Issues of Nurse Prescribing in the UK

Issues of Nurse Prescribing in the UK interpolationThe changing face of the NHS is a topic of controversy and debate from the perspectives of professionals and constitution makers. The last three decades have seen a transformation in treat in the United Kingdom, and in the ways that prevails envisage themselves (McCartney et al, 1999). This transformation is altogether one symptom of a raft of insurance policy removes which have impact the NHS.Evolution of treat as a profession has seen them moving from existence a sort out labelled the doctors handmaidens to a professional group with its protest staunchly defended identity (McCartney et al, 1999). This new professionalism has also led to diverse developments and advancements in the role and functions of maintains, with increased autonomy and crossed roles which could be dioramaed as wallop on medical exam roles or as ideal focussing of an already skilled and companionshipcapable workforce. As far back as 1986, the Cumberledge explanation raised the possibility of allowing company halts to regularise independently, and several years ulterior the necessary legislation was initiated (McCartney et a, 1999). In 1997, the government established a check out of prescribing, impart and administration of medicines, chaired by Dr June Crown (Stephenson, 2000). This became k directlyn as the spinning top comprehend (DH, 1998). It was chiefly use uped with the supply and administration of medicines by group protocols (Stephenson, 2000).A group protocol could be described as a specific written instruction, drawn up locally by doctors and pharmacists, for the supply or administration of named medicines by other(a) health professionals in an place clinical situation (Stephenson, 2000). A number of authors support this move and in particular, the mogul for nurtures to be able to prescribe medications for clients in certain circumstances. However, the execution of this policy change has been n either uniform or timely. This paper provide explore the policy context of the implementation of nurse prescribing, utilising a theoretic framework to examine the laggard nature of the change and the reasons why nurse prescribing stick arounds unfinished business in the professional and policy arena. The suppositious framework used will be the Diffusion of Innovation theory, as defined by Rogers (1962, 1976).Diffusion of InnovationRogers (1962, 1976) defines the diffusion attend to as the spread of a new idea from its source of invention or creation to its ultimate users or conveyers. This could be considered the macro pile of change assimilation or til now awareness. However, the nonion of diffusion of trigger is to a greater extent than a macro concept, and Rogers (1962, 1976) further oppositeiates what he describes as the borrowing process from the diffusion process in that the diffusion process occurs inside society, as a group process whereas, the adoption process is individual. In Rogers (1962, 1976) opinion, the adoption process is the mental process through which an individual passes from first hearing close to an innovation to final adoption. The theoretical construct of chief concern here is that of macro level diffusion of a professional innovation. on that point are five breaker points in the Innovation-Decision Process as described by Rogers (1962, 1976) and these will be mapped against the writings below. starting knowledge of innovation (Rogers, 1962, 1976).First knowledge of innovation could be pinpointed to the Cumberledge report in 1986, which was a report into community nursing, after which the issue was debated and discussed and entered into the theoretical arena in the health attending professions and healthcare policy and governance in general. However, Jones (2004) cites the subject area of nurses who began to make a case for prescriptive authority in 1978. thither is varying turn up of how diffuse this knowledge beca me at a societal and policy level and in that location is round evidence of widespread resistance in the medical and pharmaceutical professions (Jones, 2004).It is important to remember that for some critics, nurse prescribing does not ineluctably constitute something entirely innovative. Nurses already perform a number of roles which necessitate full knowledge of medications, scarce on that point whitethorn be issues about precept and skill levels across nurses educated in different places (King, 2004). If there are questions already about nurses knowledge and ability around medications, thusly the preliminary debate about this issue (which extended over devil decades) is understandable.Forming an attitude toward the innovation (Rogers, 1962, 1976)A number of attitudes towards this innovation are homely in the literature. For example, Jones (2004) educes that implementation of this innovation would be characterized by political machination, the consume to construct an e ffective case, and deft manoeuvring at heart the corridors of power. This raises issues to do with the context indoors which the innovation takes place, as already discussed. Jones (2004) also alludes to the district nurses who presented a case in the 1970s, and the RCN who continued to press that case further. This also relates to Rogers (1962, 1976) description of some of the factors or prior conditions that affect the innovation-decision process, such as previous coif (which whitethorn influence the decision makers in a positive or a negative way), and the norms of the mixer systems in which the innovation is taking place. The