Nurse prescribing roles in acute care: an evaluative case study

Aim. This paper is a report of an evaluation of the implementation of nurse prescribing in an acute care hospital in England. Background. At the time of the study, evaluation of nurse prescribing had taken place in community settings, but little was known about its impact and effectiveness in acute care. Although nurse prescribing has permitted doctor-nurse substitution in acute episodic care, some doctors have expressed concerns about patient safety in relation to nurse prescribing. Methods. A mixed methods single-case study was conducted in 2005-06, using purposive sampling. Semi-structured interviews were carried out with 18 hospital staff, non-participant observation of two nurses and two doctors undertaking 52 patient-prescriber consultations with 47 patients, and a questionnaire survey with 122 patients (response rate 61%: n = 74). Results. Nurse prescribing was found to benefit patients through service delivery improvement and using staff skills differently. Nurse prescribers and their colleagues were positive about role and service changes and their impact on patient care. No differences were found between the ways in which nurses and doctors performed prescribing roles, but there was a statistically significant difference between the medication-related information satisfaction ratings of patients who had seen a nurse prescriber, compared to those seen by a doctor. Conclusion. Nurses and doctors were found to provide equivalent care. Shared vision, local champions, action learning and peer support were the enabling factors that helped to embed the new prescribing roles within the study site.