FAQs: RN prescribing

What is the status of the RN prescribing regulation? 

The Ministry of Health approved regulations on Nov. 6, 2023.  to expand the RN scope of practice to permit RNs to prescribe medication and to communicate diagnosis for the purposes of prescribing. Under the regulations, RNs must complete education approved by CNO’s Council to become authorized to prescribe medication.

In December 2023, Council started approving  RN prescribing education programs in Ontario. Each program curriculum includes these competencies to support safe RN practice.

Is CNO developing new resources to support RN prescribing authority?

CNO has created a Registered Nurse (RN) Prescribing practice standard outlining the legislated scope of practice and the accountabilities of RNs with prescribing authority. We are also creating new and updating existing resources to reflect the broader accountabilities of all nurses.

If the new authority also includes “communicating a diagnosis” why does CNO focus on prescribing?

“RN prescribing” is the terminology that is best understood by the public and other stakeholders. CNO’s work on RN prescribing includes regulatory mechanisms needed for an RN to safely prescribe medication and communicate a diagnosis for the purpose of prescribing.

Once an RN completes the approved education that qualifies them to prescribe, are they permitted to prescribe in any practice setting?

No. Even if an RN has completed the education approved by Council to become authorized to prescribe, their practice environment may not allow for it. This may be determined by law (for example, the Public Hospitals Act prevents RNs from ordering treatments for hospital clients) or by employer preferences and requirements. 

Employers are responsible for determining the roles and responsibilities of their employees, including determining whether nurses can perform certain activities and procedures in the practice setting. RNs are expected to consult with their employers to confirm that prescribing is permitted in the practice setting.

Can CNO enable RNs to prescribe medication for hospital clients?

No. The Public Hospitals Act prevents RNs from ordering treatments for hospital clients.  Any change to the Public Hospitals Act is a government decision.

How will the public and others know that I am authorized to prescribe?

Once an RN completes a Council-approved prescribing education program, information will be added to their profile on CNO’s public Register, Find a Nurse.

I am an RN and do not want to prescribe medication. Will this affect my information on the public register, find a nurse?

No. If you are not interested in becoming authorized to prescribe, these changes will not affect how your information appears on the public Register, Find a Nurse.

Will my class or category of registration change if I become authorized to prescribe?

No. There is no change in the class or category of registration when a nurse becomes authorized to prescribe.

Am I required to declare that I am authorized to prescribe when renewing my certificate of registration?

No. You do not need to declare your prescribing practice when renewing your CNO certificate of registration.

Does RN prescribing affect professional liability protection?

At this time, CNO’s professional liability protection requirements are not changing for RNs who prescribe medication. For more information on professional liability protection, read our FAQs.

What are the accountabilities of RNs with prescribing authority?

Please refer to CNO’s Registered Nurse (RN) Prescribing practice standard to understand the accountabilities of RNs who have the authority to prescribe. 

Can RNs and RPNs accept an order from an RN who is authorized to prescribe?

RNs and RPNs can accept an order from an RN with prescribing authority if sector specific legislation and practice setting policies permit it. For information about practice expectations when providing medication to client, please review the Medication and Scope of Practice practice standards.

All RNs and RPNs are expected to understand, and practice in accordance with the standards of practice and relevant legislation.

I work in a hospital, can I accept an order from an RN authorized to prescribe?

No. The Public Hospitals Act prevents RNs from ordering treatments for hospital clients.

As an RN or RPN, do I have to check that an RN has authority to prescribe?

All nurses are accountable to ensure client safety. To confirm that an RN has the legal authority to prescribe in certain circumstances. To verify if a nurse has the authority to prescribe, visit CNO’s public Register Find a Nurse.

What medications can authorized RNs prescribe?

For a list of medications, please click here.

How did CNO decide the specific medications RNs can prescribe?

CNO is accountable for developing and implementing a regulation that will support competent and safe RN prescribing. The medications list was informed by multiple sources of evidence, including:

• Literature
• evidence from other jurisdictions that have  implemented RN prescribing
• consultation findings from Ontario stakeholders (for example, the public, RNs and employers)
• government direction that this change in scope of practice is meant to enable RNs to manage “non-complex” client care needs
• current legislative parameters, including government laws do not permit RNs to order diagnostic and lab tests

Will this medication list expand?

CNO intends to work with relevant partners to evaluate the first group of medications of RN prescribing before adding additional medications to the medication list.

Why did CNO list these medications within the regulation?

The Nursing Act, 1991 requires that we specify, in regulation, the medications that RNs are permitted to prescribe; we may specify individual medications or categories.

The drug schedule includes a combination of individual medications and categories. The categories are based on the World Health Organization classification system. 

Are RNs authorized to prescribe controlled substances?

No. RNs in General Class are not permitted to prescribe these medications. 

Can CNO enable RNs to prescribe lab and diagnostic tests?

No, this is a government decision.

Can RNs with prescribing authority dispense or administer the medication they prescribe?

Yes. The regulation enables RNs who are authorized to prescribe to also perform the controlled acts of "administering a substance by injection/inhalation” and “dispensing a drug” so that they can provide a medication they prescribe.

If the RN does not prescribe a medication, they would continue to require an order from an authorized health professional to administer or dispense it.

Can RNs with prescribing authority order other nurses (rpns and other rns) to dispense or administer medication?

Yes. The regulation enables RNs who have prescribing authority to provide an order for another nurse (RPN or RN) to administer or dispense a medication that they are authorized to prescribe.

