Nurses as emergent prescribers in New Zealand: A descriptive comparative study using a multiple case approach

Abstract

In the past decade, New Zealand has followed other countries in introducing the role of nurse practitioners with the right to prescribe. The proposition provoked debate and criticisms reflecting similar concerns as in other countries, with claims that nurses’ inadequate biomedical knowledge and diagnostic skills could put patient safety at risk, and that changes to the traditional doctor-nurse boundaries could create confusion and undermine teamwork. Using a multiple case narrative methodology, this study collected accounts from nurses, junior and experienced doctors and midwives to answer the question: "what are the experiences of nurses in becoming prescribers and how do their experiences compare with those of other prescriber groups?" The study found that experienced nurses learn to prescribe as clinicians with a clinical area of practice that has developed over time through extensive clinical experience, while doctors begin with a solid foundation of diagnostic knowledge integrated and consolidated over time with prescribing, a skill considered embedded in practice. This study showed that the journeys of both nurses and doctors as learner prescribers are similar. They begin as novices, and over time develop skills of reasoning as they gain more clinical experience in prescribing. Both medical and nurse practitioner prescribers are confronted with challenging situations that demand specific approaches to treatment management. In some situations, nurses, as non-medical prescribers, may well be best positioned to deliver the outcome required for a more “individualised” intervention. In others, the expertise of medical prescribers as diagnosticians may be required to ensure a better outcome. Importantly, there was no evidence in this study that nurse prescribers usurped doctors and confusion resulted. This study showed that nurse practitioners prescribers were better able to work collaboratively with the medical practitioners as a common knowledge and language to communicate their clinical reasoning was developed. The study also identified that the completion of educational programmes in prescribing was but the beginning: ongoing support and education in the clinical setting was needed to support clinical reasoning skills and capabilities.