The introduction of mental health nurse supplementary prescribing services

Background: Supplementary prescribing by mental health nurses represents a new technology in clinical care in mental health services. Its introduction inevitably challenges existing organisational structures and processeswhich contribute to the reality of the healthcare context.Aims: To explore the context for establishing mental health nurse supplementary prescribing services drawing upon Lewin’s Field Force Model (Iles & Sutherland 2001). Objectives: 1. To describe potential driving forces for establishing mental health nurse prescribing 2. To describe resisting forces against establishing mental health nurse prescribing 3. To describe the perceived impact of mental health nurse supplementary prescribing upon users, mental health nurses and their professional colleagues and mental health services. Method: A postal questionnaire survey of non-medical prescribing leads and directors of nursing providing mental health services in England (n=51 Trusts) yielding a response rate of 61% (n=35) in 2005.Results: Most services were located in mental health Trusts with some in PCTs or Care Trusts. A range of disorders (schizophrenia, dementia, depression, bi-polar disorder, substance abuse, anxiety and epilepsy) were managed through the new services with schizophrenia being the most frequently identified. A range of reasons were given for establishing the services including: better use of resources and improved access to medication. These often provided a key driving force in addition to legislative and policy changes and key individuals. Resisting forces varied across Trusts and included lack of a non-medical prescribing champion, other priorities and local factors. The services were reported to have a positive impact upon service provision and the professionals involved.Discussion and conclusions: Nurses are prescribing across mental health services. Service innovation requires local leadership to be successful and has the potential to improve service delivery