Nurse and Pharmaceutical Care (NuPhaC)

Nurse Prescribing

Transforming European insights into national practice: developing, implementing and evaluating a nurse prescribing framework for Belgium

 

Background

The current global landscape of healthcare systems is characterised by a multitude of challenges, including an ageing population, the prevalence of multimorbidity, the complexity of chronic care needs and a shortage of healthcare professionals. The development of efficacious, cost-efficient approaches that meet the needs of vulnerable populations is vital for sustainable health outcomes and the reduction of health inequalities. An approach to implementing nurse prescribing (NP) that is informed by experience and based on evidence, could serve as a potential method.

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Across Europe, NP has been introduced as a response to increasing healthcare demands. Multiple European countries have developed regulatory frameworks that enable nurses to prescribe medicines in varying models, including independent prescribing, supplementary prescribing and prescribing per protocol. Evidence from these countries indicates that NP can contribute to safe medication use, improved access to care and enhanced continuity of treatment. In addition, an expanded nursing role can support professional development, autonomy and job satisfaction, which are relevant for retaining skilled professionals.

 

NP practices differ significantly between countries due to variations in healthcare policies, educational standards and regulatory frameworks. There is a large variety between countries and regions in the way NP is established. The literature indicates that NP is allowed in several countries, however caution is needed in interpreting this information. Currently, no reliable overview of prescribing policies exists, as international documents and literature reviews have failed to provide dependable summaries.

 

Until 2025, nurses in Belgium had no prescriptive authority. However, in everyday practice, nurses have been found to prescribe medications informally. This informal practice underscores the need for formal regulation. A new royal decree of April 2024, authorizes Advanced Practice Nurses (APNs) to prescribe medicines and healthcare products. The authority to prescribe will go into force on January 1, 2026. NP for APNs will be implemented trough the establishment of an interprofessional collaboration agreement (IPCA), tailored to the nurses’ level of expertise, clinical experience and the complexity of patient care. This IPCA will determine whether NP is independent or supplementary.

 

While European experiences provide valuable insights into how NP can be organised and regulate, there is a notable gap in recent high-quality international comparisons of NP policies and educational programmes. While legislative frameworks and eductaional programs are essential elements in implementing NP, it is essential to develop a sustainable strategy to evaluate the impact of NP in terms of quality, safety, clinical and implementation outcomes. At this moment, there is no core outcome set specific to NP, which has previously led to inconsistencies in research.

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Aims of the project

The overall aim of this PhD project is to develop, implement and evaluate a NP framework for Belgium, informed by European experiences and the perspectives of Belgian healthcare professionals. The project includes five work packages: (1) mapping NP in Europe and contextualising it for Belgium (Delphi), (2) developing a Core Outcome Set, (3) assessing implementation facilitators and barriers, (4)

longitudinal follow-up of NP in Belgian practice, and (5) developing an implementation and evaluation protocol.

 

This project addresses the following questions:

1. RQ1: What are the educational requirements, legislative frameworks and current practices surrounding nurse prescribing across European countries?

2. RQ2: What educational, legislative and implementation factors are essential for developing a comprehensive framework for nurse prescribing in Belgium?

3. RQ3: What standardized outcome measures are essential for evaluating the effectiveness and impact of nurse prescribing practices across diverse healthcare settings?

4. RQ4: What are the key facilitators and barriers influencing the implementation of nurse prescribing in various healthcare settings?

5. RQ5: How do nurse prescribing practices evolve over time in different Belgian healthcare settings?

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Published research

Blondeel, M., Mortelmans, L., De Belder, E., Sabbe, K., Goossens, E., & Dilles, T. (2025). Exploring nurse prescribing practices and preferences in Belgian hospitals: A multicentre cross-sectional survey on healthcare providers’ perspectives and expected impact. Journal of Advanced Nursing, 1–11. https://doi.org/10.1111/jan.70068

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Timespan

2024-2028