Essential Factors That Support National Implementation of Designated Registered Nurse Prescribing: A Systems-Thinking Approach.

AIM

To explore multidisciplinary clinical, academic, policy and governance stakeholders' perceptions of enablers and barriers to implementing designated registered nurse prescribing in Australia, using a systems-thinking approach.

DESIGN

A two-phase explorative study using a systems-thinking lens to investigate complex health-system interdependencies.

METHODS

Fifty-three participants were recruited from all Australian states and territories, including registered nurses, nurse practitioners, pharmacists, medical practitioners and health-service planners. Phase 1 involved interviews and focus groups conducted between February 2024 and April 2024 (n = 45), analysed using deductive content analysis, guided by the Sustainability of Innovation Framework. Phase 2 was a face-to-face workshop conducted in August 2024 (n = 28), with data from participant discussions and observer field notes analysed inductively and refined through reflexive dialogue. Reflexive analysis of the findings allowed the construction of recommendations for implementation in various healthcare contexts.

RESULTS

In Phase 1, participants representing all Australian jurisdictions and healthcare contexts identified that successful adoption of designated registered nurse prescribing is contingent upon several interrelated system components. These interconnected factors influence each other within the broader healthcare system and serve as the focus for Phase 2. In Phase 2, participants reported context-specific service models, stakeholder engagement, financial support, clear messaging and workforce/organisational readiness for new models of care and service delivery were recognised as dynamic interrelated elements. Three overarching themes for successful implementation were generated: The Standard-just one piece of the puzzle. Harnessing collective capability. Shared wisdom for success.

CONCLUSION

National implementation of registered nurse prescribing requires consistent but context-responsive reforms. A systems-thinking approach underscores the need for whole-of-system strategies, acknowledging interdependencies and avoiding rapid, unplanned implementation. This study highlights that sustainable adoption of registered nurse prescribing in Australia depends on recognising system interdependencies and their dynamic nature.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Designated registered nurse prescribing has the potential to improve timely access to medicines and enhance patient-centred care when implemented with whole-of-system support. This study provides key systems-level recommendations to guide policymakers and healthcare services to successfully implement designated registered nurse prescribing across various settings.

IMPACT

This study highlights key stakeholders' perspectives, providing valuable insights on the essential elements required for the successful adoption of this expanded practice. Broad systems-level recommendations are offered to guide policymakers and healthcare services to successfully implement designated prescribing across various settings, taking into account the complexity of the healthcare system.

REPORTING METHOD

Consolidated criteria for reporting qualitative research guidelines.

PATIENT OR PUBLIC CONTRIBUTION

This study did not include patient or public involvement in its design, conduct or reporting.

REGISTRATION

Not registered.