• barriers;
  • community nurse;
  • independent prescribing;
  • medication;
  • nurses;
  • nursing

Aims and objectives.  (i) To identify barriers that could either prevent community nurses from prescribing altogether or reduce the number of times that a nurse might prescribe. (ii) To determine how wide spread the barriers identified above were.

Background.  Many community nurses who are trained to prescribe are either not prescribing at all or not routinely doing so.

Method.  (i) Qualitative semi-structured interviews with nurses prescribers and Trust prescribing leads. (ii) Postal questionnaires sent to the nurse prescribing leads in each Primary Care Trust across three strategic health authorities in England.

Results.  Several barriers were identified in this study. Those that (i) prevented prescribing included roles with no patient contact, prescription pads not issued, opposition from general practitioners and lack of confidence; (ii) prevented some prescribing included lack of time in clinics, inability to prescribe for patients registered with another Trust, security concerns, lack of access to patient medical records and the use of alternative methods of supply; (iii) made prescribing more difficult included keeping records, informing general practitioner of items prescribed, delivering prescribed items to housebound patients and situations requiring items from more than one prescriber.

Conclusion.  Many barriers have been identified that have the potential to reduce the impact of nurse prescribing on patient care. Trusts should monitor the prescribing of their nurse prescribers, target appropriate support and encouragement to address problems with prescriber confidence, develop strategies to integrate their nurse prescribers into the healthcare team to improve access to patient's medical notes, and improve the efficiency of the prescribing process.

Relevance to clinical practice.  There is a danger that the anticipated benefits to patient care resulting from the introduction of nurse prescribing may not materialize if the barriers identified in this study are not addressed.