In December 2024, Health Ministers approved a new Registration standard: Endorsement for scheduled medicines – designated registered nurse prescriber, paving the way for qualified registered nurses to prescribe Schedule 2, 3, 4 and 8 medicines in partnership with an authorised health practitioner who is an independent prescriber. This landmark change will take effect mid-2025.

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REGISTERED NURSES (RNs) AND PRESCRIBING SCHEDULED MEDICINES

The Nursing and Midwifery Board of Australia (NMBA) has been developing a designated RN prescribing model since 2016.

Under the registration standard, qualified RNs will be able to prescribe within their competence and scope of practice in partnership with authorised independent prescribers, such as nurse practitioners or medical practitioners.

WHO CAN PRESCRIBE?

RNs with at least three years’ clinical experience will be eligible to apply for endorsement with the NMBA as designated registered nurse prescribers after completing postgraduate education.

RNs must be employed in a health service and not working as sole practitioners or in private practice.

Post-endorsement, applicants will undergo a six-month clinical mentorship with an independent prescriber before their competencies are assessed against the National Prescribing Service (NPS) Prescribing Competencies Framework.

EDUCATION AND TRAINING

RNs must complete additional postgraduate education approved by the NMBA and accredited by Australian Nursing and Midwifery Accreditation Council (ANMAC) leading to endorsement.

In January, ANMAC released the Registered Nurse Prescribing Accreditation Standards, which outline curriculum requirements for education providers.

These programs must teach and assess legal, medicolegal, ethical and professional principles and be aligned with the National Prescribing Competencies Framework.

Approved Programs of Study will be published on Ahpra’s website.

IMPACT ON CARE

The ability for RNs to prescribe scheduled medicines has been explored for years, with positive outcomes observed in comparable countries. Australia’s model aims to provide timelier, person-centred care by reducing waiting times and improving access to medicines.

IMPLEMENTATION

The rollout will likely vary across health services.

In some large hospitals, RNs in certain clinical areas will be encouraged to apply in a bid to streamline care and reduce wait times.

According to Julianne Bryce, Senior Professional Officer at the ANMF, the uptake will depend on the specific health service or employer. Some will be early adopters, while others may take a more cautious approach.

“The main benefit for patients will be quicker access to medicines, faster treatments, shorter stays, or even preventing hospital admissions.”

SAFEGUARDS FOR SAFE PRESCRIBING

To ensure safe prescribing, designated RNs and their partner independent prescribers will work within a clinical governance framework, employers will need to review existing governance frameworks for quality use of medicines (QUM) to support this prescribing model.

Designated RN prescribers will need to complete an extra 10 hours of continuing professional development (CPD) related to prescribing annually to maintain competence.

WORKLOAD IMPACT

Evidence suggests nurse prescribing improves healthcare teams’ efficiency, reduces referral needs, enhances patient satisfaction, and leads to better health outcomes.

Designated RN prescribers will have increased autonomy, professional growth, and be able to provide faster, more efficient care, especially to Australians in underserved areas.

WILL RN PRESCRIBERS BE PAID MORE?

The ANMF advocates for higher pay for designated RNs with prescribing responsibilities. This additional pay should take the form of an allowance.

RECOGNITION OF CURRENT PRESCRIBERS?

The ANMF argues that registered nurses with state-based prescribing recognition for rural and isolated practice should not be disadvantaged under regulatory reforms. The nurses should be granted recognition of prior learning and allowed to complete an ANMAC accredited and NMBA approved bridging program, at no additional cost.

INTERNATIONAL PERSPECTIVE

Countries like the UK and New Zealand have successfully implemented nurse prescribing models which have increased access to medicines, and reduced workloads for medical staff.

Research by the ANMF shows that nurse prescribing is safe and effective, particularly when supported by ongoing education and proper integration into healthcare systems.

In the UK, RNs reported that prescribing allowed for more patient-centred care, streamlined patient journeys, and better continuity of care. Barriers included time-consuming paperwork, insufficient training, and inadequate pay for additional responsibilities.

PREPARING FOR CHANGE

RNs interested in prescribing should explore approved programs, keep updated with NMBA developments, and seek advice from nurses with prescribing experience.

A survey found that more than 80% of Australian RNs are interested in becoming prescribers, signalling strong interest.

RNs should regularly check the NMBA website for updates.

An advance copy of the standard has been published on the NMBA website.

WHAT DO NURSES THINK?