiation of training programmes within higher education institutions (HEIs), and proposed expansion of the nursing formulary (While, 2002). In this paper, Latter and Courtenay provide a comprehensive and interesting review of the current literature surrounding the effectiveness of nurse prescribing.
It is striking, when reading the review, that the range of evidence appraising the effectiveness of nurse prescribing is limited mainly to small-scale qualitative studies. These studies focus on the attitudes of nurses and their patients towards independent nurse prescribing, with results that are encouraging, though unsurprising.
Latter and Courtenay highlight that patients generally reported positive experiences with nurse prescribing, particularly in relation to issues of convenience and the fact that medication is prescribed by a practitioner with whom they have a close bond. Those nurses involved with prescribing have also been found to be broadly in favour, citing greater autonomy and enhanced job satisfaction.
What are noticeable by their absence are any large-scale, quantitative studies that include an economic evaluation and a review of clinical governance issues. It should be noted, that in specific relation to patient safety, steps have been taken to reduce risk – notably the restricted formulary available to nurses, and the development of formal, HEI-based training programmes for nurse prescribers. However, there do not appear to be significant research data that provide reassurance surrounding the clinical effectiveness of nurse prescribing.
This lack of quantitative data supporting the effectiveness of the scheme should not detract from the simple assertion that nurse prescribing is essentially a sound idea. There is no fundamental reason why experienced, highly trained nurses, should not be deemed competent to prescribe a range of medication. From a professional aspect it is a logical progression of role expansion, from a patient point of view it is more convenient, and from a systems analysis standpoint it is simply more efficient.
However, in the context of an expanding nurse formulary, and a UK government aspiration in ‘The NHS Plan’ for over half of all nurses to prescribe medicines by 2004 (Department of Health, 2000), further research is urgently required. In particular, a full review of the implementation of nurse prescribing should be commissioned to examine both the economic and clinical effectiveness of the initiative. This evaluation should also seek to clarify the clinical governance arrangements associated with nurse prescribing to ensure safe systems of working and clinical audit programmes are in place nationwide.
Despite a widespread view that nurse prescribing is a welcome initiative designed to streamline patient care and empower nurses, there are some detractors. Criticisms of the scheme include suggestions that nurse prescribing is nothing more than tokenism designed to save money and challenge the medical profession (McCartney et al., 1999), or is a political experiment designed to mask a shortage of medical staff (Horton, 2002). Without data to support the clinical effectiveness of nurse prescribing, the initiative does remain open to such criticism from those who doubt the publicized reasons for supporting this expansion of the nursing role.
It may be possible to look overseas for further insight into the effectiveness of nurse prescribing. Though the review produced by Latter and Courtenay was of great value, it was limited by only exploring research from the UK. Although there is often some difficulty in applying international research to nursing in the UK, there is much that could be learnt from the experience of nurse prescribers overseas. Indeed, a piece of Swedish research recently published in this journal (Wilhelmsson & Foldevi, 2003) demonstrated that similar issues related to nurse prescribing are experienced outside the UK. A wider literature review incorporating works from abroad may yield valuable information to inform future research in this country.
The evidence discussed in Latter and Courtenay's review is noticeably concentrated in primary care settings. This is perfectly understandable, as independent nurse prescribing currently has the greatest influence in these areas. However, the impact of nurse prescribing in acute care will also require further exploration in the future. Indeed, a significant amount of research has already been published on the use of Patient Group Directions (PGDs) – an alternative method of nurses supplying medication. For example, within the field of cardiology, nurses initiating the administration of thrombolytic therapy to patients suffering myocardial infarction have been shown to reduce treatment times safely and effectively (Wilmhurst et al., 2000; Heath et al., 2003). The studies on the effectiveness of PGDs may offer a model upon which clinical appraisals of nurse prescribing can be based.
Latter and Courtenay's valuable literature review gives confidence that nurse prescribing is seen as a positive step forward by both patients and nurses. Crucially, the review also highlights the need for further research to be completed to fully evaluate the effectiveness of nurse prescribing. As a bare minimum, this research should provide an economic evaluation and a review of the clinical effectiveness of the scheme. Future research, coupled with robust systems of clinical audit, will hopefully demonstrate the significant benefits of nurse prescribing for both the nursing profession and patients.