Exactly a year on from registered nurse prescribing becoming a legal reality, there are now more than 80 RN prescribers.
The regulation introducing RN prescribing in primary health and specialty teams came into force on September 20 last year, with the aim of improving access to medicines for vulnerable populations.
The 29 new RN prescribers authorised to prescribe from a schedule of common medicines for common and long-term conditions join 53 diabetes nurse specialists authorised to prescribe in diabetes health, making 82 RN prescribers in total.
Pam Doole, the Nursing Council’s Strategic Policy Manager, shared the updated statistics on the new second level prescribing at the Clinical Nurse Specialist Society NZ conference in Christchurch earlier this month.
There are now also 254 nurse practitioner prescribers (the top level and only autonomous nurse prescribers), and a group of nurses are currently trialling a third and more limited level of RN prescribing in community health. The first NP prescriber was authorised in 2003 and a pilot followed in 2011 of RN-designated prescribing in diabetes (applications under the diabetes regulations close in November).
Doole said to date most of the 29 RN prescribers in primary health and specialty teams have come through the alternative pathway of having first completed a clinical master’s degree. But the first graduates of the council-approved postgraduate diplomas in registered nurse prescribing were now starting to seek prescribing approval.
RN diploma prescriber
Hawke’s Bay’s Rachael Engelbrecht is one of the first RN prescribers to come through the diploma model.
The former practice nurse specialising in diabetes said she finished a postgraduate diploma in health sciences in 2015 at EIT and spent 2016 waiting for the new prescribing diploma path to be finalised and approved so she could do the EIT diploma’s prescribing practicum.
Engelbrecht began her practicum at the start of this year at the general practice where she had worked for eight years and had become the lead diabetes nurse after developing an interest in diabetes. She said she had a very supportive GP mentor and they envisaged that while her main prescribing focus would be diabetes, it would be useful for her to also have the potential to prescribe for conditions like urinary tract infections and other long-term conditions apart from diabetes.
But midway through her prescribing practicum she changed roles and took up a new post as a diabetes nurse specialist for Hawke’s Bay District Health Board’s diabetes service and completed her diploma practicum under an endocrinologist.
The new RN prescriber believed the role was more clear cut in secondary services and was still evolving in primary care where some issues, like what to charge for an RN prescriber consultation, needed to be worked through.
At the DHB she is one of seven diabetes nurse specialists, with five of them now prescribers – four through the diabetes prescribing regulations and herself through the primary health and specialty team regulations. She said a sixth was currently following the diploma pathway to prescribing.
Changes afoot to regulations controlling RN prescribing
Pam Doole told the clinical nurse specialists’ conference that developing the RN prescribers’ medicines list of commonly used medicines for common conditions had not been a simple process.
Including the Council needing to respond to concerns raised by doctors and pharmacists, which led to it removing some medicines from the final list that was approved and gazetted by the Ministry of Health under the Medicines Act 1981.
Doole said she was aware that medicines used by some nursing specialties, and some new medicines, were not covered by the list. She said the medicines list, gazetted in 2016, was unlikely to be reviewed for a couple of years and in the interim nurses could develop a case for adding additional medicines that could make a difference to their patients.
Meanwhile, work was underway on a new regulatory regime to replace the Medicines Act 1981 and regulations, which could see controls on prescribing shifted to the Health Practitioners Competence Assurance Act and authorities like the Nursing Council. Doole said she was not sure yet whether that meant control of the medicines list would also come under Council’s control, but it could be simpler to make changes in the future if it did.
The specific common and long-term conditions that nurses authorised to prescribe in primary health and specialty teams can prescribe for include:
- diabetes and related conditions
- respiratory diseases including asthma and COPD
- anxiety and depression
- heart failure
- palliative care
- common skin conditions and infections.
Examples of primary health and specialty team settings that RN prescribers can work in include:
- general practice
- outpatient clinics
- family planning
- sexual health
- public health
- district and home care
- rural and remote areas.
The requirements for registered nurses who wish to prescribe in primary health and specialty teams are:
- a minimum of three years full-time practice in the area they intend to prescribe in with at least one year of the total practice in New Zealand or a similar healthcare context
- the completion of a Council-approved postgraduate diploma in registered nurse prescribing for long term and common conditions or equivalent as assessed by the Nursing Council
- a practicum with an authorised prescriber, which demonstrates knowledge to safely prescribe specified prescription medicines and knowledge of the regulatory framework for prescribing
- satisfactory assessment of the competencies for nurse prescribers completed by an authorised prescriber
- RN prescribers in primary health and specialty teams must work in a collaborative team with a doctor or nurse practitioner available for consultation if the patient’s health concerns are more complex than the RN can manage.