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Nurses are 'floundering' in their new prescribing role

Nurse prescribers lack the pharmacological knowledge and clinical understanding to perform their roles effectively, a scathing evaluation warns.

The analysis bears out doctors' worst fears over nurse independent prescribing after last year's controversial decision to award nurses access to the entire BNF, writes Daniel Cressey.

The majority of trained nurse prescribers scored zero points on tasks set to assess their clinical problem-solving abilities, and few were able to identify key problems in clinical scenarios or provide 'acceptable solutions'.

It follows a Pulse survey

conducted last year with Doctors.net.uk, which found 89 per cent of doctors believed the new regulations on nurse prescribing were not adequate to protect patients.

Study leader Dr Maxine Offredy, reader in primary health care at the University of Hertfordshire, said nurses were 'perhaps knowledgeable in their small area of practice but flounder outside this'.

'We demonstrated lack of

appropriate pharmacological knowledge coupled with lack of confidence in prescribing,' she added.

Carried out over two PCTs, the study involved 18 qualified nurse prescribers and seven nurses undertaking a prescribing course. All had a minimum of eight years' experience in their area of practice.

The majority were 'unable to identify the issues' involved in the four scenarios and 'failed to provide an acceptable solution to the problem'. Only six participants provided a full, correct response to the first scenario and performance was even worse on the other three (see below).

In interviews, one nurse criticised her training on pharmacology as 'really awful'.

Around half of participants scored zero points out of three in each of the scenarios tested.

Dr James Kingsland, a GP in Merseyside who trains nurse prescribers, warned: 'There's a big difference between nurse prescribers and nurse diagnosticians. When a treatment plan hasn't been drawn up and they're left with uncertainty then you're moving into areas nurses are not trained for.'

Dr Nigel Watson, chief executive of Wessex LMCs, said: 'It confirms what many of us thought. I struggle with the idea that everybody can do our job better than we can.'

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