An Evaluation of the Expansion of Nurse Prescribing in Scotland

CHAPTER FOUR NURSE PERSPECTIVES ON NURSE PRESCRIBING

Introduction

4.1 This chapter provides perspectives on nurse prescribing by nurse prescribers themselves. It details on the responses to the national questionnaire survey sent to all 3,700 nurse prescribers listed in Scotland in May 2005 (948 completed questionnaires where returned representing a response rate of 26%), along with nurse prescribers views from case studies. A profile of nurse prescribers' in terms of age, work environments, prescribing type, locations and past experience is also presented.

Profile of Nurse Prescribers

4.2 Nurse prescribers work in a wide range of clinical and community settings. Their profile - in terms of numbers, training, range of practice, and roles - has altered significantly since the late 1990s and especially between 2003 and 2007.

4.3 The majority of respondents to the survey reported that they were employed as nurses (64%) or health visitors (35%). Another 4% were employed as midwives. Some respondents reported that they were working in more than one capacity.

4.4 The majority of nurse prescribers were aged over 40 at the time of the survey (table 4.1).

Table 4.1 Nurse Prescriber age profile 2005

Age	%	N
under 40 years	18	172
40 - 49 years	55	521
50 - 59 years	26	246
60 years or more	1	9
Total	100	948

* Base: all respondents - 948

4.5 Respondents worked in a range of areas in their practice. Some respondents worked in more than one area. Overall 44% reported that their practice covered an urban area, 34% a suburban area and 41% a rural area. 9% of respondents reported that their practice included a remote area. Nearly three quarters of respondents (71%) were based in health centres or GP practices, less than 10% were based in acute settings, and the rest were based in a variety of other setting.

Table 4.2 Prescriber category

Prescriber category	%	N
HV/ DN Independent nurse prescribers	70	664
Extended and supplementary prescribers	23	218
Other type of prescriber	7	66
Total	100	948

*Base: all respondents - 948

4.6 The majority of prescribers (75%) were Grade ⁷ in their current role with a further 16% in Grade H. A total of 83% of the respondents had been in their current role for more than a year; 39% had 2 to 5 years experience in the post, 18% 6 to 10 years, 20% 11-20 years and 6% had more than 20 years experience in their current post.

4.7 Independent Nurse Prescribers were the most common category of prescriber with just under a quarter of respondents reporting that they were extended and supplementary prescribers (table 4.2).

Past experience and training

4.8 The majority of respondents (89%) had attained a Registered Nurse ( RN), Registered General Nurse ( RGN) or State Registered Nurse ( SRN) adult qualification. A third had also qualified as a Registered Midwife ( RM) and a third in district nursing or health visiting. Many of these respondents attained these qualifications before 1991, for example, 79% of those with a RN/ RGN/ SRN adult qualification received this before 1991.

4.9 Of those who reported the date they attained their qualification, just under a half (48%) had attained their qualification between 2001 and 2005.

4.10 Independent nurse prescribers tended to have been qualified and worked in the role for a longer period of time than extended and supplementary nurse prescribers. For example, 67% of independent prescribers had been in that role for 1-5 years and a further 5% for 5 or more years compared to 40% of extended and supplementary nurse prescribers who had been in their role for a year or less and 60% for 1 to 5 years.

4.11 Independent prescribers were more likely to work in health centres and GP practices, whereas extended and supplementary nurse prescribers were more likely to work in acute hospitals.

Current practice

4.12 The majority of respondents (78%) reported that they prescribed in their current job. The proportion prescribing was higher amongst those working in health centres and GP practices (87%) than in other settings. The majority of nurse prescribers wrote between 2 and 10 prescriptions per week (Table 4.3)

Table 4.3 Level of prescribing by nurse prescribers

Level of Prescribing	%	N*
Between 2 and 10 prescriptions per week	60	443
Less than 2 prescriptions per week	23	170
More than 10 prescriptions per week	16	119
Don't know/Not stated	1	7
Total	100	739

*Base: all current prescribers - 739

Factors influencing decision to become a Nurse Prescriber

4.13 All respondents were asked to indicate what motivated them to undertake training to become a nurse prescriber. Improvement in patient care and the opportunity for continuing their professional development were very or quite significant factors in their decision for over 90% of respondents. Job satisfaction was also an important factor for many (table 4.4)

