The attitudes of physicians toward nurse prescribing rights: a cross-sectional study

In November 2022, the global population reached 8 billion, of which the proportion of people aged 65 and over is expected to rise from 10% in 2022 to 16% in 2050 [1]. According to the 2023 China Statistical Yearbook, there are 210 million people over the age of 65, accounting for 14.9% of the total population [2]. This aging process has resulted in a rise in chronic conditions, disabilities, and handicaps. In 2022, the number of practicing physicians in China was only 4.22 million, which has led to an attempt to delegate prescribing rights from physicians to nurses [2].

Nurse prescribing right is the right of nurses to prescribe effective treatment for patients’ health issues in nursing practice [3]. In general, the right to prescribe has always been the preserve of physicians. In 1971, to address inadequate medical resources and increase patient access to health care, Idaho became the first state in the United States to allow legislation for nurse prescribing rights [4]. Over the past 20 years, nurse prescribing rights have become very common in many countries, such as the United Kingdom, the United States, and Australia [5]. In September 2021, the International Council of Nurses formulated the world’s first Guidelines on prescriptive Authority for Nurses, and 44 countries or regions worldwide have formulated formal laws and regulations granting nurse prescribing rights [6]. In 2018, Anhui Province took the lead in piloting nurse prescribing rights, which provided experience in developing nurse prescribing rights in China [7]. In 2022, medical regulations in the Shenzhen Special Economic Zone grant specialist nurses the right to prescribe [8], indicating the gradual development of nurse prescribing rights in China.

Nurses have the most contact with patients and often find the changes of patients’ conditions in the first time. Nurses have the rights to prescribe and can assume part of the role of physicians, which helps physicians have enough time to deal with difficult diseases and realize the efficient allocation of medical resources [9]. More importantly, nurses have the rights to prescribe, which can provide nurses with a new career direction and promote the development of nursing discipline [10]. However, the advancement of the nurse prescribing role encounters various obstacles, such as the attitude of physicians, the integrity of laws, and so on, with the negative attitude of physicians being the most prominent barrier [11, 12]. In previous studies, the results of physicians’ attitudes toward nurse prescribing rights differed, and some showed that physicians supported nurse prescribing rights [5, 13]. The results of the study by Abbey Hyde et al. [14] showed that it was safe for nurses to prescribe ionizing radiation. The positive attitudes of physicians play an important role in expanding the range of prescriptions that nurses can prescribe. However, some studies showed that physicians were opposed to nurses having the right to prescribe. Reasons cited for their opposition include the inadequate knowledge of nurses [15], the uncertain purpose of nurse prescribing rights [16], and so on. To our knowledge, no prior study has investigated Chinese physicians’ attitudes toward nurse prescribing rights. Therefore, the present study aimed to assess the attitudes of Chinese physicians toward nurse prescribing rights.

The practical objectives of this study were to (1) explore the attitudes of physicians toward nurse prescribing rights, and (2) explore the factors correlated to physicians’ attitudes toward nurses prescribing rights.

The present cross-sectional study was performed to explore physicians’ attitudes toward nurse prescribing rights and its correlated factors. The study included 112 physicians. They come not from one province but from Beijing, Tianjin, Guangdong, Hebei, Henan, Heilongjiang, Shandong, Shanxi, Shaanxi, Sichuan, and Zhejiang provinces. Therefore, the results of this study have a certain regional representation and universality.

