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Journal of Advanced Nursing - 2025 - Fox - Essential Factors That Support National Implementation of Designated Registered702.55 kB
Published Version (Advanced Access)CC BY-NC-ND V4.0, Open Access
Journal article
Essential Factors That Support National Implementation of Designated Registered Nurse Prescribing: A Systems-Thinking Approach
Journal of Advanced Nursing, Vol.Advanced access
2025
PMID: 40679303
Abstract
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.
Details
- Title
- Essential Factors That Support National Implementation of Designated Registered Nurse Prescribing: A Systems-Thinking Approach
- Authors
- Amanda Fox (Corresponding Author) - Queensland University of TechnologyFrances Lin - Flinders UniversitySuzanne Williams - Queensland University of TechnologyRia Joseph - Flinders UniversityElla Tomkins - Redcliffe HospitalHuahua Yin - Flinders UniversityLynne Stuart (Mandandanji Woman) - University of the Sunshine Coast, Queensland, School of Health - NursingPatsy Yates - Queensland University of TechnologyRaymond Chan - Queensland University of Technology
- Publication details
- Journal of Advanced Nursing, Vol.Advanced access
- Publisher
- Wiley-Blackwell Publishing Ltd.
- DOI
- 10.1111/jan.70075
- ISSN
- 1365-2648; 0309-2402
- PMID
- 40679303
- Copyright note
- © 2025 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
- Grant note
- This work was supported by Queensland University of Technology and Flinders University.
- Organisation Unit
- Indigenous and Transcultural Research Centre; School of Health - Nursing
- Language
- English
- Record Identifier
- 991139406102621
- Output Type
- Journal article
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