. 2014 Jul 22;28:77.

Table 3 . Summary of barriers of nurse prescribing identified by the meta-synthesis .

Categories	Cods	Illustrations	Authors
Legal limitations	limitations of Nurse Prescribers’ Formulary	There is some variation in the prescribing patterns of district nurses’, health visitors’ and practice nurses, and the limitations of the original Nurse Prescribers’ Formulary (NPF) have been highlighted	Latter and Courtenay, 2004⁽¹⁰⁾
	legal restrictions	All Western-European and Anglo-Saxon countries that have realised or initiated nurse prescribing have imposed legal restrictions on which categories of nurses can prescribe medicines, what, how much and to whom they can prescribe, and whether they are allowed to do so on an independent basis or under the supervision of a physician.	Kroezen, et al., 2011 ⁽²⁾
Executive Factors	implementation barriers	implementation barriers emerged from the empirical and anecdotal literature, including funding problems, delays in practicing and obtaining prescription pads, encumbering clinical management plans and access to records.	Cooper, et al., 2008 ⁽¹¹⁾
	safety concerns	There were a number of safety concerns identified including: nurses using their professional judgment to deliberately work outside the parameters of PGDs (Miles et al, 2001), poor record keeping (Brooks et al, 2003; Deave et al, 2003; Baileff, 2007) and the development of PGDs that failed to comply with legal requirements (Deave et al, 2003).	Price, et al., 2012 ⁽¹⁶⁾
Humanistic Factors	Lack of confidence in applied pharmacology and therapeutics among nurses	although patients were consent with nurses prescribing medication, nurses lacked confidence in applied pharmacology and therapeutics and hence, required additional scientific education	Banning, 2004⁽⁸⁾
	nurses’ fears of becoming overconfident	Bradley et al (2007) reported nurses’ fears of becoming overconfident and prescribing outside their competency area.	Creedon , et al., 2009⁽¹³⁾
	medical apathy	medical apathy and independent prescribing potentially undermine the success of SP	Cooper, et al., 2008⁽¹¹⁾
Educational deficiencies	Lack of doctors knowledge on the training of nurse rescribers	The Swedish GPs interviewed in Wilhelmsson and Foldeive’s (2003) study lacked knowledge on the training of nurse prescribers, which could account for their negative views on nurse prescribing	Creedon , et al., 2009 ⁽¹³⁾
	substantial gaps in the knowledge base	Our review suggests that there are substantial gaps in the knowledge base to help evidence based policy making in this arena.	Bhanbhro, et al., 2011 ⁽¹⁵⁾
	deficits in the scientific preparation of nurses	This review has drawn attention to the deficits in the scientific preparation of nurses in applied pharmacology and therapeutics.	Banning, 2004⁽⁸⁾
Research weaknesses	methodological weaknesses	there are both methodological weaknesses and under-researched issues that point to the need for further research into this important policy initiative.	Latter and Courtenay, 2004 ⁽¹⁰⁾
		Empirical studies were often methodological weaknesses and under-evaluation of safety, economic analysis and patients’ experiences were identified in empirical studies	Cooper, et al., 2008 ⁽¹¹⁾