The introduction of designated registered nurse prescribing in Australia will improve patient access to care while complementing, not competing with, other nursing roles, a panel of nursing leaders told delegates at the recent Australian College of Nursing’s National Nursing Forum in Melbourne.
The panel brought together Chief Nursing and Midwifery Officers from across the country, alongside Professor James Buchan, to unpack the rollout of designated RN prescribing and what it means for nurses, patients and the health system.
Chairing the discussion, ACN’s Chief Nursing Officer Frances Rice highlighted that while many nurses had heard of registered nurse prescribing, there was still a lack of understanding about what it would mean in practice
Reflecting on the reform journey, NSW Chief Nursing and Midwifery Officer Jacqui Cross described RN prescribing as the culmination of almost a decade of collaboration.
“I think back to that [early forum in 2017] and think how courageous it was to start a conversation and to set those expectations,” she recalled, of exploring what prescribing might look like for registered nurses.
“This is actually about patient access to care.”
Drawing on international experience, Professor James Buchan said Australia had many of the foundations needed to successfully introduce RN prescribing, including regulation, legislation, funding, career structures and an education system equipped to provide the necessary training and development.
He told delegates countries that have introduced nurse prescribing had done so primarily to improve access to healthcare rather than substituting other professions. He encouraged Australia to consider its end goal for the nursing workforce, including what proportion should ultimately work as nurse practitioners.
“The primary reason any country is doing it now is to improve access,” he said.
“So, that’s about access and equity. It’s not about task sharing or substitution. It’s about growing the workforce and expanding delivery of care based on nurses being able to practice at a high level, including having nurse prescribing.”
ACT Chief Nursing and Midwifery Officer, Adjunct Associate Professor Marina Buchanan-Grey, said it was important to explain the reform in simple terms and avoid framing designated RN prescribing as competition with nurse practitioners.
“This is not a competition of nursing roles,” she stressed.
“There is great value to the system in what every one of us brings and every role that we hold.”
Instead, she said the focus should remain on improving patient care while creating opportunities for professional growth that helps retain nurses in the workforce.
“It’s about the impact of patient care and patient outcomes,” she said.
“So, whilst we’re here to go on a journey around elevating scope of practice, expanding scope for the registered nurse workforce, optimising and augmenting delivery of healthcare services, it’s the endpoint of the users of our system that we’re here to actually benefit, as well as that professional growth and satisfaction to keep nurses in the workforce, either bring them back or encourage them to step in.”
The panel agreed designated RN prescribers and nurse practitioners would have complementary roles within future workforce models.
“When we start planning services, we think about what it is that we want to deliver to what part of our community and why, and think about the skills, confidence, knowledge and capability of the workforce that will actually achieve that,” Tasmania’s Chief Nurse and Midwife, Francine Douce, told delegates.
“Then we start to think about, what are the core parts of our workforce that we have. This is where I see this beautiful design of workforce really enhancing extended scope of practice and the advanced practice arena as part of a bigger workforce design. This is not a competition, but I can see that we can elevate nursing leadership in nurse practitioner roles, but also co-design of workforces that actually, truly have the patient in the centre of what we do.”
Asked what advice she would give nurses interested in becoming designated RN prescribers, Victoria’s Chief Nursing Officer Emma Saddington encouraged them to first learn as much as they could about the role.
“Find yourself some time and have a really deep read to understand what it is, understand where it’s come from,” she said.
“Then, I think at a jurisdictional level, you also need to have a deep understanding that there’s different regulatory and legislative platforms that will enable a designated RN prescriber to be able to work in an authorising environment that will look and feel really different in each jurisdiction.
“Finally, if it’s something that you are thinking about doing, have those really early conversations with your organisations, with your senior leaders, with your peers, with people across all groups to think about where could a DRNP add value in an organisation that you’re working in? What’s the best environment that a DRNP could work in your organisation? And that look and feel really different for all of you.”
Addressing concerns about increasing workloads, panellists said the reform should be implemented through careful service design rather than simply adding responsibilities to already stretched nurses.
One panellist suggested many nurses were already informally undertaking aspects of prescribing within their organisations, such as “hallway conversations” to access medications for patients. Formalising the role, they said, would recognise and support knowledge and skills nurses were already using every day.
Professor Buchan pointed out that while relatively new and novel in Australia, RN prescribing would become commonplace within 5-10 years.
“Across that period, one of the major learnings I’ve seen in other countries is don’t just focus on the individual nurses who are going through the training and legislation to develop to become practitioners and prescribing,” he said.
“It’s about looking at the health system and the workforce in which they’re going to be working and ensuring it’s prepared to maximise their contribution.”