Table 4.4 Motivation to undertake training and become a nurse prescriber

Motivation	Very significant	Quite significant
	%	%
Improvement in patient care	69	23
Personal professional development	63	30
Job satisfaction	55	29
Improving job prospects	19	32
Employer pressure	19	21

Base: all respondents 948

4.14 The factors influencing the decision to become a nurse prescriber showed no significant differences across health settings. However, there were variations when these factors were analysed by the number of prescriptions written per week. Those writing one or less prescriptions per week were more likely to say that employer pressure was a factor in undertaking nurse prescriber training than those writing 11-30 prescriptions per week (51% vs. 23%). Improvement in job prospects was more likely to be a motivating factor for nurse prescribers who wrote more than 30 prescriptions per week compared to those writing 1 or less per week (71% vs. 41%). All nurse prescribers writing more than 30 prescriptions per week reported that improving patient care was a significant factor in undertaking nurse prescriber training compared to 82% of those prescribing 1 or more prescriptions per week.

Satisfaction and impact on role

4.15 Overall, 80% of current nurse prescribers were very satisfied or satisfied in their role as nurse prescriber. Extended and supplementary prescribers were more likely to express satisfaction with their role (85%) than other nurse prescriber categories (supplementary prescribers 81%, independent prescribers 79% and extended formulary prescribers 70%).

4.16 The majority of respondents felt that becoming a nurse prescriber had had a positive effect on their role with respect to quality of patient care, in their professional autonomy and in improving job satisfaction (table 4.5). Some respondents felt that becoming a nurse prescriber had had a negative effect on their time (24%) and particularly on the amount of administration (46%) they had to do in their role.

Table 4.5 Impact of becoming a nurse prescriber on role*

Impact of becoming a nurse prescriber	Very positive	Slightly positive
	%	%
Professional autonomy	62	29
Quality of patient care	62	29
Job satisfaction	56	33
Ease of working	38	39
Time	29	26
Administration	8	17

*Base: all current prescribers - 739

4.17 The data suggested there was little difference in the proportions across the various types of nurse prescribers who felt prescribing had had a positive effect with respect to job satisfaction and patient care. The exception was supplementary nurse prescribers. A 100% of this group were felt nurse prescribing had a positive impact on both quality of patient care and job satisfaction compared to 90% of other prescribing nurse types for both factors. However, there were only a few supplementary nurse prescribers in this survey so these comments should be viewed with caution. Looking across the healthcare settings in which nurse prescribers work, 97% of those working in community settings considered nurse prescribing had a impact on patient care compared to 84% working in acute care.

4.18 Nurses who wrote the most prescriptions per week were more likely to report greater job satisfaction as a positive effect of becoming a nurse prescriber. The very positive effect on time varied from a low of 11% among nurses who wrote 1 or less scripts per week to over 68% for those who wrote more than 30. Nearly 90% of those writing more than 30 scripts per week believed their new job had led to a very positive effect on the quality of patient care (in contrast, just over a third of those writing one or less prescription per week felt that their prescribing had a positive effect on patient care). The situation was similar with reference to job satisfaction. The impact on professional autonomy was even higher with nearly 95% of those prescribing 30 or more scripts a week claiming a very positive impact.

Perception of benefits of nurse prescribing to patients

4.19 Nurse prescribers considered the main benefits to patients were in continuity of care (90% strongly or tending to agree), making the pathway of care easier for patients (85% strongly or tending to agree) and in saving patients' time (83% strongly or tending to agree) (table 4.6).

Table 4.6 Nurse prescriber views of benefits to patients

Perceived benefits to patients	Strongly agree	Tend to agree
	%	%
Continuity of care	53	37
Eases pathway of care	45	40
Saves patients' time	44	39
Provides more information for patients	42	41
Gives patients more time to understand prescriptions/treatments	27	44
More convenient for patients	23	39
Patient sees more appropriate medical professional	20	37

* Base: all nurse prescribers - 739

Location of training

4.20 Respondents completed their training at a variety of institutions in Scotland (Table 4.7) with just under a quarter of all respondents undertaking their training at Glasgow Caledonian University.

