Steady but slow steps towards RN prescribing

October 2015 Vol 15 (5)

Nursing Review updates the next steps towards widened registered nurse prescribing in, hopefully, 2016.

carolyn reedNobody is ready to set a date yet for when widened prescribing for approved registered nurses will come into being.

But with a draft cabinet paper and regulatory impact statement expected with the Minister in October, the concept is one step closer and RN prescribing may be a reality sometime in 2016.

The proposal would allow experienced registered nurses working in primary healthcare settings with patients with long term and common conditions, as well as RNs working in specialist teams in outpatient settings, to apply for Nursing Council authority to prescribe commonly used medicines in their specialty area. The nurses will be required to first complete a postgraduate diploma in RN prescribing and to continue to be supervised during the first 12 months of prescribing practice.

It was back in February 2013 that the Nursing Council first consulted, at the invitation of then health minister Tony Ryall, on extending prescribing to ‘suitably qualified’ registered nurses. This move followed the successful demonstration sites for prescribing by diabetes nurse specialists.

The Nursing Council lodged a formal application with the Ministry of Health back in October 2014 for designated prescribing rights for RNs practising in primary health and specialty teams. After initial analysis and feedback, the Minister of Health Jonathan Coleman this winter agreed to Ministry of Health officials progressing the application to the next step, which is the drafting of a cabinet paper and regulatory impact. Coleman’s office said it was expecting the draft papers to be with the Minister in October but there was no timeline beyond that for when RN prescribing could come into effect. 

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The Ministry of Health says once Cabinet had considered the prescribing Cabinet paper, the next step was drafting prescribing regulations.

Carolyn Reed, chief executive of the Nursing Council, says it is expecting the next steps in the process to take some time and realistically it could be about 12 months before prescribing regulations were gazetted. She says meanwhile the council was not silent behind the scenes as it was doing a lot of work with postgraduate education providers preparing the proposed new postgraduate diploma in registered nurse prescribing in readiness for when the RN prescribing regulations are introduced. It had also consulted on adding an ophthalmology schedule of medicines to the proposed regulations and developing a plan for ongoing updating of all the schedules of medicine. It is also working on a safety framework for monitoring RN prescribing, informing the public about what RN prescribing entails, and establishing a ‘grandparenting’ arrangement for already prescribing diabetes nurse specialists.

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Reed says it has agreed to education standards for the new diploma but until the prescribing regulations are gazetted the Council can’t approve prescribing diploma programmes. “But we’re anticipating that when we get to the finishing line and it becomes legal, there will be people ready to apply who already have met all the [education] requirements,” she says.

This refers in particular to nurses who have a clinical master’s degree, though some may still need to do a supervised prescribing practicum. It is estimated that around 1,000 nurses may already have a clinical master’s degree but Reed points out that prescribing RNs require not only the qualification but also a supervised working environment for their first year of practice. “I don’t think there will be 1,000 workplaces ready to go with that … it [RN prescribing] also requires workplace readiness.”

New education standards for NPs due

A new ‘broad and generic’ nurse practitioner scope of practice is due to be announced soon, along with new draft education and registration standards for NPs.

Nursing Council chief executive Carolyn Reed said the Council adopted a new scope for NPs in September that was basically a refined and tightened version of its consultation document in late 2014.

Reed says analysis showed that 77 per cent of submissions supported the proposed ‘broad, generic’ scope of practice and removing specific areas of practice for nurse practitioners. A similar percentage supported the proposed new narrower focus on leadership in clinical practice, rather than current requirements for prospective NPs to demonstrate leadership on a national level.

The council also adopted in September some draft proposed NP education standards and options for a new registration process for NPs, including alternative options to the current panel requirement. The Council hoped to release a consultation document shortly on the draft standards and registration process options.

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