The first cohort of registered nurses undertaking newly accredited RN prescribing courses commences next week. La Trobe University Course Coordinator for the Graduate Certificate in RN Prescribing, Corinne Dunningham, spoke with the ANMJ about the landmark change.
Hailed as one of the most significant shifts in nursing regulation in two decades, RN prescribing aims to improve Australians’ access to safe, affordable healthcare and medicines.
La Trobe’s Graduate Certificate in RN Prescribing is one of four programs approved by the Nursing and Midwifery Board of Australia (NMBA) and accredited by the Australian Nursing and Midwifery Accreditation Council (ANMAC) leading to designated prescriber endorsement.
Prescribing is “an extra tool in the toolkit” for nurses, says Ms Dunningham, an emergency nurse practitioner (NP), also coordinator of La Trobe’s Master of Nurse Practitioner program.
“RNs have been managing medications for years. We administer medications to patients all the time. With this change, nurses are now able to write the prescription or chart the medication rather than going to the doctor saying, ‘can you write this please?’ It reduces delays in care and supports patient flow whether it be in hospital settings, community settings, or in rural and remote locations.”
The course deepens existing medication knowledge to enable nurses to make those prescribing decisions, she says. “Medications are not new to nurses. We’ve been managing them and supporting patients with them for years. This extends our role further into the prescribing space.”
Course curriculum
La Trobe’s part-time online course runs over one year, with two subjects per semester. It is open to RNs with at least three years’ post-registration experience.
“We give nurses a strong foundation in pharmacology, pathophysiology and safe prescribing principles within a designated prescriber framework, which differs from autonomous prescribing. An assessment subject links physical and patient assessment to prescribing decisions,” says Ms Dunningham.
Nurses study pharmacology to a depth comparable to NP students. “If you’re making those prescribing decisions, you should know pharmacology to the same level, no matter if you’re autonomous or a designated prescriber. You should have a deep knowledge of what the drugs do to the body and what the body does to the drugs, because that’s where the safety inherently lies. That’s how we’ve designed the course.
“The designated prescriber framework looks at how that all works as a designated prescriber as opposed to an autonomous prescriber from the NP course perspective.”
Autonomous vs Designated prescriber
An autonomous prescriber legislatively, medically and legally can diagnose and prescribe without the need for collaboration with another clinician. These are roles with protected titles under legislation to prescribe, such as medical practitioners, nurse practitioners, and endorsed midwives.
A designated RN prescriber can prescribe, but it in a partnership with an autonomous prescriber under a governance framework and a prescribing framework that is negotiated and discussed with the organisation they work with.
For example, in primary care, a RN prescriber may have a prescribing agreement with a GP or NP outlining specific medications and conditions they can prescribe for in that primary practice.
“A patient on stable blood pressure medication coming in for routine checks could have their repeat prescription written by the RN rather than needing to see the GP”, says Ms Dunningham.
Legislation around RN prescribing is broad, enabling organisations to tailor prescribing arrangements to local needs. Prescribing arrangements are governed by the local organisation, the autonomous prescriber and the designated RN prescriber. “It’s a partnership between the three. But there needs to be that governance framework and that prescriber agreement,” says Ms Dunningham.
If a clinical situation falls outside agreed parameters, the RN must refer to the autonomous prescriber. “It’s a two-way partnership that supports safe practice,” she says.
First intake
Four RN prescribing courses have now been approved – La Trobe University, Queensland University of Technology, University of Melbourne and University of Tasmania.
La Trobe’s first intake for the semester begins next week, with around 36 participants including from primary care, aged care, mental health and rural and remote settings.
“We’ll start with smaller cohorts but plan to scale up. Some health organisations are taking a cautious ‘wait and see’ approach as we all learn how this new role will be implemented,” says Ms Dunningham.
The course has attracted applicants from almost every state and territory. A national focus considers the differing legislation in jurisdictions, she says.
“Students then take that knowledge back to their organisation on how it will look for them in their settings. We are looking at the health service holistically from that national perspective.”
“I feel it gives our students that national focus if you were to move states. We are nationally registered, but we are often state based in a lot of our training.”
Industry support
Support has so far come largely from primary care, public tertiary and private providers, with growing interest from aged care.
“Industry partners have spent the past six months identifying where this expanded RN scope will improve patient flow, equity and access,” says Ms Dunningham
“It’s been fabulous to see the industry embracing this, we’ve had great feedback and they’re excited, particularly in metro Melbourne, but in rural settings too. Hopefully a lot of other healthcare settings will be able to embrace this change ongoing.”
Endorsement
After completing the course, RNs can apply for endorsement as a designated prescriber and must undertake a 3–6 month internship regulated by the NMBA and Ahpra.
“Once they’ve done that internship, they work under that framework with oversight from both the organisation and the autonomous prescriber on the designated prescribing frameworks. Regular reviews by all parties then ensure the prescribing framework is still working, or adjustments are made to increase or decrease the scope of that prescribing,” says Ms Dunningham.
Discourse and debate
RN prescribing has generated strong discussion across mainstream and healthcare media.
With 17 years’ experience in emergency nursing and NP endorsement since 2021, Ms Dunningham says she’s seen discourse both for and against RN prescribing.
“There’s concern about additional workload for NPs or doctors mentoring nurses in prescribing. And the discourse that ‘they’re stealing our work’ is absolutely not true. I see the change can be enacted in a way that supports RNs and that is equitable for autonomous prescribers,” she says.
“Anything that supports the health system and helps nurses grow is positive. RN prescribing isn’t going to stop there being NPs – lack of NP positions is a wider health system issue. For me, if I can have my RN colleagues help me manage some of my workload and more patients are able to be seen, then I think that’s a win for patients.”
She welcomes the RACGP’s support for RN prescribing in community settings. “It’s about utilising skills and sharing the workload. There are long waits and delays everywhere. This expands nurses’ toolkit within the RN framework to support the healthcare system.”
“We’re excited to have the course ready for semester one. Seeing it all come together with accreditation has been incredibly rewarding, and I hope students love what we’ve prepared.”
More information
Courses
La Trobe University Graduate Certificate in Registered Nurse Prescribing here
University of Melbourne Specialist Certificate in Registered Nurse Prescribing here
University of Tasmania Graduate Diploma Nursing Advanced Practice Pathway here
Queensland University of Technology Designated Prescribing Course here
Endorsement
Australian Health Practitioner Regulation Agency here
Background information here
