NPs delighted to gain same prescribing status as midwives and GPs

1 January 2014

The nursing sector’s patience has finally been rewarded with the passing of a bill that grants nurse practitioners equal prescribing status to GPs, midwives, and dentists.

Nurse practitioner leaders Dr Michal Boyd and Rosemary Minto say NPs are “delighted” and “relieved” that the Medicines Amendment Bill 2011 has finally been passed. Likewise, College of Nurses director and longstanding nurse prescribing advocate Dr Jenny Carryer said it was wonderful to have the bill passed “at last” to “free NPs to do what they are qualified to do”.

Temuka NP, Sharon Hansen, who is also deputy chair of the Rural General Practice Network, has described the bill’s passing as a “good start” to overcoming legislative barriers hindering NPs working at the top of their scope.

The long-awaited change from designated prescriber to authorised prescriber means NPs are no longer limited to prescribing from a gazetted list of medications but can prescribe all medicines relevant to their scope of practice. They can also now, like their GP colleagues, issue and supervise prescribing standing orders for registered nurse colleagues.

“It is great news for NPs who are struggling to provide essential services to patients, for example, prescribing opioids, and who can only prescribe three days worth under the current legislation,” said Minto, the immediate past-president of the NZNO College of Primary Health Care Nurses.

She said this has been an unnecessary barrier for patients and created more hardship by more prescription costs or the need to see more than one provider.

The first NP was approved by the Nursing Council to prescribe a decade ago and the lobbying began soon after to remove some of the cumbersome barriers to NP prescribing, leading in 2007 to the first bill being tabled (the later shelved Therapeutic Products and Medicines Bill) that proposed authorised prescribing status.

Carryer noted that the “world of health policy and legislation moves so slowly” but now the bill had been passed, it “paved the way for RN prescribers and much greater consumer access to care”.

Minto said it was also a boon for NPs who wished to mentor or be clinical supervisors for NP interns.

“It will take some of the load off busy GPs and doctors who historically have been providing oversight for these NP students.”

Hansen said it was heartening to see the support of the work NPs do as the restriction placed on NP prescribing had been an “ongoing source of frustration” and a significant barrier for patients requiring controlled medications.

The Rural General Practice Network chair and GP Dr Jo Scott-Jones said the move was an appropriate acknowledgement of NP’s skill, training, and responsibilities.

“Rural primary care services remain at significant strain due to the continued pressure of attracting health professionals into rural areas.The ability of NPs to prescribe more freely can only be good news for patients in the communities where they serve.”

Boyd, a leading NP and former head of Nurse Practitioners New Zealand, said she was delighted to see the bill finally passed. A year ago, as then-NPNZ leader, she expressed frustration that the long awaited bill’s fine print said it would not come into effect until July 2014.

A spokesman for the Associate Health Minister Peter Dunne said at the time “that no delays were anticipated” and the commencement date was expected to be “well before” July 2014.

But in a statement to acknowledge the passing of the bill, the current Associate Health Minister, Todd McClay, said the default commencement date for the prescribing changes was still 1 July 2014 and the default commencement date for amending the medicines approval process was 2017.

He said the bill was an “interim measure until such time as the Therapeutic Products and Medicines Bill is passed”. The bill also gives authorised prescriber status to optometrists so both NPs and optometrists are now aligned with medical practitioners, midwives and dentists and can “prescribe all medicines appropriate to their scope of practice”.