Australia's health system is one of the highest quality and most equitable in the world.
Author
- Marie Gerdtz
Professor and Dean School Nursing and Midwifery, La Trobe University
Yet our rapidly ageing population, rising rates of chronic disease and poor access to doctors means patients can't always access the medicines they need. These shortages are particularly prevalent in poorer, rural and regional areas.
To strengthen the skilled workforce and reduce delays in care, from September 30, registered nurses can prescribe a range of medicines , after undergoing additional training and supervision.
What will nurses be able to prescribe?
Registered nurses who are eligible for endorsement as a nurse prescriber will be able to prescribe the following types of medicines, in partnership with a doctor or nurse practitioner:
schedule 3 medicines, which usually require pharmacist advice but not a prescription, such as emergency contraception known as the morning-after pill
schedule 4 prescription-only medicines, such as antibiotics and medicines for high blood pressure and high cholesterol. These require a prescription due to potential side effects and interactions
schedule 8 controlled drugs, which are prescription substances with a high potential for dependence or misuse, such as morphine and methadone.
It's unclear whether nurse prescribers will work in primary care clinics, aged care, community health centres, or hospitals - or all of these settings. And we don't know what proportion of registered nurse prescribers will be needed, or who will seek to work in these settings.
It's also uncertain whether patients will be able to access the Pharmaceutical Benefits Scheme (PBS) subsidies for medicines a registered nurse prescribes. Nor do we know whether patients will be able to access the Medicare Benefits Schedule for consultation rebates.
What education and oversight will prescribing nurses need?
Registered nurses who want to prescribe will need endorsement from the Nursing and Midwifery Board of Australia .
For this, they must hold current general registration, have the equivalent of three years' full-time clinical experience after initial registration, and complete a board-approved postgraduate qualification or equivalent units of study in registered nurse prescribing. This may take four to six months of part-time study, or more.
The education program will include:
- physical health assessments
- pharmacodynamics - the biological and physical effects of drugs
- pharmacokinetics - how drugs are absorbed, distributed, metabolised and excreted
- the quality use of medicines.
Candidates must also undertake a six-month period of structured clinical mentorship with a doctor or nurse practitioner, work within a defined governance framework, and adhere to state/territory legislation.
During the mentorship phase, the doctor or nurse practitioner will oversee the nurse's prescribing practices. This will develop into a collaborative model, as the nurse's skill develops. This type of oversight is similar to that provided in nurse practitioner education programs.
In the longer term, the collaborating doctor or nurse practitioner is expected to monitor the nurse's prescribing practices. They will also ensure the nurse is following other safety and quality assurance processes, such as adhering to evidence-based guidelines and documenting any drug sensitivities or reactions, as well as any errors.
These requirements are designed to ensure safe, effective prescribing.
Lessons from countries where nurses have long prescribed
Nurses have prescribed for decades in some countries. In Sweden, nurse prescribing was first introduced in 1994, initially limited to a small number of medicines for specific conditions.
In the United Kingdom, legislation enabling nurse prescribing also began in 1994, with gradual expansion over the following decades to include independent prescribing of most medicines, including controlled drugs .
These reforms were driven by the need to improve access to medicines, reduce delays in care and make better use of the skills of health professionals other than doctors.
A 2016 Cochrane systematic review of 46 studies with more than 37,000 participants found patients with nurse (and pharmacist) prescribers had comparable outcomes to medical prescribers when managing chronic conditions such as high blood pressure, diabetes and high cholesterol.
Other international evidence highlights further benefits of registered nurse prescribing, as well as important considerations for implementation.
Nurse prescribers often provide more personalised medication counselling and spend more time with patients. This can improve the chance a person will take their medicine and result in higher rates of patient satisfaction, particularly when nurses are managing chronic diseases.
However, early evaluations of nurse prescribing in Sweden revealed professional tensions and concerns about boundaries between doctors' and nurses' roles, especially in primary care, where responsibilities weren't clearly defined.
More recently in New Zealand, registered nurse prescribing has broadened access to care. A 2020 study found nurse prescribers experienced greater job satisfaction and delivered more holistic care, while patient wait times reduced.
A descriptive survey also from 2020 found NZ nurse prescribers worked safely within their scope of practice. However, the authors emphasised the need to regularly update the prescribing formulary: the list of drugs approved for prescribing within a certain context and scope of practice.
What about in Australia?
In Australia, studies ) have found nurses perceive prescribing as a natural extension of their clinical role, particularly in settings where they already exercise significant autonomy. This includes sexual and reproductive health, drug and alcohol services, and palliative care.
However, registered nurse prescibers will not be able to autonomously prescribe, or order diagnostic tests.
Nurse prescribing has the potential to leverage the expertise of the nursing workforce to address persistent gaps in access to health care and medicines.
But it's important for nurse prescribers to be supported by appropriate education, governance and collaborative practice models to ensure safety, clarity and their integration within the broader health system.
Implementation must also be carefully evaluated to ensure the scheme is meeting its aims and protecting patients.
Marie Gerdtz does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
