Legal authority and workplace jurisdiction: A multiple-case study of nurse prescribing in hospitals

M Kroezen Centre for Health Services and Nursing Research, Catholic University Leuven, Belgium Contact: marieke.kroezen@kuleuven.be Background Governments increasingly see the shifting of tasks from physicians to nurses as suitable policy response to alleviate health workforce shortages. In a growing number of countries nurses obtain prescriptive authority. Yet little is known how legal task substitution is implemented in everyday clinical practice and to what extent legal and workplace jurisdiction resemble each other. Methods A multiple-case study of prescribing by nurse specialists in five Dutch hospitals was conducted, including non-participant observations of nurse specialists’ prescribing consultations (n = 49), semi-structured interviews with nurse specialists (n = 15) and medical specialists (n = 14), and document analysis. Results Across hospitals and wards, there was great variety in the extent and way in which nurse specialists’ legal prescriptive authority had been implemented, e.g. in terms of the number and range of medicines prescribed, supporting documents used and (mandatory) consultation or supervision by physicians. Nurse specialists’ legal authority seems to have a vague relation to workplace realities. While Dutch nurse specialists are legally allowed to independently prescribe any licensed medicine within their specialism and competence, in the workplace they prescribe less often and in less independent ways. This has implications for policy expectations about the effects of nurse specialist prescribing. Conclusions This paper is included in the workshop because it points out the discrepancy between nurse specialists’ prescriptive authority at macro (legal) and micro (workplace) level and shows that task substitution processes should take into account the considerable influence of the meso (organisational) level. 8th European Public Health Conference: Parallel Sessions 33