Research
Update
A Survey of Nurse
Prescribers - Rhetoric or Reality? Prescribing behaviour of DN/HV nurse
prescribers
Lesley Coles, Mark Rawlinson and Jackie Yardley,
School of Midwifery & Nursing, University of Southampton, UK
What are District Nurses (DNs) and Health Visitors (HVs)
prescribing from the NPF and what is influencing their behaviour? The
preliminary results of a survey of nurse prescribers in Hampshire and the
Isle of Wight are presented here. The aim of the survey was to elicit a
'snapshot' of prescribing behaviour following completion of the National
Rollout programme for DNs and HVs.
Method
Postal semi-structured questionnaires were sent out to a
sample of nurse prescribers in the area and 49% were returned (331 out of
671). DNs accounted for 117 responses, HVs for 187, and 27 were other
practitioners who held the qualification but were in different roles.
Findings
Several barriers to prescribing emerged from the
responses: lack of time, particularly in relation to completing the
documentation, and restricted access to records or information if
prescribers were not based with GPs. At least one nurse felt that a request
to a GP for a prescription was quicker. Several of the nurses commented that
the long gap, nine months in one case, between completing the course and
receiving a prescription pad had not helped. They could not put theory into
practice and were no longer confident of their competence.
To ascertain if other tools influenced prescribing behaviour respondents
were asked if they used the Jarman Index or its equivalent [Table 1]. Of the
304 DNs or HVs, 91 (30%) used the Jarman index or similar index of
deprivation to assess their practice area, 189 (62%) did not and 22 (7%) did
not respond to this question. Some nurses were more likely to prescribe for
lower-income families. However, this was not necessarily with the use of a
deprivation index.
Of the products prescribed once a month or less [Table 2] the products
prescribed most by the HVs were analgesics, oral care products, threadworm,
scabies and head lice products, and skin preparations (35, 35, 33, 28, 51,
and 49 respondents, respectively).
For the DNs, the most commonly prescribed products were: laxatives,
analgesics, local anaesthetics, oral care, ear drops, elastic hosiery and
diabetes appliances (44, 27, 27, 36, 29 and 31 respondents, respectively).
For products prescribed occasionally (four times a month or less) [Table 3]
the products prescribed most by the HVs were: oral care and head lice and
skin preparations (39, 29 and 60 respondents, respectively). DNs were more
likely to prescribe: laxatives, local anaesthetics, skin preparations,
elastic hosiery and catheters/urinary (31, 24, 27, 30 and 29 respondents,
respectively).
For products prescribed often (more than four times a month) [Table 4], HVs
were more likely to prescribe skin preparations (16 respondents); for DNs it
was: skin preparations, disinfection/cleansing products, wound products and
catheters/urinary (23, 43, 78 and 46 respondents, respectively). It would
seem therefore, that those DNs who are prescribing wound care and
disinfection/cleansing products, are doing so frequently. Overall, HVs were
much less likely to be prescribing products often than DNs.
Conclusion
Despite the political significance of nurse prescribing in the modernisation
of the NHS, and the plans for its extension, it has been under-researched.
This survey gives some clues about how nurse prescribers from the DN/HV
course are using their new competencies, and the barriers to prescribing
they are experiencing.
Table 1: Jarman Index: Results
Question: Do you use the Jarman Index or similar tool to assess your
practice area?
"If family on low income I know it may help to ensure treatment" North
Hampshire Health Visitor
"What is the Jarman Index?" North Hampshire District Nurse
"More likely to prescribe for lower income families." Isle of Wight Health
Visitor
|
|
Isle of Wight
|
Portsmouth |