Table 4.7 Where nurses completed nurse prescribing training

Higher Education Institute	%	N*
Glasgow Caledonian University	24	228
Queen Margaret University College (now QMU)	17	161
University of Paisley	16	152
Robert Gordons University (Aberdeen)	14	134
Abertay University (Dundee)	9	85
University of Dundee	7	66
University of Stirling	6	57
Others	5	47
Not stated	2	18
	100	948

*Base: all respondents - 948

4.21 Overall, respondents thought the education programme they undertook was effective in helping them adequately prepare for their role. A quarter of respondents (25%) thought it was very effective and 56% thought it was quite effective.

4.22 Analysis of data by institution shows that the proportion of respondents who considered the training they undertook as very or quite effective ranged from 85% to 71%.

4.23 Independent prescribers were more likely to say that the education programme was very/quite effective (84%) than the extended formulary (60%) and extended and supplementary prescribers (74%).

Table 4.8 Effectiveness of training for a variety of areas*

Training effective in helping to:	Very effective	Quite effective
	%	%
Prescribe safely	53	38
Prescribe within relevant legislation	45	45
Make effective use of NP's formulary	45	41
Assist patients to gain faster access to medicines	37	41
Apply knowledge in practical prescribing	34	48
Build on existing skills	33	51
Assess patients needs	27	50
Make effective use of advice from other professions on prescribing	23	47
Critically evaluate social & clinical circumstances that impact on prescriptions	22	48
Work effectively with teams in prescribing	21	40

* Base - All respondents 948

4.24 Training was considered to be most effective in enabling respondents to prescribe safely, prescribe within relevant legislation and in making use of NP's formulary. It was less effective in enabling respondents work with prescribing teams, making effective use of advice from other professions and in evaluating the social and clinical circumstances that impact on prescriptions (Table 4.8).

Factors affecting prescribing work

4.25 Respondents were asked about the factors which had a positive or negative effect on their prescribing work (table 4.9). Being trained or educated and having up to date information were the factors which most respondents mentioned as having a positive effect on their prescribing work. Peer support was considered to have a positive effect on prescribing work by just over half of the respondents.

Table 4.9 Factors affecting prescribing work*

Factors affecting prescribing work	Positive effect	Negative effect
	%	%
Being trained educated	81	4
Availability of up-to-date prescribing information	71	9
Peer support	53	5
Appropriate infrastructure and prescribing systems	48	19
Time schedule	32	26

* Base: all current prescribers 739

4.26 A lower proportion of respondents in remote areas compared to other areas considered that availability of up-to-date prescribing information and peer support had a positive effect on their work.

4.27 A total of 61% respondents working in community hospitals felt that appropriate infrastructure and prescribing systems had a positive effect on their prescribing work compared to 46% in health centres/ GPs and 39% in acute hospitals.

Future practice and developments

4.28 A large majority of current prescribers reported that they would definitely (83%) or probably (13%) like to continue nurse prescribing. Very few said they would be unlikely to continue in the role. Half of those respondents who were not prescribing currently said they would definitely or probably look to return to prescribing in the future.

4.29 In remote areas, 67% of nurse prescribers reported that they would definitely continue with prescribing compared to 83% nationally.

4.30 Health centre/ GP based staff (95%) were more likely to report that they would definitely or probably continue prescribing than other groups. Community hospital staff were least likely to report that they were likely to continue prescribing (85%).

4.31 All respondents were asked what future developments they would like to see in nurse prescribing (Table 4.10). Two thirds or more of respondents wanted to see a larger nurse prescribing formulary, greater support for nurse prescribers and an increase in professional awareness of the nurse prescribing role.

Table 4.10 Desired future developments in nurse prescribing

Future developments:	%	N*
Larger nurse prescribing formulary	72	683
Greater support for nurse prescribers	68	645
Increase in professional awareness of the role	66	626
Increase in public awareness of role	58	550
Greater nurse prescribing powers	46	436
More nurse prescribers	42	398

* Base: all respondents - 948

4.32 There was little difference between respondents in remote, rural, urban or suburban settings in the developments they wanted to see. However, there were some differences across healthcare settings. 59% of staff in acute hospitals wanted to see greater nurse prescribing powers (at other settings the percentage was around 40%) while 79% of community/district nurse wanted to se greater support for NPs. The figure was around 60% in other settings. NPs may be working in more than one setting.

4.33 For all developments, extended and supplementary nurse providers were more likely to state that they wanted to see these developments happen in the future than respondents in other nurse prescribing roles.

4.34 These responses indicate both confidence in the ability of prescribers to undertake new work and the importance these professionals attach to both limited support and greater professional recognition of the role.