intemperately entrenched hierarchical norms of the NHS and healthcare systems in general could be viewed as the biggest hindrance to nurse prescribing, and so forming an attitude towards the innovation, for all the constitute players within the system.A decision to adopt or reject (Rogers, 1962, 1976)The decision to adopt the innovation occurred piece meal and somewhat sequentially in time. Jones (2004) states that it was after frequently initial scepticism and a good deal of negotiation that a tacit agreement amongst nursing, medicine and pharmacy was reached in 1988. Subsequently, the RCN wree able to cause the government to initiate the Crown report in 1989. However, there were limitations to this decision, in that it was restricted to health visitors and district nurses who would be able to prescribe by virtue of them having post registration qualifications that marked them as sufficient in this advanced field (Jones, 2004).Implementation of the new idea (Rogers, 1962, 1976).It is this stage which is the most problematic in relation to nurse prescribing, perhaps payable to the nature of adoption across the wider NHS context. Nurse prescribing is sanctioned, but remains a locally differentiated policy with plain piecemeal implementation. This could raise issues of attribute and also the ability to evaluate the effects an d impact of nurse prescribing at the macro level. Despite the adoption of the principle, there was a distinct drop of action in moving the agenda forward, and it was some time onward the bill was passed through Parliament in 1992 (Jones, 2004). The literature shows that the legislation passed in 1992, and in 1994 nurse prescribing began in eight demonstration sites (Bates, 2002). Following this pilot, a national roll out of nurse prescribing began in 1998 (Bates, 2002). This, however, applied further to nurses with district nurse of health visitor qualifications working in the community and employed by an NHS Trust or GP (Bates, 2002). balk of the decision.Confirmation of the decision can also be seen within the literature, in that in 1999 there was a review of prescribing, which then recommended that prescribing rights be extended to hold other groups of nurses and other health professionals (Bates, 2002). Subsequent to this, the NHS Plan (2002) clearly supported the recommenda tions and it was posited that by 2004, nurses should be able to prescribe independently, or supply medicines in Patient Group directions in four areas minor illness, minor injury, health promotion and palliative care, within the aegis of a Nurse Prescribing pharmacopeia (Bates, 2004). Bates (2004) stated that there were approximately 22000 nurse prescribers in the UK, 3000 of which were in Scotland (at the time of her article). This suggests that there is widespread confirmation of the decision through demonstrable changes in practice. It is also notable that nurse prescribing has further progressed towards supplementary nurse prescribing, which allows nurses and other health professionals to prescribe for a patient who has been through an initial assessment by a doctor, in accordance with a clinical management plan (NHS Scotland, 2002).It should be noted that prior conditions affect the innovation-decision process. Prior conditions implicate previous practice, snarl reads/probl ems, innovativeness, and norms of the social systems (Rogers, 1962, 1976).Consequences of Innovations (Rogers, 1962, 1976).Any discussion of the innovation-decision process, must also consider the military issues or changes that can occur to a social system as a result of the adoption of an innovation. Rogers (1962, 1976) identifies three significations or changes.Desirable versus un wanted consequencesThe primary purpose of nurse prescribing is to give uttermost benefit to patients and the NHS, whilst also supporting quicker and much efficient annoy to healthcare eon promoting a more flexible use of the skills of the actual workforce (Bates, 2002). This however could be a somewhat idealistic view of general nurse prescribing. While for many nurses it whitethorn enhance their ability to provide care, others may consider that it simply adds to their already onerous workload. There may also be ethical issues, perhaps through conflicts between personal, official and levelheade d senses of duty for nurses, which could result in cognitive interference between their conceptual model of their nursing role and the new directives to extend this role in to a traditionally medical area of responsibility.Nolan et al (2001) in a study of mental health nurses perceptions of nurse prescribing lay down that most of their respondents felt that this would significantly improve clients access to medication, improve compliance, prohibit relapse, and prove cost effective. However, the same respondents also felt that they may not have sufficient knowledge and skills to assume responsibility for prescribing (Nolan et al, 2001). In this case, as elsewhere, nurse prescribing is a double-edged sword, but it seem from this research that the nurses felt that the benefits outweighed their concerns, and their concerns were, after all, possible to overcome through additional training.Direct versus substantiative consequences.Some of the mediate consequences may be easier to app reciate than the direct consequences, while some of the direct consequences may be less popular, in a sense, because they benefit members of the institutional system in ways less grateful to some of the professionally defined or client-defined groups within the system. For