Barriers and facilitators to the application of nurse practitioners' training pilot programs in China: A CFIR-guided descriptive qualitative study

Abstract

Background: The Guidelines on Prescriptive Authority for Nurses released by the International Council of Nurses indicate that 44 countries or territories worldwide have enacted legislation granting prescriptive authority to nurses. In the US, 27 states, two territories, and Washington, D.C. have authorized certified nurse practitioners full practice authority, including prescriptive authority, and momentum is building. Currently, in mainland China, there is no national legal mandate for nurse practitioners to prescribe, although a few institutions have initiated pilot training programs for nurse practitioners. However, little is known about the factors influencing their prescribing. Research on the value of such pilot programs from the perspectives of nurse practitioners and stakeholders is required. Aim The purpose of this study is to identify, assess and synthesize the perceptions of nurse practitioners and stakeholders in two pilot training programs on the barriers and facilitators to the potential development and implementation of nurse prescribing in mainland China.

Design: A descriptive qualitative research design.

Settings: The study was conducted at two nurse practitioner pilot institutions in mainland China.

Participants: Five nurse practitioners, three collaborators, three policymakers and three trainers of nurse practitioners from two pilot institutions.

Methods: Data were collected via semi-structured interviews. The Consolidated Framework for Implementation Research (CFIR) was used as a framework to orient the data analysis.

Results: Within the five Consolidated Framework for Implementation Research domains, we identified 31 barriers and 50 facilitators influencing the potential implementation of nurse practitioner prescribing. Barriers mainly included insufficient urgency for change, lack of policy and legal support, inadequate education and training on prescribing, and low public awareness. Facilitators encompassed nurses' practical prescribing experience, their competence and confidence in role expansion, effective teamwork, and a strong demand orientation within healthcare settings.

Conclusion: Our findings suggest that China possesses significant potential to successfully carry out nurse practitioner prescribing initiatives. It is crucial to explore factors hindering or promoting the development of nurse practitioners to effectively support their implementation within healthcare systems while strategizing for future advancements in this area. In the case that the national policy has not yet been promulgated, the outcomes derived from our pilot work will carry substantial influence over national policies.

Keywords: Consolidated framework for implementation; Nurse education; Nurse practitioner; Prescriptive authority; Qualitative research; Strategy.