Several papers specifically investigate nurse prescribing from a patient perspective but the views of patients are, almost without exception, discussed in all the prescribing literature. This attention reflects the point that patient acceptability and patient benefit were guiding principles for the extension of nurse prescribing (DH1989; DH1999a). Crown, in her two reports to the advisory group on nurse prescribing, set out how patients were, expected to benefit from nurse prescribing. Her commitment was clear, the development of nurse prescribing was not to be a matter of professional aggrandisement or practitioner substitution, but would benefit patients.
When researchers asked patients to comment on the acceptability of nurse prescribing they did so by drawing on the role of the nurse and talking about their own experience. Patients talked in positive terms about the relationship between themselves and the prescribing nurse. Nurses were described as being approachable (Luker, Austin, Hogg et al., 1998a; Brooks et al., 2001; Latter et a.,l 2004), central to the continuity of care (Brooks et al., 2001; Luker , Austin et al., 1997b) knowing the patient and patient centred in their approach (Luker et al., 1998a; Jones et al., 2007). In using these terms, patients pick out attributes of nursing they believe complement a prescribing role. Also important to patients was that they should have convenient access to medicines. Patients believe nurse prescribers enable this access (Luker et al., 1998a; Brooks et al., 2001; Latter et al., 2004).
Patient views were one of several data sets collected in ten case studies of extended independent prescribing, Latter et al.(2004). Researchers asked patients in receipt of a nurse prescription to complete a post- prescription
questionnaire. The study results do not offer details about whether the patients were new or existing service users. It is, however, acceptable to assume that across 10 case studies from primary and secondary care some patients will be new and some existing. Views from 118 patients were gathered. Patients said that they felt comfortable talking to the nurse, 71% of patients found the nurse was approachable and 61% specifically valued the continuity of care they experienced whilst receiving nursing care. Independent extended prescribing requires the nurse to establish a diagnosis before prescribing and the authors report that 91% of patient participants believed the nurse had correctly diagnosed their problem. This however, leaves a number of patients who did not believe the diagnosis was correct.
Latter et al. (2004) report 73% of respondents agreed that nurses should be able to prescribe more medicines. These two points, that not all patients believed the nurse diagnosis was correct and that most patients felt nurses should be able to prescribe more medicines, are important. Extended independent prescribing, which was the focus for Latter’s research, required the nurse to diagnose minor illness and minor ailments.
Brooks et al. (2001) and Jones et al. (2007) refer to nursing expertise suggesting that expert knowledge and time to explain about medicines are suitable reasons to support nurse prescribing. Not all patients agree, patients in a study of mental health service users were concerned that nurses had limited knowledge on which to base prescribing decisions (Harrison 2003). At the time of this research, mental health nurse prescribers could prescribe drugs for mental illness but only under
supplementary prescribing arrangements. Under supplementary prescribing arrangements the doctor is responsible for the diagnosis. In 2006 nurse
prescribers gained authority to prescribe these drugs under independent prescribing which requires the nurse to diagnose the condition before prescribing treatments. Berry, Courtenay and Bersellini (2006) conducted research using a clinical scenario that asked the public to imagine they were at risk of coronary heart disease and need a prescription. Their study focussed on supplementary prescribing under which the nurse can
prescribe all licensed and unlicensed medicines. The drugs, which the nurse prescriber can prescribe, have to be included a patient specific clinical management plan. The doctor must make a diagnosis and agree a range of drugs suitable for supplementary prescribing. This arrangement can be seen to assure the patient that both diagnosis and drug therapies are appropriate because the doctor has been involved. The literature to date has not asked patients for their views on the nurse diagnosing and prescribing for patients with chronic diseases and complex or co-
morbidities. From the available evidence, it is possible to assume patients will find this new prescribing acceptable however, we do not know. The literature suggests that patients are happy to consult with nurse
prescribers but they also wish to retain a right to see a doctor when they feel it is necessary (Luker et al., 1998; Brooks et al., 2001; Latter et al.,2004; Berry, Courtenay, Berselini et al., 2006).
Both patients and public (Berry et al., 2006) consistently voice an expectation that all prescribers give information about the drugs they prescribe, explain side effects and offer treatment choice. This expectation also relates to prescribing by doctors, Dickinson and Raynor (2003). The finding is significant to the development of prescribing and the integration of nurse prescribing in practice. To enter into these conversations with patients and meet their information needs the nurse must be able to apply theoretical prescribing knowledge to patient specific clinical situations.
Although patient and public acceptance of nurse prescribing is established gaps in the literature remain. Cooper et al. (2008), in a review of nurse and pharmacist supplementary prescribing literature, were surprised to find only a few published studies explore the opinions or experiences of patients in supplementary prescribing partnerships. The partnership between
patient and prescribers is central to the concept of supplementary
prescribing and fundamental to the development of a clinical management plan. The literature shows more concern with showing nurse prescribing to be acceptable to patients than in the patient experience.