Negotiating the prescribing role: District Nurses reveal strategies for managing conflict.

Abstract

Background: Nurse prescribing by District Nurses is well established in the United Kingdom. Although considerable work has been undertaken which discusses nurse prescribing, there is little which focuses on relationships between prescribers and those with whom they interact, in particular the ways in which prescribing can appear to question established professional boundaries. Aims: This project seeks to explain how District Nurses negotiate difficult conflicts related to prescribing. Methods: Using qualitative semi-structure interviews, District Nurses, Pharmacists and General Practitioners explained their working activities associated with prescribing. Data were analysed after Morrell’s (2004) notion of naïve functionalism. Critical realism, as espoused by McEvoy and Richards (2003) was used as a bridging strategy in order to link findings to the works of Weber and Foucault. Results: For many District Nurses, prescribing appears unproblematic; however, for others there was evidence showing that GPs were explicit in the control they exerted over prescribers, even when they had no authority to do so. Discussion: Despite having no legal ‘authority’ over nurse prescribers, some prescribers reveal practices that show a clearly authoritarian approach to nurse prescribing, by some GPs. These range from GPs stipulating times when they were available for professional dialogue, to direct supervision and (dis) approval of a nurse prescribers’s activities. Conclusions: Although nurse prescribing was expected to enhance inter-professional working and collaboration in the interest of improved service to patients, there is an indication that, for some nurses and GPs, relationships focussed on nurse prescribing are less than harmonious. Contribution to the development of knowledge and policy and practice within health and health care: As a result of these research findings, relationships within Primary Care may be re-evaluated. For educators there is an opportunity to explore inter-professional relationships from a practitioner perspective.