title: Factors influencing nurse and pharmacist willingness to take or not take responsibility for non-medical prescribing.
abstract: BACKGROUND
  In the UK, the majority of non-medical prescribers (NMPs) are nurses or pharmacists working in community or primary care. However, little is known about what influences their decisions to prescribe, unlike with medical prescribing. It is also unclear whether the medical findings can be extrapolated, given their very different prescribing training.
  
  
  OBJECTIVE
  To explore the factors influencing whether nurse and pharmacist NMPs in community and primary care settings take responsibility for prescribing.
  
  
  METHODS
  Initially, 20 NMPs (15 nurses and 5 pharmacists) were purposively selected and interviewed using the critical incident technique about situations where they felt it was inappropriate for them to take responsibility for prescribing or where they were uneasy about doing so. In addition, more general factors influencing their decision to take or not take prescribing responsibility were discussed. Subsequently, the themes from the interview analysis were validated in three focus groups with a total of 10 nurse NMPs. All data were analyzed using a constant comparison approach.
  
  
  RESULTS
  Fifty-two critical incidents were recorded--12 from pharmacist NMPs and 40 from nurse NMPs. Participants experienced situations where they were reluctant to accept responsibility for prescribing. Perceptions of competency, role and risk influenced their decision to prescribe. Workarounds such as delaying the prescribing decision or refer the patient to a doctor were used.
  
  
  CONCLUSIONS
  For NMPs to feel more confident about taking responsibility for prescribing, these issues of competency, role and perceived risk need to be addressed. Roles of NMPs must be clear to colleagues, doctors and patients. Training and support must be provided to enable professional development and increasing competence of NMPs.
authors.affiliation: Manchester Pharmacy School and Manchester Academic Health Sciences Centre (MAHSC), Oxford Road, Manchester M13 9PL, UK.
authors.forename: C
authors.initials: C
authors.lastname: Maddox
authors.affiliation: Manchester Pharmacy School and Manchester Academic Health Sciences Centre (MAHSC), Oxford Road, Manchester M13 9PL, UK.
authors.forename: D
authors.initials: D
authors.lastname: Halsall
authors.affiliation: Manchester Pharmacy School and Manchester Academic Health Sciences Centre (MAHSC), Oxford Road, Manchester M13 9PL, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hall
authors.affiliation: Manchester Pharmacy School and Manchester Academic Health Sciences Centre (MAHSC), Oxford Road, Manchester M13 9PL, UK. Electronic address: Mary.tully@manchester.ac.uk.
authors.forename: M P
authors.initials: MP
authors.lastname: Tully
mesh_terms: D003157:Community Pharmacy Services / Q000706:statistics & numerical data; D006801:Humans; D009726:Nurses / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000706:statistics & numerical data*; D010820:Physicians; D055656:Prescriptions / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D024382:Professional Role; D012017:Referral and Consultation; D012306:Risk; D013647:Task Performance and Analysis; D006113:United Kingdom
keywords: Competence; Non-medical prescribing; Nurses; Pharmacists; Responsibility