In the United Kingdom (UK), around 35,000 community and public health nurses (including district nurses, community staff nurses, school nurses and health visitors) can independently prescribe from a limited list of medicines described in the Nurse Prescribers Formulary (NPF) for community practitioners. Although prescribing is viewed as a key role for these nurses, by both nurses themselves and healthcare policy, decreasing numbers of these nurses actively prescribe, and there have been reports that items included in the NPF no longer meet the needs of the patients these nurses manage.
Changing population profiles have led to international interest in the work of community and public health nurses. Although there is a huge diversity in community and public health nursing roles globally, the available international evidence suggests a shift in focus, over the last 20 years, in the typical activities of these nurses. Activities have moved away from longer term support and care, to the provision of a more ‘acutely’ focussed episodic care with increasing involvement in health promotion activities.
As the items listed in the NPF have remained unchanged for two decades, it is highly likely, given the changing population profiles and changing patterns of client and service delivery, that these items no longer reflect the prescribing needs of these nurses. This study, a modified Delphi technique, was designed to provide national consensus on the range of conditions CPNPs manage, and for which it is considered important that they can prescribe.
Panelists reached a consensus, with consistent high levels of agreement reached, on nineteen conditions (both chronic and more acutely focused) for which each group of CPNPs believed it to be important for them to be able to prescribe.
Strategies are required to address health service demands in low-, middle- and high-income countries. Strengthening nurses’ capacity by extending their scope of practice to include prescribing is one such strategy which improves nurse’s ability to reach more people with quality health services. Although it is recognised that the findings of this work originate from a UK perspective, and so leaves open the need for adaptation to other healthcare systems and consideration of other national and regional concerns, our findings provide some guidance for those countries in which prescribing by community and public health nurses is established, and for those countries wishing to establish prescribing by these nurses, with regards to the conditions they manage and so the medicines they will need to prescribe. Our findings can also be used to direct national education and training for the preparation of community and public health nurses.
by Molly Courtenay
Courtenay, M, Franklin, P, Griffiths, M, Hall, T, MacAngus, J, Myers, J, Penistone-Bird, F, Radley, K (2018). 'Establishing priorities on the range of conditions managed by UK community practitioner nurse prescribers': A modified Delphi consensus study. Journal of Advanced Nursing