What do nurse practitioners think about registered nurse (RN) prescribing?

RN prescribing study

While acknowledging that Registered Nurse (RN) prescribing offers an opportunity to potentially improve patient access to medicines and enhance healthcare system efficiency, many nurse practitioners remain equally concerned about how it will be implemented, possible role ambiguity, and patient safety, a recent study has revealed.

The survey of 229 Australian nurse practitioners, about 10% of the NP workforce, set out to gauge views on the Nursing and Midwifery Board of Australia’s (NMBA) proposed RN-prescribing standard. According to the NMBA, the proposed RN-prescribing model will enable RNs with an endorsement for scheduled medicines to prescribe within their level of competence and scope of practice in partnership with an authorised prescriber, such as a doctor or nurse practitioner.

Researchers wanted to understand the views of NPs because, as authorised prescribers, they will play a major role in supporting partnership nurse prescribing and ensuring its successful adoption.

The majority of NPs (76.2%) agreed that prescribing would optimise RN knowledge, skills and capability, as well as increase access to nurse-led models of care (75.1%) and improve healthcare system capacity (68%). Nearly 90% of NPs felt the highest-rated enabling factor for introducing RN prescribing was the availability of appropriate mentors.

In terms of workforce preparation, 55.8% of NPs felt a minimum of five years of prior clinical nursing experience should be required to undertake a nurse prescribing course, while 23.6% thought 10 or more years should be the minimum. Most NPs surveyed (62%) deemed universities, or universities in collaboration with health services, best-placed to develop and deliver educational programs for RN prescribing.

When analysing nurse practitioner views on RN prescribing, the study identified three themes – the lived experience of nurse practitioners, concern about the impact on the nurse practitioner role, and fear of patient harm.

According to the study, NP participants reflected on the organisational and legislative challenges they have faced trying to practice to their full scope. While there is support for the introduction of nurse prescribing, many worry the same challenges they experienced in progressing their roles may be repeated with the introduction of RN prescribing. Others suggested outside influences that continue to impact the ability of NPs to work to their full scope may also pose similar challenges for RNs.

“Nurse practitioners are already legislated to be able to prescribe but due to Government obstacles…nurse practitioners are not able to work to their full scope of practice. This illustrates that the problems are not to do with who the prescriber is, but the medical model the Australian legislators refuse to move away from,” one participant said.

“I think the medical profession will need to be on board for this to progress, look at how restrictive their views have been on Nurse Practitioner practice, without Medical Association support, this will never happen,” another participant said.

Meanwhile, many NPs who took part in the study expressed other concerns, including that an increased scope of practice for RNs to prescribe could lead to erosion of the nurse practitioner role. If RNs have increased scope, it could reduce nurse practitioners’ credibility and would risk diluting the NP role and endorsed title, some reported.

Further, some participants were concerned about the potential overlap of roles and responsibilities, which might impact the NP role within multidisciplinary teams. While others said that RN prescribing could cause confusion among health practitioners, patients and the public.

Fear of patient harm was another theme to emerge from the study.

“Whilst I feel this is a positive move, I do not feel that the existing knowledge, skills and capability of RNs is acceptable without further education and strict protocols or guidelines to ensure safe use of medicines.”

Researchers state that successful implementation of RN prescribing in Australia will require collaboration, support, and building trust between all healthcare practitioners. While nurse practitioners’ views on the proposed expanded scope of practice for RNs were conflicted, RNs are well-placed to undertake nurse prescribing providing it is introduced alongside supportive education and legislation.

“The introduction of RN prescribing under a partnership model has the potential to increase access to medicines and facilitate innovate models of care to improve healthcare access for Australian communities,” authors wrote.

“Previous research findings suggest that RNs are prepared to undertake this expanded practice, and this study indicates that nurse practitioners acknowledge the advantages of RN prescribing. Future implementation efforts should acknowledge concerns of nurse practitioners and engage them in facilitating future success of nurse prescribing.”

4 Responses

  1. Some prescribing options being available to RNs, particularly in rural, remote, or sole practitioner areas, would be helpful. Each area would need to be looked at, for it’s unique situation. So many MPS centres are struggling and using the My Emergency Dr service for minor health issues, especially in areas where people have minimal access to GPs locally, need to travel long distances or wait weeks for an appointment.

  2. Commencing and maintaining an effective system of standing orders would be a great place to start.
    So many orgs in Australia really don’t support this kind of thing.
    The CARPA manuals that are used in remote locations works well for them.

  3. The RIPRN course (scheduled medicines) needs to be recognized Australia wide not just VIC and QLD. We don’t actually prescribe but use the the Health Management Protocols in the Primary Clinical Care Manual for the particular presentation we’re dealing with. It’s a great course for Rural Remote areas.

  4. I was an RN designated prescriber in New Zealand within my speciality of IBD and I was only allowed to prescribe within my area of expertise. I prescribed the medications that I was comfortable with and I had amazing support from my ongoing prescribing mentor and would always ask if something was appropriate if it seemed slightly unconventional. I would ensure that tests had been done prior as needed, checking side effects and interactions with other medications. I could also offer holistic care and ensure vitamins were prescribed as required I.e iron, vitamin d which ensured the patients were having replacement as needed. I also ensured that I had conducted a clinic review recently to remain with good prescribing practice. If I’m seeing a patient in my nurse led clinic it makes sense to be able to prescribe as needed or even de-prescribe. We worked from a list of medications and we wouldn’t deviate into other areas for example I would prescribe cardiac or diabetic meds when my area is gastro! Nurse prescribing in both NZ and the UK has had an amazing response and I believe that within specialist teams it can be utilized effectively and safely. I was surprised that Australia is not nurse prescribing given that NZ is and would feel that Australia would be losing an amazing opportunity to further their nursing workforce.

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