Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature

BMC Health Services Research Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature Marieke Kroezen 0 Liset van Dijk 0 Peter P Groenewegen 0 2 Anneke L Francke 0 1 0 NIVEL, Netherlands Institute for Health Services Research , PO Box 1568, 3500 BN Utrecht , The Netherlands 1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research (EMGO 2 Department of Sociology and Department of Human Geography, Utrecht University , Utrecht , The Netherlands 3 ) of VU University Medical Center , Amsterdam , The Netherlands Background: A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. Methods: A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. Results: One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Conclusions: Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights. - Background The number of countries where nurses are legally permitted to prescribe medication has grown considerably over the last two decades [1,2]. However, even though the term nurse prescribing suffices as descriptor term, the actual practice it refers to varies considerably, both within countries and internationally [3]. Still, international comparisons with regard to nurse prescribing are scarce and those reviews that make an international comparison either focus on the effects of nurse prescribing [4], or lack a clear theoretical and systematic approach [5,6]. A comparative review of the extent of, and the ways in which nurse prescribing has been realised or is being initiated internationally, supported by a sound theoretical model, is lacking. The way in which prescribing by nurses is organized has far-reaching implications, both for the allocation of jurisdictional control over prescriptive authority and for the potential success of nurse prescribing in daily practice. Theoretical insights can help to shed light on these relationships. We therefore set out an international systematic review of publications dealing with the implementation process of nurse prescribing and current nurse prescribing practices within Western European and Anglo-Saxon countries. The theoretical framework used in the review is based on Andrew Abbotts theory on the division of expert labor in modern societies [7]. Traditionally, the task of prescribing medicines has been the domain of the medical profession [8,9], but the development of nurse prescribing represents an incursion on the medical professions jurisdiction over prescribing. According to Abbott [7], jurisdiction - the link between a profession and its work - forms the central phenomenon of professional life. Since one profession can pre-empt anothers jurisdiction or control over a task, professions exist in an interdependent system with competing jurisdictional claims. These claims can be made in several arenas, i.e. professions can claim control over tasks in the legal arena, the workplace and in the arena of public opinion. Abbott [7] extensively discusses the internal and external forces that shape professional competition over jurisdiction. Examples of external and internal forces that could possibly shape professional competition over prescribing rights are, respectively, striving for a more costeffective healthcare system and a shortage of doctors within the healthcare workforce [10]. However, there are only so many full jurisdictions to go around [7]. Consequently, most professional conflicts over jurisdiction result in so-called limited jurisdictional settlements, of which Abbott distinguishes five: - Subordination: the second most desired outcome of a jurisdictional conflict, as the incumbent profession controls the division of labor in which one or more subordinate groups take their place. - Intellectual jurisdiction: in which the incumbent profession controls the cognitive knowledge of an area but allows practice by other professions. - Division of labor: in which the jurisdiction over a certain task is divided between professions into functionally interdependent but structurally equal parts. - Advisory jurisdiction: the weakest form of control, whereby a profession seeks a legitimate right to interpret, buffer or partially modify actions another takes within its own full jurisdiction. - Client differentiation: in which segments of a profession serve different client groups. This is considered a workplace settlement by Abbott. Figure 1 shows a graphic and partial representation of Abbotts theory, applied to the case of nurse prescribing. Although this article focuses on the introduction and realization of legal nurse prescribing, potential jurisdictional claims over prescribing held by one of the involved professions in other arenas were (...truncated)