title: Nurses' reported use of standing orders in primary health care settings.
abstract: BACKGROUND
  The Medicines (Standing Order) Amendment Regulations 2011 allow medicines to be supplied or administered to a patient by a nurse in the absence of a medical practitioner and without a prescription. Regulations have been in place since 2002, but no substantive research has occurred in New Zealand concerning their use.
  
  
  OBJECTIVE
  This paper reports a survey of registered nurses (RNs) who work in primary health care (PHC) settings and explores aspects of their practice relating to their use of standing orders.
  
  
  METHODS
  A self-reported survey using a non-probability sample of RNs working in PHC who use standing orders in their practice (n=231). Data were analysed descriptively.
  
  
  RESULTS
  The sample were experienced RNs (mean 24 years since registration) and 53% have a postgraduate qualification. Some nurses' understanding of a standing order included provision of a prescription to a patient. Standing orders were used frequently (42% reported use 1 to >5 times/day) for a wide variety of conditions. There is a significant relationship between undertaking the stated professional development requirements and confidence in the clinical decisions made (p=0.025). Over half (52%) would like to use standing orders more often.
  
  
  CONCLUSIONS
  Standing orders are used extensively in PHC settings. The conditions nurses are involved in treating are usually already differentiated or have a high degree of diagnostic certainty. Nurses can effectively provide medicines under standing orders when doctors support their use, issue evidence-based orders, and have confidence in nurses with advanced skills. Doctors need to meet their responsibilities under the Regulations.
authors.affiliation: School of Nursing, Massey University, Wellington, New Zealand. j.wilkinson@massey.ac.nz.
authors.forename: Jill
authors.initials: J
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D024802:Nurse's Role; D009726:Nurses / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D012111:Residence Characteristics; D012959:Socioeconomic Factors