The first patient to receive a prescription written by an asthma, cardiac or practice nurse prescribing in their own right and in their own name should happen this year.
The right for suitably qualified registered nurses (RNs) working in primary health and specialty teams to be able to prescribe from a limited list of commonly used medicines has been a long time in anticipation, but is now in sight.
“We are optimistic that we will have our first nurse authorised this year,” says Nursing Council strategic policy manager Pam Doole.
The first prescribing nurse practitioner (NP) was authorised in 2001 and the first registered nurses (RNs) to prescribe followed a decade later in 2011 with the demonstration trial of prescribing diabetes nurse specialists.
That same year then-Health Minister Tony Ryall invited the Nursing Council to apply to widen prescribing rights for other suitably qualified RNs. A consultation document followed and at the end of 2014 the Nursing Council submitted its application for RN prescribing rights.
This culminated late last year in the Cabinet signing off the proposal and in June one of the last steps – enacting the government regulations required – is expected to happen and regulations expected to come into force in September.
Then there is just one last hurdle to jump before the Nursing Council can set a date to start assessing and authorising applicants who may already meet the education and prescribing practicum requirements to become RN prescribers. (From next year approved nursing schools will start offering the new postgraduate diploma in RN prescribing for long-term and common conditions but in the interim the Nursing Council is gearing up to consider case-by-case applications.)
That hurdle involves Pharmac, which is understood to be waiting for the regulations to be enacted so it can consult on amending its own prescribing regulations so medicine subsidies are extended to the patients of RN prescribers like they currently are for NPs and approved diabetes nurse specialists.
The Ministry of Health’s Office of the Chief Nursing Officer said in April that it is working with Pharmac to ensure that subsidies are applied to the medicines on the RN designated prescriber list.
Plus, it said, it is working with the Nursing Council and Pharmac to ensure that the diabetes nurse specialists currently prescribing under the 2011 regulations (set up to allow the diabetes nurse specialist prescribing demonstration) retain their prescribing status and ability to prescribe subsidised medicines when the wider regulations come into force.
Jane O’Malley, the Chief Nursing Officer, says RN prescribing will improve access to medicines for people with common and long-term conditions and make the best use of the health workforce by RNs with appropriate experience, education and skills being able to work to the full extent of their scopes of practice. She says it also creates a pathway for RNs to advance their practice including steps along the way to becoming an NP.
How many RN prescribers are in the wings?
It is estimated that there are around 1000 nurses who may have completed a clinical master’s degree, but it is uncertain how many of these have completed a prescribing practicum and are waiting in the wings to seek prescribing authority from the Nursing Council. Of specific uncertainty is how many have been able to keep their prescribing knowledge current and have the backing of their workplaces to become prescribers – as, once authorised, RN prescribers are required to complete a further 12 months of supervised prescribing practice.
Doole says they intend to distribute guidance on what nurses need to consider before they seek prescribing authorisation. “We really want to set nurses up to succeed and also it has to be prescribing within a collaborative
healthcare team.”
She says the emphasis of the regulations is on nurses being able to give patients better access to medicines in primary health care and in those specialty teams where nurses have a significant role in managing long-term conditions such as respiratory, cardiovascular and diabetes.
When it comes to which specialties can be covered under the regulations, Doole says the Council is suggesting that nurses take a good look at the medicines schedule, when finally approved as, while there are medicines there for most common conditions, some of the smaller specialties are not covered.
The 15-page initial medicines schedule lists drugs covering from heart failure and hypertension to treatments for acne, warts and common infections; plus contraceptive pills to antidepressants and painkillers to bronchodilators. Also listed are drugs for which RN prescribers cannot initiate prescriptions, but can approve a repeat prescription.
An authorised RN prescriber will have:
- a minimum of three years’ experience in the area of prescribing practice
- a postgraduate diploma in registered nurse prescribing for long-term and common conditions, such as asthma, diabetes and hypertension
- completed a 150-hour prescribing practicum – with a designated authorised prescriber (medical or nurse practitioner) working with a collaborative multi-disciplinary team – as the final component of their diploma
- a limited list of medicines they can prescribe relating to their area of practice
- a requirement to complete a further 12 months of supervised prescribing practice after being authorised by the Nursing Council to prescribe, and thereafter ongoing competence requirements
- an authority to prescribe while working with a collaborative, multi-disciplinary team to manage and monitor patients with common or long-term conditions in outpatient or general practice clinics or by providing home-based care
- the ability to seek advice or refer patients with complicated, complex or uncertain health conditions that are beyond their expertise to a medical or nurse practitioner within the team.