However, the findings indicate that the majority of physicians have a positive attitude toward nurse prescribing rights. The findings align with the study results reported by Karen Stenner et al. [22]. Although prescribing had always been a tradition for physicians, in some countries where prescribing was permitted, they had regulated the conditions for nurses to prescribe and ensured patients safety through physicians supervision and other measures [23], which lessened the resistance of physicians to nurses having the right to prescribe. The study by Saija Koskiniemi et al. [24] found that providing knowledge of nursing for patients at prescription appointments with nurses could potentially lead to cost savings with fewer readmissions. According to a previous study, patients were just as or more satisfied with the treatment received from nurses with the right to prescribe medication than that from physicians [25]. In addition, physicians’ positive attitudes toward prescribing could promote the development of nurse prescribing rights. Prescribing was thought to improve nurses’ ability to promote evidence-based practice [26]. The results of the study by Roisin Lennon et al. [27] demonstrated the positive impact of nurse prescribing rights on patients and its role in elevating the standard of medication prescribing. According to the prescribers, this arose from the complete episode of safe and improved service delivery that they brought to their caseload of patients. Regarding those nurses who wrote the prescriptions, it was both appropriate and within the limits of their competence to prescribe for patients [28].

The study results showed that physicians had a high score in nurse-physician collaboration. Consistent with our findings, a study by Shu Chunmei et al. [29] conducted in China, it was reported that the nurse-physician collaboration in tertiary hospitals was also at a good level. Nurse-physician collaboration refers to the process in which physicians and nurses make joint decisions to provide treatment and nursing for patients on the premise of equality, autonomy, mutual respect, and trust in each other’s knowledge and ability [30]. Through good cooperation between physicians and nurses, working time could be saved, and the pressure on physicians and nurses could be reduced. In addition, previous studies [31, 32] have shown that active nurse-physician collaboration could reduce the incidence of mortality, complications, and adverse prognosis in patients. Since good nurse-physician collaboration can dramatically improve patient care, it is necessary to strengthen the establishment of nurse-physician partnerships.

Our findings revealed that the score of knowledge about nurse prescribing rights was medium. However, this was inconsistent with the findings of Hamidreza Haririan et al. [13], which showed that physicians had a relatively high knowledge of nurse prescribing rights. This could be related to the short time that nurse prescribing rights were introduced into China from abroad. Currently, China has no laws and regulations to support and manage nurse prescribing rights at the national level. The prescription by specialist nurses could provide patients with more comprehensive and high-quality medical and health services [33]. If the National Health Commission begins looking into the implementation of a certification system to grant nurse prescribing rights to specialist nurses, in that case, we believe that this will not only increase public awareness of nurse prescribing rights but also promote the development of nurse prescribing rights in China.

This study identified several factors, including sex, nurse-physician collaboration and knowledge of nurse prescribing rights, that were correlated with physicians’ attitudes toward nurse prescribing rights. In the study, female physicians were opposed to nurse prescribing rights. For female physicians, male physicians were more likely to be satisfied with their jobs, and nurse prescribing rights could have a further impact on the status of female physicians and produce more dissatisfaction with their work [34], which could be the reason why female physicians were reluctant to support nurse prescribing rights. Nurse-physician collaboration was an important factor in promoting the development of nurse prescribing rights [9]. Therefore, handling the nurse-physician partnership would make it easier for physicians to accept the right of nurses to prescribe. We suggest that nurses seek guidance from physicians when making prescriptions and that physicians periodically evaluate and offer input on nurses’ prescriptions. This practice will not only enhance nurses’ confidence in their work but also guarantee the safety of their prescriptions. Therefore, we propose to strengthen media publicity, popularize knowledge about nurse prescribing rights to the public through newspapers, the internet, television, etc., and increase physician awareness of nurse prescribing rights [35]. Consequently, this will also help to reduce the resistance of physicians to the right of nurses to prescribe. Similarly, it will also help to reduce the resistance of physicians to the right of nurses to prescribe.

In the present study, the majority of physicians agreed with nurse prescribing rights. The attitudes of physicians toward nurse prescribing rights were correlated with sex, nurse-physician cooperation and the knowledge of nurse prescribing rights. Female physicians had negative attitudes toward nurse prescribing rights. In addition, we also believe that popularizing the knowledge of nurse prescribing rights and improving the nurse-physician partnership to improve physicians’ attitudes toward nurses’ prescribing rights. Finally, we call on the media to increase the publicity of nurses’ prescribing rights so that physicians can gradually understand them, which will help in the development of nurses’ prescribing rights.