The gap between training and practice of prescribing of drugs by nurses in the primary health care: a case study in Brazil

Abstract

Background: In many countries, the inclusion of nurses as prescribers is considered to be an advanced practice. In Brazil, such prescriptions are legally regulated and restricted to primary health care protocols. The presence of prescribing nurses has provoked a debate among medical and nursing corporations. However, there are few studies examining the qualifications, protocols and in-service training that are aimed at prescribing nurses in primary health care.

Objective: We sought to investigate possible gaps between the education, qualifications, self-assessments and practice of prescribing medicine in primary health care from the perspective of nurses.

Design: This investigation is a case study with a qualitative approach.

Setting: This research was conducted in a Brazilian municipality with 84.04% family health strategy coverage and 400,002 inhabitants in northeast Brazil.

Participants: The participants were an intentional sample of 37 nurses in primary health care who were linked to the family health strategy.

Methods: The study was conducted between August and November 2011 with four focus groups, a script validated by the Delphi technique, and a pilot study. This study addressed the qualifications for the prescription of medication, the sufficiency of the Ministry of Health protocols and self-assessments of the ability to prescribe. Qualitative analysis was applied.

Results: All nurses reported having received insufficient training in the discipline of pharmacology to qualify them for prescriptive practice. The nurses emphasised the need for post-graduate training, the importance of clinical experience, and the lack of discussions and training. Only a small number of nurses self-assessed themselves as competent in prescribing drugs, and the others revealed fears of causing adverse reactions to medication.

Conclusions: There are gaps in the education, training, and daily demands of the prescription of medication by nurses in primary health care. It is suggested that prescription practices should be incorporated into undergraduate studies and continuing education in health services.

Keywords: Nursing; Prescription of medication; Primary health care; Qualification.