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To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.
Cross-sectional national survey.
A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.
Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.
APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.
Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.
This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.
A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.
A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.
A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.
The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.
Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.
What problem did the study address? What were the main findings? Where and on whom will the research have an impact?
This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.
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