Southampton |
North Hampshire |
|
|
HV(9) |
DN(8) |
HV(70) |
DN(26) |
HV(53) |
DN(44) |
HV(55) |
DN(39) |
|
Yes |
44% |
0% |
44% |
54% |
17% |
14% |
40% |
18% |
|
No |
44% |
88% |
53% |
35% |
74% |
79% |
56% |
69% |
|
No response |
12% |
12% |
3% |
11% |
9% |
7% |
4% |
13% |
Table 2: Reported Monthly Nurse
Prescribing - Frequency Prescribed: 'Rarely' x 1 a month or less
|
Products (NPF)
|
Isle of Wight
|
Portsmouth |
Southampton |
North Hampshire |
|
|
HV(9) |
DN(8) |
HV(70) |
DN(26) |
HV(53) |
DN(44) |
HV(55) |
DN(39) |
|
Laxatives |
0 |
1 |
4 |
11 |
6 |
16 |
7 |
16 |
|
Analgesics |
0 |
1 |
12 |
4 |
8 |
14 |
15 |
8 |
|
Local Anaesthetics |
0 |
0 |
0 |
6 |
0 |
11 |
0 |
10 |
|
Folic Acid |
0 |
0 |
3 |
0 |
4 |
0 |
2 |
0 |
|
Oral Care |
1 |
0 |
17 |
10 |
10 |
11 |
7 |
15 |
|
Ear Drops |
0 |
1 |
0 |
5 |
1 |
11 |
0 |
12 |
|
Threadworm Products |
0 |
0 |
13 |
1 |
9 |
0 |
11 |
2 |
|
Scabies Products |
0 |
0 |
10 |
1 |
6 |
0 |
12 |
2 |
|
Head Lice Products |
0 |
0 |
24 |
2 |
16 |
1 |
11 |
2 |
|
Skin Preparations |
2 |
1 |
21 |
4 |
10 |
7 |
16 |
8 |
|
Disinfecting/Cleansing |
0 |
0 |
1 |
1 |
0 |
4 |
0 |
10 |
|
Wound Products |
0 |
1 |
4 |
1 |
0 |
2 |
0 |
4 |
|
Elastic Hosiery |
0 |
0 |
0 |
4 |
0 |
10 |
0 |
15 |
|
Catheters Urinary |
0 |
1 |
1 |
1 |
0 |
6 |
0 |
8 |
|
Stoma Products |
0 |
0 |
1 |
6 |
0 |
9 |
0 |
5 |
|
Appliance/Diabetes |
0 |
0 |
1 |
7 |
0 |
12 |
0 |
12 |
|
Fertility Products |
0 |
0 |
0 |
0 |
1 |
0 |
|
0 |
Number of Responses by Practitioners
Table 3: Reported
Monthly Nurse Prescribing- Frequency Prescribed: 'Occasionally' 4 x a month
or less
|
Products
(NPF) |
Isle of Wight
|
Portsmouth |
Southampton |
North Hampshire |
|
|
HV(9) |
DN(8) |
HV(70) |
DN(26) |
HV(53) |
DN(44) |
HV(55) |
DN(39) |
|
Laxatives |
1 |
0 |
0 |
7 |
0 |
13 |
0 |
11 |
|
Analgesics |
2 |
0 |
2 |
2 |
2 |
0 |
0 |
2 |
|
Local Anaesthetics |
0 |
0 |
0 |
8 |
0 |
11 |
0 |
5 |
|
Folic Acid |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
1 |
|
Oral Care |
0 |
0 |
17 |
4 |
7 |
6 |
15 |
3 |
|
Ear Drops |
0 |
0 |
0 |
4 |
0 |
6 |
0 |
2 |
|
Threadworm Products |
1 |
0 |
0 |
0 |
1 |
0 |
1 |
0 |
|
Scabies Products |
1 |
0 |
0 |
0 |
0 |
0 |
2 |
0 |
|
Head Lice Products |
2 |
0 |
9 |
0 |
5 |
0 |
13 |
0 |
|
Skin Preparations |
4 |
0 |
28 |
7 |
16 |
10 |
12 |
10 |
|
Disinfecting/Cleansing |
0 |
1 |
1 |
4 |
0 |
9 |
0 |
10 |
|
Wound Products |
0 |
1 |
2 |
2 |
0 |
6 |
0 |
5 |
|
Elastic Hosiery |
0 |
0 |
0 |
10 |
0 |
18 |
1 |
11 |
|
Catheters Urinary |
0 |
0 |
0 |
7 |
0 |
10 |
0 |
12 |
|
Stoma Products |
0 |
0 |
1 |
4 |
0 |
3 |
0 |
4 |
|
Appliance/Diabetes |
0 |
0 |
0 |
6 |
0 |
7 |
0 |
5 |
|
Fertility Products |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Number of Responses by Practitioners
Table 4: Reported
Monthly Nurse Prescribing - Frequency Prescribed: 'Often' more than 4 x a
month
|
Products
(NPF) |
Isle of Wight
|
Portsmouth |
Southampton |
North Hampshire |
|
|
HV(9) |
DN(8) |
HV(70) |
DN(26) |
HV(53) |
DN(44) |
HV(55) |
DN(39) |
|
Laxatives |
0 |
0 |
0 |
2 |
0 |
0 |
0 |
1 |
|
Analgesics |
0 |
0 |
1 |
0 |
0 |
0 |
0 |
0 |
|
Local Anaesthetics |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
|
Folic Acid |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Oral Care |
1 |
0 |
5 |
0 |
1 |
1 |
1 |
0 |
|
Ear Drops |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
|
Threadworm Products |
0 |
0 |
0 |
0 |
0 |
0 |
2 |
0 |
|
Scabies Products |
0 |
0 |
0 |
0 |
0 |
0 |
1 |
0 |
|
Head Lice Products |
0 |
0 |
3 |
0 |
0 |
0 |
0 |
0 |
|
Skin Preparations |
2 |
0 |
7 |
7 |
2 |
10 |
5 |
6 |
|
Disinfecting/Cleansing |
0 |
1 |
0 |
16 |
0 |
16 |
0 |
10 |
|
Wound Products |
0 |
1 |
0 |
20 |
0 |
31 |
0 |
26 |
|
Elastic Hosiery |
0 |
1 |
0 |
4 |
0 |
7 |
0 |
7 |
|
Catheters Urinary |
0 |
1 |
0 |
14 |
0 |
21 |
0 |
10 |
|
Stoma Products |
0 |
0 |
0 |
0 |
0 |
1 |
0 |
0 |
|
Appliance/Diabetes |
0 |
0 |
0 |
3 |
0 |
1 |
0 |
2 |
|
Fertility Products |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
Number of Responses by Practitioners
|