Nurse prescriber views from case studies

4.35 In addition to the findings of the survey of nurse prescribers the case studies also shed light on how nurse prescribers themselves viewed nurse prescribing.

Benefits to practice

4.36 Nurse prescribers reported benefits in relation to their personal development and feelings of personal reward, including satisfaction at being able to provide total patient care. Other benefits related to freedom in decision-making and enhancements in responsibility and autonomy. The ability to 'see through' their patients' care from beginning to end was particularly valued in the context of seamless, continued care and more efficient use of time, which was contrasted with previous frustrations of having to provide a more stop-start service and resulting impacts:

"It was something that I found really frustrating to be doing…to be making the decisions for patients but having to go to a G.P. and have them sanction it and actually write the prescription, it was really frustrating…I think it's fantastic to be able to go to the patient, talk about what you want to talk about, make the decision and I think the patients really benefit from that and your role is more clarified, rather than you being a middle person otherwise. You know, I feel you are a middle person if you are having to go back to the G.P". (Community Nurse)

4.37 Nurse prescribers found additional benefits linked to enhanced professional respect and recognition for prescribing work and validation of prescribing work that had been undertaken informally in the past:

"I think it's more satisfying that you're able to carry out what you were doing anyway. Before, you were writing a note for a G.P. saying 'can you prescribe something for somebody' actually specifying exactly what it was and they would write it out and sign it without ever having seen the patient so you were more or less doing it. So now you're getting recognised and people are acknowledging that it's you that is actually doing that part of their care rather than somebody else who is doing part of their care. So I think that professionally it has aided nurse development". (Community Nurse)

4.38 Nurse prescribers stated that they were able to develop areas of practice that they felt were better run by nurses than GPs, particularly public health initiatives. For example, participants reported that smoking cessation programmes run by some of the community teams had better success with nurse leads when compared to medical leads. Some indicated that nurse prescribing was particularly beneficial to out of hours activity especially in community hospital settings and rural communities. The nurse prescribers stated that potential for the nursing profession to move further on prescribing in some areas, including public health initiatives, trauma care, wound care, palliative care and nurse led-clinics was recognised. There was a view expressed that nurse prescribing expectations were increasing although resource limitations could threaten new professional developments.

4.39 Nurse prescribers found they were able to use their time more effectively since the time spent seeking out or waiting for GP/medical authorisation of prescriptions had been removed:

"Because we are getting busier as a service, it does save us a lot of time, which as you know, it means you can devote your time to other things so it has definitely been a positive for the service and has let us expand"(Community Nurse).

Concerns in practice

4.40 A number of concerns about nurse prescribing were raised by stakeholders during the research. The public sometimes perceived nurses as perhaps less busy than GPs and so expected nurse prescribers to be able to prescribe 'here and now'.

4.41 It was felt that nurse prescribing saved patient and doctor time in relation to decreased workloads. However, it can increase nurse workloads because of the greater number of tasks to be undertaken. On the other hand it can save nurses' time as they no longer have to seek prescription authorisation.

4.42 Nurse prescribers viewed the BNF developments as a positive and largely useful step forward. Despite this there were concerns that the developments were daunting in the sense that further education was required on drugs and products that could now be prescribed. Nurse prescribers recognised, however, that confidence and competence would develop through prescribing experience over time. Some nurse prescribers also discussed hypothetical concerns in relation to other nurse prescribers perhaps not being as 'cautious' as themselves. This was particularly in relation to the formulary opening up and potential pressure on nurse prescribers being expected to prescribe outwith their 'comfort-zone';

"I know that I am extremely cautious, probably too cautious, but I think, I would hope nurses all take onboard the accountability thing because that's a wee bit of an issue, if you are very confident and you think you are more competent than you are…and you know I have met nurses in my career who do think they know it all and it's a wee bit of a worry for me but fortunately I don't feel that I'm guilty of that. It's about being accountable, we're all accountable for our own practice but I think there is scope there for abuse really". (Nurse prescriber)

4.43 Lack of ongoing education and support: Nurse prescribers noted a lack of continuing education in relation to prescribing practice and suggested different mechanisms to address this. For example, a yearly training course update or a post-qualification mentor was viewed by some as desirable;

