Effectiveness of nurse prescribing: a review of the literature

Background. In the UK, the number of nurses able to prescribe medicines is rapidly increasing in line with Government policy directives. Whilst a number of research studies have been conducted on nurse prescribing, review and synthesis of the findings from these studies had not been undertaken. Aims and objectives. The literature review was conducted to identify key findings about the impact and effectiveness of nurse prescribing as well as under-researched issues, in order to inform future research, education and practice in this area. Methods. A review of the literature on the first phase of nurse prescribing (1993-2002) in the UK was undertaken using electronic databases and specified search terms; some hand searching and identification of grey literature was also carried out. Results. Eighteen research-based publications were included in the review. Findings indicate that patients are generally satisfied with district nurses' and health visitors' prescribing in the first phase of nurse prescribing. Nurses who prescribe are also generally satisfied with their role, although some concerns about the adequacy of their pharmacological knowledge have been raised. There is some variation in the prescribing patterns of district nurses', health visitors' and practice nurses, and the limitations of the original Nurse Prescribers' Formulary (NPF) have been highlighted. Some preconditions for good nurse prescribing practice have begun to be identified. Some nurse prescribing outcomes - e.g. its impact on the prescribing practices of doctors, and the perspectives of certain patient groups - remain un-evaluated. Research into the first phase of nurse prescribing is inevitably confined to those with a district nurse and/or health visitor qualification who were prescribing from the original NPF, thus limiting conclusions that can be drawn for the current policy context. Conclusions. The review highlights that nurse prescribing has generally been evaluated positively to date; however, there are both methodological weaknesses and under-researched issues that point to the need for further research into this important policy initiative. Relevance to clnical practice. The review focuses on a clinical issue central to current and future forms of health care practice. Findings from the review highlight both the impact of nurse prescribing and the prerequisites that require consideration by those responsible for the development of nurse prescribing in clinical practice.