example, if the direct consequence of nurse prescribing is a reduction in doctors workloads, this will benefit doctors, and may indirectly benefit patients by providing more or better woodland doctor-patient contact, and patient outcomes. But there is no evidence so suggest that this rather optimistic viewpoint could be true. A reduction in doctors workloads may demonstrate no improvement in patient care, but an increase in nurses workloads could be viewed as having more potential indirect consequences for the patient experience. Deontological debates also raise this issue, and the question is where does the duty of the nurse very lie?Another indirect consequence of the innovation might be the burden placed on nurses to conform to this professional development and to flummox to the directive. Nurses who do not wish this level of responsibility and autonomy may suffer personally and professionally, finding themselves non-conformists through no fault of their own. However, if some other consequence is an enhancement in the status (and pay) of nurses, nurses who prefer not to prescribe could be viewed as holding the profession back.Anticipated versus unanticipated consequences.It is grueling to evaluate the anticipated consequences against the unanticipated ones, given that there is little literature discussing these. Some anticipated consequences might relate to improvements in medication education by nurses (Rycroft-Malone et al, 2000), whereby the nurses will be more knowledgeable, competent and perhaps footsure in this activity. This is an important issue in the modern healthcare servicing where consumerism has become one of the most powerful driving and defining forces (Rycroft-Mal one et al, 2001). It is this potpourri of consumer power which contributes to future policy direction, after all, although the current rhetoric, with its implicit assertion that greater consumer involvement in health care is both desirable and beneficial (Rycroft-Malone, 2001), could be challenged by those who believe that the conferred authority of medicine (and nursing) should take the lead. This author can only project certain consequences, some of which may relate to consumer power and the negotiation of power dynamics between different groups. However, it is debateable if these could be considered anticipated or foreseeable consequences.Another anticipated consequence of this innovation is the close evaluation of the innovation, with inevitable close scrutiny of the nursing profession and its actions in response to the new powers and responsibilities. Latter and Courtenay (2004) in a review of evaluations of nurse prescribing found that the initiative had been by and large su ccessful. However, they also pick out areas for much further scrutiny and consideration, such as gaps in the knowledge base about prescribing, the nature of the evidence about nurse prescribing, and the need to evaluate the extension of prescribing powers to nurses working right(prenominal) the initially defined settings (Latter and Courtenay, 2004).It would shape up that the nurse-patient relationship may be a positive dimension of patients perceptions of nurse prescribing, but there is a need to further evaluate the more intermittent contacts that patients may experience with nurses in certain settings (Latter and Courtenay, 2004). McKenna and Keeney (2004) found that there is still a lack of understanding of the roles of, in particular, community and specialist nurses, but that there is unexclusive support for nurse prescribing. Questions still remain about nurses ability to be effective in working outside their standard professional area (McKenna and Keeney, 2004). This rai ses questions about the consequences for nurses in how they interact with their clients, and suggests that nurse prescribing may contribute to changing the professional face of nursing.ConclusionThe modernization of the NHS, with its emphasis on timely and effective delivery of answers, has been a key factor in the implementation of nurse prescribing and its development into independent prescribing, even into the hospital setting (Clegg et al, 2006). The history of nurse prescribing demonstrates the drive for professional harvest-time in certain areas, sanctioned by changes in the context of service delivery, but hampered by traditional roles and concepts of professional domain. Debates also consider the challenges of training, legal issues, professional issues, budgetary and practical issues surrounding nurse prescribing (Clegg et al, 2004). What is most apparent from this examination of the literature, however, is that while the embryonic stage of nurse prescribing is long gone , the innovation is still undergoing a process of growth and maturation, which is persistently emergent and consequently leaving the status of the profession in relation to this issue largely unformed.This examination of nurse prescribing has shown that change spreads by a process of diffusion, which could be viewed in retrospect as a piecemeal process drive from different directions and according to the perhaps hidden agendas of different agencies, such as nurses, the government, and the consumer. More research is required to examine the ongoing growth and consequences of this innovation, for the professions and the clients, now that it has become an established part of healthcare practice in the UK.2,500 rowReferencesBates, C. (2002) Independent nurse prescribing. RCM Midwives journal 5 (2) 63.Berry, D., Courtenay, M. and Versellini, E. 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