Mental health nurse independent prescribing: what are nurse prescribers' views of the barriers to implementation?

Authors

  • J. D. ROSS MSc (Distinction) BA (with Specialist Practice), RN RMN,

    Corresponding author
    1. Advanced Practitioner in Adult Mental Health, Nurse Independent Prescriber, Cognitive Behavioural Therapist, Centre for Advanced Studies in Nursing, Division of Applied Health Sciences
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  • A. M. KETTLES PhD MSc BSc RMN RN PGCEA RNT Dip. Crim FHEA

    1. Assistant Professor, Honorary and Visiting Lecturer, Centre for Spirituality, Health and Disability (CSHAD), University of Aberdeen, Aberdeen, UK
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J. D. Ross, Block A, Royal Cornhill Hospital, 26 Cornhill Road, Aberdeen AB25 2ZH, UK, E-mail: janed.ross@nhs.net

Abstract

Accessible summary

  • • Nurse prescribing was launched in the UK in the 1990s, but was introduced to psychiatric/mental health nursing within the last 7 years. Information is available about nurse prescribing in general practice and adult nursing, but there is little research relating to mental health. Most mental health nurses choose not to qualify to prescribe and many who have qualified to prescribe choose not to.
  • • As more than half of mental health nurse prescribers in this study were not prescribing, they were asked what they thought prevented them from doing so.
  • • The majority of prescribers in the study did not feel adequately supported in their role and considered that the additional responsibility of the role should be recognized.
  • • Nurse prescribing has the potential to improve care provided to service users and to enhance access to services. However, in order for this to happen the barriers which prevent prescribing need to be identified and then removed. This study identified many of these barriers to prescribing and these will be discussed. It is hoped that this study's findings will serve as a catalyst to prompt the removal of barriers to prescribing in mental health nursing and ultimately to enable independent nurse prescribing. Awareness about mental health nurse prescribing needs to be raised so that health care professionals, service users, carers and the general public become more familiar with the role. This should help the role to become more accepted and established in everyday practice.

Abstract

This paper reports a pilot study exploring mental health nurse prescribers' perceptions of barriers to prescribing independently but also includes perceptions of barriers to supplementary prescribing. Current prescribing practice as experienced by mental health nurses suggests a need to identify and highlight these barriers. A mixed methodology explanatory sequential study was carried out over 3 months in Scotland in 2008 as part of a Master's degree. A questionnaire was completed by 33 mental health nurse prescribers. A focus group was conducted with 12 mental health nurse prescribers. Participants' views exposed a number of barriers to prescribing previously unidentified in a review of the relevant literature, and concurred with some previously documented barriers. Sixty per cent of mental health nurse prescribers in the study were not prescribing. Barriers identified in the study included concern about how prescribing impacts on the therapeutic relationship, role conflict, lack of support, inappropriateness of prescriber training, remuneration, qualifying to prescribing time, supervision, prescribing policies, clinical governance and nurse management. Nurse prescribing involves increased accountability and responsibility which is not currently recognized in job status or pay banding. Mental health nurse prescribing has the potential to enhance service provision, but until barriers to prescribing have been identified and addressed as part of the process of organizational change, nurse prescribing cannot achieve its maximum potential.

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