An Evaluation of Considerations and Decision-Making during Nurse Prescribing in a Dutch Clinical Setting: a Qualitative Study

Abstract

Title: An Evaluation of Considerations and Decision-Making during Nurse Prescribing in a Dutch Clinical Setting: a Qualitative Study Background: Since January 2012, Dutch nurse specialists have been authorized to prescribe medicines to patients for an experimental period of five years. There is a lack of evidence in national research, so the quality and safety of nurse prescribing in the Netherlands is unclear and has to be assessed. Aim and research question: The aim was to get a first impression of nurse prescribing in a Dutch general hospital in order to discover and research possible issues to ensure further implementation of the new task. The research question was: what factors influence the considerations and decision-making of nurse specialists in a Dutch general hospital when prescribing medicines? Method: A qualitative, exploratory case study was conducted from January 2013 till June 2013. A convenience sample was used to select the participants: three nurse specialists and three physicians working in a Dutch general hospital. Data collection involved observations during eight nurse-prescribing consultations and semi-structured interviews with the six participants. Thematic analysis of data proceeded in stages and the general principles were analytic induction and theoretical sensitivity. Results: Four overarching themes emerged describing factors in the considerations and decision-making of nurse prescribing: guidelines and protocols, role physician, personal experience and role patient. Conclusion: Formal guidelines and consultation with physicians were the determining factors in prescribing medicines by nurse specialists in a Dutch general hospital. Personal experience and consultation with patients were of less influence in the considerations and decision-making of nurse prescribing. Recommendations: Further qualitative research could be conducted with a larger purposeful sample to explore the decision-making process of nurse prescribing, the pharmacological knowledge base, continuing professional development and the use of protocols by Dutch nurse prescribers in the future. These recommendations should be made, viewed from government policy’s perspective, to decide about definitive permission of nurse prescribing in the law BIG.