An Examination of the Nurse/Midwife Prescribing Programme in Ireland: Confidence, Accuracy, Seeking Advice and working within the Scope of Practice

The purpose of this study is to explore the impact of the nurse/midwife prescribing programme on nurse/midwife prescribers and measuring the confidence, accuracy, advice seeking behaviour and scope of practice of the participants. A concurrent mixed method approach was used. Data were gathered from 28 qualified nurses and midwives in Ireland, 14 of whom were registered nurse/midwife prescribers and 14 of whom were undertaking the prescribing programme, using semi- structured interviews, and testing the participants with validated clinical scenarios. Relevant literature was also reviewed which revealed tensions between views of medicine and nursing, issues of power and knowledge, and differences between positivist and post- positivist views of research methodology. The qualitative analysis of the data using MAX QDA to manage the data resulted in the identification of themes including, aspects of the programme which were more useful to the nurse/midwife prescribers; the effect the nurse/midwife prescribing programme had on their clinical practice and their thinking; how has the programme influenced or changed their view of prescribing practices; how they used the nurse/midwife prescribing decision making framework developed by An Bord Altranais; how did the nurse/midwife prescribing programme prepare them for their role as a nurse/midwife prescriber in Ireland and the changes that are required to the nurse/midwife prescribing programme in Ireland. The quantitative element of the study found high levels of confidence and accuracy among nurse/midwife prescribers, a willingness to seek advice from medical and nursing colleagues and it emerged that participants had good awareness of the limits of their scope of practice. The study found that nurse/midwife prescribing was perceived by the participants to have changed their practice in terms of caring for the whole patient and their awareness of potential dangers in prescribing such as polypharmacy. Also, the study found that the prescribing programme was effective in preparing the nurse/midwife prescribers, and that being a nurse/midwife prescriber produced efficiencies in patient care as well as quality enhancement in that care. The study revealed frustrations with the governance system particularly the monitoring system that seemed to incentivize prescriptions. Finally, the study highlighted the pedagogical implications of this study for nurse/midwife prescribing education and how real-world learning through simulation, cooperative learning, and interdisciplinary education, could enhance learning, increase safety, and ultimately lead to better patient outcomes