"There's not a regular meeting and I think there should be and I think a lot of us would say that but we are kind of left to it on our own, you know. You hear changes like being able to prescribe anything through the press rather than from our line management, out own local mechanisms or organisations. And I think for safety, you know, there should be far more support than there is". (Nurse prescriber)

4.44 The policy to discourage nurse prescribers from receiving information from pharmaceutical representatives because of possible bias in decision-making raised additional questions for nurse prescribers about what alternative sources of information might be available to replace commercial ones. Nurse prescribers did not comment on the commercial self-interest of pharmaceutical companies in selling their products. Pharmacology education often came from drug representatives in the past and this new lack of engagement contributed to perceptions of a lack of ongoing education and development. One nurse prescriber (case study one) for example reported a lack of knowledge around steroid skin preparations and was currently looking at ways of addressing this gap in knowledge;

"The lack of continuing education is slightly concerning…they are not keen for us to meet with reps anymore…they used to provide a bit of education for you at lunchtimes, they used to come and do talks and different things, and they're discouraging us from seeing reps as they think it biases our opinion then your education becomes even more limited". (Community nurse)

4.45 Overall, nurse prescribers saw the lack of continuing education and updates as threats to accurate knowledge and therefore patient safety.

Recognition, rewards and roles

4.46 Nurse prescribers were troubled about their responsibilities and work roles advancing without financial recognition and reward. Some thought that the nursing profession could be exploited because nurses prioritised patient care rather than themselves. Hence nurses have taken on prescribing roles for the benefit of their patients but without receiving benefits in terms of their own job roles. This was contradictory as there was increasing satisfaction and professional recognition as a nurse prescriber, without the financial recognition to go with it. It would appear that 'Agenda for Change' has not yet resolved this matter.

4.47 Changing boundaries of nursing were identified and some participants discussed issues around the need to maintain professional identity and resist a gradual shift towards more medical roles.

Support in practice

4.48 Support and subsequent increases in confidence post-qualification came largely from peer and colleague support during and after training. This particularly related to support from the other nurse prescribers within teams, and participants highlighted the benefits of team-working and discussion around decision-making in prescribing practice. Participants therefore identified such support as contingent on the level of nurse prescribing activity within a team;

"We're all prescribers now so generally it's really…sometimes if you've got a decision to make and you are not quite sure about it, you'll run it past each other and it's very good to do that". (Community Nurse)

4.49 In areas where there was only one nurse prescriber, for example with the community hospital night sister, this support was seen as lacking.

4.50 Nurse prescribers identified support and advice from pharmacists as particularly beneficial to working practice. Following on from pharmacy support during training, the pharmacist was perceived as a source of "best advice";

"The pharmacists were really interested in the development of the heart failure service at the beginning and we spoke with them and to them a lot. They were always inviting us to their meetings about the development of the service and they always wanted to be kept involved…you know they've very much said to us 'use us as a link".

4.51 Pharmacy support was also valuable with regard to patient safety because pharmacists would question and hence 'check' prescriptions NPs were unsure about.

4.52 Some individual teams had set up systems that aided prescribing , for example in case study 1 a log system had been set up which ensured that all prescribers within the team knew the medications and products that had been prescribed for each patient.

4.53 Positive feedback from GP/hospital based medical staff was valued, particularly in areas where there had been initial medical resistance or concern until nurse prescribers were able to demonstrate their competence;

"I think when they (G.Ps) are on board it makes a huge difference, you know even just the fact that they've signed the management plan and sent it back to you lets you know that they've got confidence in you to be able to make these changes. So just even then that make things easier".

4.54 Regular meetings with other members of the clinical team and support with decision-making was reported as useful means of support:

"Every 6 weeks we have a case study review where we will review the various different aspects of that patient's monitoring and their medication management and their general condition and we have a consultant who supports these case study reviews. So I would say that in itself is quite good, so if there us something that you wondered about, what you should do, what's the right course of action…whatever it might be, we've got a good mechanism to be able to review that".

4.55 'In house' support from colleagues were contrasted to board level support and nurse prescribers, in general, felt that more support from managerial and administrative bodies was required;

"Coming out into some of the quite isolated roles that we're working in, I would say that the support mechanisms are not there and they definitely need to be improved upon".

4.56 It was felt that better supports from outwith the practice would be beneficial to patient care. Consequently, some nurse prescribers were in the process of setting up networking groups and meetings.

