Big step forward for registered nurse prescribing

20 October 2014

Opening up prescribing to suitably qualified nurses in primary health and other specialties is a step closer with a formal application being lodged by the Nursing Council with the Ministry of Health.

Currently only nurse practitioners and approved diabetes nurse specialists can prescribe but a push began in 2011, at the instigation of then health minister Tony Ryall, to widen prescribing to include more registered nurses leading to Council consulting on nurse prescribing options last year 

Carolyn Reed, Nursing Council chief executive, said in a statement today that it had lodged an application for experienced registered nurses (RNs), holding a postgraduate diploma in registered nurse prescribing, to be granted designated prescribing rights.

This would allow the approved RNs to prescribe commonly-used medicines for long-term and common conditions like asthma, diabetes and hypertension. Or in specific specialties, for example opththalmology or respiratory medicine.

The council says it is estimated that there is currently about 100 registered nurses in New Zealand who are qualified and could prescribe as soon as a regulation is put in place.

"The reason the Council has developed this application for further registered nurse prescribing is to improve patient care without compromising patient safety; to make it easier for patients to obtain the medicines they need; and make better use of the skills of health professionals," said Reed.

The Council's application acknowledges that "some medical and pharmacists groups" – including the New Zealand Medical Association –in submissions to last year's consultation paper had not supported RNs gaining designated prescribing rights and instead preferred a model of delegated prescribing.

"The Council carefully considered these submissions but decided the prescribing authority would be too restrictive, would not maximise benefits for patients and was not supported by the nursing profession or all medical professionals," says the application.

But it also said it had responded to concerns raised about patient safety, misdiagnosis and inappropriate RN prescribing and fragmentation of care by reviewing the requirements for designated RN prescribing.

These included increasing the number of years experience required in the RN's chosen specialty from one year to three years, modifying the list of medicines RNs can prescribe and strengthening requirements for education, supervision, collaboration with an authorised subscriber and continuing competence.

The RN will not only to have completed a postgraduate diploma in RN prescribing for long-term and common conditions but also completed a prescribing practicum of at least 150 hours under the supervision of a doctor or NP in a "collaborative health team environment". After gaining prescribing rights the nurse will also be rquir3d to continue to be supervised by a doctor or NP for the first 12 months of their prescribing practice.

"Working with a multidisciplinary team will enable registered nurse prescribers to consult other prescribers or refer more complex patients to a medical or nurse practitioner," said Reed.

The Council has also set out the required education standards for the proposed postgraduate prescribing diploma and said it would also implement a process to recognise relevant papers already gained by nurses in pathophysiology, clinical assessment and pharmacology, or nurses who have completed a prescribing practicum as part of their clinical masters degree.