September 2017

RN prescribing: What happened, what’s next?

In May 2017, the Ontario government changed the Nursing Act to permit RNs to prescribe medications and communicate a diagnosis for the purpose of prescribing.

RNs are not yet authorized to perform these activities; however, the Minister of Health and Long-Term Care has asked the College to begin the work needed to enable RN prescribing and ensure these services can be delivered safely and competently as soon as possible.

The College’s ultimate goal is ensuring RN prescribing in Ontario will be safe for clients. 

What’s happened so far?

In June, Council discussed this change in legislation and heard from the Ministry. Council set an 18-month timeline for conducting the necessary research to make evidence-based decisions that are in the public’s interest. Although this is an ambitious timeline for a change in scope of practice, Council’s focus will be on ensuring this change is implemented safely. For details, see pages 65-68 of the June Council meeting notes.

In July, the College completed an exploratory survey of RNs to collect general information to help inform Council’s early work.

Many RNs who completed our survey indicated that prescribing will positively affect their clients. Read the survey findings and other background research on pages 32-61 of the September Council briefing notes.

In September, Council considered evidence from multiple sources, including the July survey, to set the direction for regulating RN prescribing in Ontario. They approved the following vision: that RN prescribing in Ontario will be safe for clients.

Council also reviewed an approach for implementing RN prescribing. This includes:

  • RN prescribing will focus on particular areas of practice (see “What’s next?” below)

  • The College will take a phased approach implementing this change

  • There will be no changes to entry-level competencies at this time. To be able to prescribe, RNs will need to meet additional requirements which will be determined based on evidence and consultation with stakeholders over the next year.

As well, Council’s discussion was informed by the following parameters set by government:

  • The Minister has indicated these changes are meant to authorize RNs to treat “certain non-complex conditions”

  • The medications that RNs prescribe must be specified in a College regulation; we have the ability to list individual and categories of drugs

  • RNs in hospital settings will not be permitted to prescribe medications because the laws governing Ontario hospitals don’t allow it

  • Various other laws prevent RNs from ordering lab or diagnostic tests, prescribing controlled substances or treating sexually transmitted infections

Council is taking a cautious approach to this change that puts the public first. At its September meeting, Council discussed the risks and opportunities of RN prescribing, including the balance between reducing risk and supporting access to care. Prescribing and diagnosing are areas of risk – and the College is accountable for ensuring the regulatory mechanisms are in place to ensure RN prescribing is safe.

What’s next?

The Minister has directed the College to put regulations in place as soon as possible, within the parameters mentioned above. To that end, Council has asked College staff to explore specific areas that may be appropriate for beginning RN prescribing, such as:

  • immunization

  • contraception

  • travel health

  • smoking cessation

  • wound care (topical medications)

In the coming months, there will be opportunities for you to participate in consultation and provide feedback to the College on a range of topics related to RN prescribing. For up to date information, visit our dedicated webpage: Journey to RN prescribing.

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