Hindrances to practice

4.57 Delays in receiving prescription pads were noted as a major hindrance and frustration, particularly because it led to decreasing knowledge and confidence around prescribing skills by the time that pads were received. These issues were particularly highlighted in some case studies (case study one, case study 4) and were linked to a lack of support and action by managerial and administrative colleagues:

"I'm now 18/19 months after and I don't have my prescription pad and I hadn't anticipated this amount of hassle and it would be very easy just to throw in the towel and say right I'm not prescribing, I'm not taking that responsibility because I don't actually feel anybody else is taking the responsibility for taking it forward…I've tried my best to take it, I mean I've written about a hundred emails in the time to try and get this moved forward…I think if I hadn't done it, it would be very easy to have done the course and said, we haven't got prescription pads, we can't do this and it would have been very easy for that money to have been completely wasted for all of us".

4.58 Administrative tasks associated with nurse prescribing hindered practice, particularly when nurse prescribers had to access and update patient records on computer, whilst still writing the prescription. Two tasks for the nurse prescriber had been created in comparison with a single task for GPs of simply accessing the prescription and printing it out on their computer.

4.59 A lack of information and support on current changes in relation to the formulary hindered practice. Some nurse prescribers were not yet prescribing in the light of the changes. There were anxieties around a lack of knowledge on advantages and disadvantages of new drug treatments and a need for some educational updating. This was against a background of the potential increase in expectations of nurse prescribers, after legislative changes, from GPs/hospital based medical staffs. The medical staff, some prescribers felt, might expect nurse prescribers to take on prescribing that they were uncomfortable with. Public expectations too of nurse prescribers could be raised as nurses might be viewed as even more approachable than before;

"My concerns are that people might be expecting, since the BNF has opened up, even more. That people might be expecting more of us than we…because each of us are accountable for what we are prepared to be accountable for".

Inter relationships between health professionals

4.60 Most nurse prescribers had a good working relationship with GPs and hospital-based medical staff. References were made to an improved relationship post-prescribing qualification and this appeared to occur after a period of 'proving competence' and the realisation of nurse prescribing benefits;

"I think it's actually improved maybe a bit of the relationship with G.P.s because I think they can see what we are doing and its obviously having a positive effect. So I think it's actually improved the relationship with G.P.s… and then they can see what you're doing is working when they've obviously got more confidence in us as well".

4.61 The relationship between nurse prescribers and pharmacists had benefited from closer working and there was increased contact and support from the pharmacists post-nurse prescribing;

"The pharmacists in the practices, we've got a sort of healthy relationship with them and a lot of the time that's who, they are our first point of contact rather than the G.P. because they can get things organised. Every time you need a prescription change we always write to the pharmacist to let them know, so I would think it's probably had a positive effect on the pharmacist".

4.62 One local pharmacist (case study one) had expressed some concern over prescriptions when nurse prescribers changed from independent to extended independent. However, the nurse prescribers found that this was due to misunderstandings. Nurse prescribers valued this element of questioning as it promoted patient safety.

4.63 Nurse prescribers did not report any marked impact on their relationship with non-prescribing colleagues. However, some nurse prescribers perceived the grading system to be unfair and thought that prescribers should be on a higher grade than their non-prescribing counterparts, due to the increased responsibility and time required.

Summary and conclusions

4.64 The picture provided by the nurse prescriber survey indicates that most nurse prescribers were both positive about their work and the future development of prescribing in Scotland. Many felt it gave them a greater degree of professional autonomy and enabled them to offer improved patient care. There was also an improvement in job satisfaction and ease of working which may be important factors in retaining this group of qualified professional carers.

4.65 The nurse prescribing training undertaken was largely considered to be effective and had a positive impact on nurses' prescribing work. However there were a few areas where the training was felt to be less effective and could be improved. These areas included working effectively with teams in prescribing, supplying and administering medicines.

4.66 There were a small number of problems with some aspects of nurse prescribing. These negative aspects included the negative effect on nurses' time and the amount of administration associated with prescribing. The age profile of the nurse prescribing workforce may prove problematic and may be more difficult to address but that is part of a wider debate about the workforce planning in Scotland.

4.67 Benefits to patients in terms of saving them time, greater continuity of care and greater understanding of the process were also acknowledged.

4.68 The role of nurse prescribing has been successful from the perspective of nurse prescribers with benefits to both the service providers and patients.