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Exclusive: Nurses 'more cautious' prescribers than doctors

Independent nurse prescribers are “more cautious” than doctors and most do not initiate treatments without first seeking medical advice, despite their qualifications, suggests a UK study.

It found that although nurses tended to have greater holistic awareness of patients, they were also more “risk aware”.

Nurse prescribers were given full access to the British National Formulary in 2006, putting them on a par with doctors. At present, around 3% of nurses are qualified to prescribe independently.

The study, published in full in this week’s Nursing Times, compared the habits and decisions of nurse prescribers at a mental health provider with those of doctors.

Researchers from South Staffordshire and Shropshire Healthcare Foundation Trust interviewed 14 nurse prescribers and nine of their medical mentors.

They found nurses perceived independent prescribing as a “risky activity”, and displayed a reluctance to make independent prescribing decisions “even within their specialist fields”.

However, when they did prescribe, nurses “generally felt” they involved patient more in decision-making and concordance than doctors did, and that they were better at liaising with other services about medication.

The study authors said: “Greater strategic focus and vision are needed so nurse prescribing can develop to meet patients’ needs and lead to a more equitable sharing of prescribing responsibilities with doctors.”

The new study reflects previous research by Reading University, which found that some independent prescribers still preferred supplementary prescribing to help develop their skills and confidence.

The earlier study of 1,400 independent nurse prescribers – conducted at the end of 2006 – found that more than 40% were still using supplementary prescribing.

Readers' comments (11)

  • I understand why colleagues are 'more cautious', however independant prescribing is something I do every day - couldn't do my job without it!

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  • Tiger Girl

    I think this is not a surprise: it might change somewhat over time.

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  • michael stone

    This is interesting.

    As 'Independent Prescribers' the nurses should feel confident, and shouldn't 'feel nervous' - if someone isn't confident, why is she/he allowed to prescibe ?

    On the other hand, at risk of attracting a lot of 'we are not handmaidens !' type comments, I think the finding does support the possibility that a 'nurses are there to support doctors' idea still lingers, even among some nurses (it doesn't necessarily follow: an alternative, just as likely or perhaps even more likely, is that nurse prescribers [probably correctly] consider 'that we will get blamed for making a mistake, more than doctors who made the same mistake would).

    However, specialist nurses, really should be confident to prescribe within their specialism.

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  • When will nurses get it into their heads that the idea of a nurse and a doctor along with other relevant health professionals are there to work as a TEAM to provide the besst possible care and outcome for the patient. Too much time money and effort has been spent on bickering about "handmaidens to doctors". No matter what the nurses role if she/he is and feels proficient to do their job as prescribed they should get on and do it. Lets forget the blame culture too!

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  • perhaps the historic lack of support that nurses have had compared to Doctors makes us wary BUT still nevertheless safe prescribers
    one only has to look at the low number of Doctors struck off by the GMC to see how Doctors back their own and very few are removed permanetly - Not sure the same can be said for Nurses....they would hang us out to dry if push came to shove
    the V300 precsribing course is no walk in the park and compared medical student the time and effort required to suceed is 10 fold what medics needs to do to become safe and competent prescribers !

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  • As an Independent NMP working in addictions; I would agree that a great degree of caution is power-mount, probably due to risk of having limited support from other colleagues "if I make a mistake" whereas, a doctor's profession is purely to prescribe and treat. However, I feel confident enough to make my own prescribing decisions at work and don't need the doctors advice as I complete the medical assessment myself. I do find that I need sometimes a second opinion at times and get advice of both other NMP's and doctors if available. I believe that some prescribers lack confidence or possibly experience, hence the reluctance to prescribe on there own. I have worked with many medical students and trainee doctors and have ben surprised with the lack of competency or even lack of medication knowledge as expected from a nurse.
    As mentioned in the commentary the GMC looks after their doctors and even have organisations set up the GP/ doctor became unwell. The only worry with the NMC is whether we as NMP's would be treated fairly in terms of prescribing for patients.

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  • A study of only 14 prescribers? Who were they, what speciality, hospital or community? So many questions before we give this tiny study any credibility. I've been prescribing independently for years, and never needed to ask a doctor for advice. As commentators say, particularly Michael Stone, if we're trained, we should be competent and confident. I find that doctors of all levels are the ones asking me for advice rather than vice versa!

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  • Comment removed due to offiensive nature. Please refer to this site's terms and conditions before posting further:
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  • I would agree with "anonymous" comments regarding generalisability of these findings. Although interesting it only really identifies the prescribing practices in one Trust. Different organisations may take different approaches to CPD and governance leading to their NMP's being more or less confident in this area.

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  • michael stone

    It was a very limited study.

    But it does, to my mind, match 'expected findings' (i.e. what you think would be likely, before the study was carried out).

    I remember discussing on these pages, 'so how exactly are nurses different from doctors, when they seem to overlap so much these days ?', with the much-missed [other] 'mike' a few years ago. Mike's answer was essentially something to do with 'approach and thinking' which isn't an easy fit with everyone now trying to apply evidence-based treatment/behaviour.

    I think I said to Mike, that my lay expectation, would be that doctors had been much more extensively trained in differential diagnosis. There is of course a connection between the correct diagnosis and an appropriate prescription - this difference between doctors and nurses [assuming I'm right about that differential diagnosis point] could be the basic reason why nurses are more concerned about getting a prescription wrong.

    From the patient's perspective, it doesn't matter who prescribes, so long as the prescription is a good one !

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  • support, training and support make the difference. not rocket science. the more you fear/receive criticism the less confidence you will feel. unless you are lacking in reflection skills of course in which case you may be worryingly confident!

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