Can RNs delegate prescribing a drug and communicating a diagnosis?

No. RNs with prescribing authority cannot delegate the controlled acts of prescribing a drug and communicating a diagnosis.

Do RNs with prescribing authority need a diagnosis from a physician prior to prescribing?

No. The Nursing Act permits RNs to perform two additional controlled acts: prescribing drugs that are designated in regulation, and communicating a diagnosis made by the RN for the purpose of prescribing those drugs. RN prescribing education programs will be expected to teach the competencies for safe practice related to both controlled acts. 

What information is required on a prescription?

Please refer to CNO’s Registered Nurse (RN) Prescribing practice standard which outlines medication practices for RN prescribing, including what is required in a prescription.  

I am working with a vulnerable client who does not have a physical address. How should I document the prescription?

You will need to include “no fixed address” in place of the address. 

Can RNs with prescribing authority prescribe vaccines for a person who is planning travel (for example, hepatitis b), if it is not listed under the travel health category?

Yes. While the Hepatitis B vaccine is not listed under Travel Health, it is listed under Immunization. Under the regulation, authorized RNs can prescribe any vaccines for prevention of bacterial and viral disease. 

If there is a combined medication, for example atovaquone-proguanil, where one drug is a member of the medication list and the other isn’t, can I still prescribe it?

RNs are encouraged to review the WHO classification system to determine if a combined medication is listed under the appropriate drug categories that are authorized for RNs with prescribing authority to prescribe.  

In this example, RNs would be permitted to prescribe Atovaquone-Proguanil because it is listed under the category of “Biguanides” under the WHO classification system.

The following are answers to questions about RN prescribing education.

Are RNs required to complete education before being authorized to prescribe medication?  

Yes, RNs are required to complete education approved by Council to become authorized to prescribe medication.  

Are all RNs required to complete prescribing education?

No, RN prescribing is optional.  Only RNs who want to be authorized to prescribe will be required to complete the education.

Will education programs be accessible to RNs in remote communities?

This depends on the course format of each individual education program. Please contact the school directly or visit their website for more information.

Are RN prescribing programs virtual or hybrid?

This depends on the course format of each individual education program. Please contact the school directly or visit their website for more information.

What is the duration of these programs?

This depends on the course format of each individual education program. Please contact the school directly or visit their website for more information.

Where can I find out more information about the Council approved RN Prescribing education programs?

Please visit each program’s website for information including admission requirements and the application process.

What is the status of the RN prescribing regulation? 

The Ministry of Health approved regulations on Nov. 6, 2023.  to expand the RN scope of practice to permit RNs to prescribe medication and to communicate diagnosis for the purposes of prescribing. Under the regulations, RNs must complete education approved by CNO’s Council to become authorized to prescribe medication.

In December 2023, Council started approving  RN prescribing education programs in Ontario. Each program curriculum includes these competencies to support safe RN practice.

Is CNO developing new resources to support RN prescribing authority?

CNO has created a Registered Nurse (RN) Prescribing practice standard outlining the legislated scope of practice and the accountabilities of RNs with prescribing authority. We are also creating new and updating existing resources to reflect the broader accountabilities of all nurses.

If the new authority also includes “communicating a diagnosis” why does CNO focus on prescribing?

“RN prescribing” is the terminology that is best understood by the public and other stakeholders. CNO’s work on RN prescribing includes regulatory mechanisms needed for an RN to safely prescribe medication and communicate a diagnosis for the purpose of prescribing.

Once an RN completes the approved education that qualifies them to prescribe, are they permitted to prescribe in any practice setting?

No. Even if an RN has completed the education approved by Council to become authorized to prescribe, their practice environment may not allow for it. This may be determined by law (for example, the Public Hospitals Act prevents RNs from ordering treatments for hospital clients) or by employer preferences and requirements. 

Employers are responsible for determining the roles and responsibilities of their employees, including determining whether nurses can perform certain activities and procedures in the practice setting. RNs are expected to consult with their employers to confirm that prescribing is permitted in the practice setting.

Can CNO enable RNs to prescribe medication for hospital clients?

No. The Public Hospitals Act prevents RNs from ordering treatments for hospital clients.  Any change to the Public Hospitals Act is a government decision.

How will the public and others know that I am authorized to prescribe?

Once an RN completes a Council-approved prescribing education program, information will be added to their profile on CNO’s public Register, Find a Nurse.

I am an RN and do not want to prescribe medication. Will this affect my information on the public register, find a nurse?

No. If you are not interested in becoming authorized to prescribe, these changes will not affect how your information appears on the public Register, Find a Nurse.

Does the regulation support “independent” prescribing?

As regulated health professionals, all nurses are accountable for their practice – which is what makes a health professional independent. RNs who prescribe are solely accountable for their prescribing decisions and for complying with CNO standards.

Will my class or category of registration change if I become authorized to prescribe?

No. There is no change in the class or category of registration when a nurse becomes authorized to prescribe.

Am I required to declare that I am authorized to prescribe when renewing my certificate of registration?

No. You do not need to declare your prescribing practice when renewing your CNO certificate of registration.

Does RN prescribing affect professional liability protection?

At this time, CNO’s professional liability protection requirements are not changing for RNs who prescribe medication. For more information on professional liability protection, read our FAQs.

What are the accountabilities of RNs with prescribing authority?

Please refer to CNO’s Registered Nurse (RN) Prescribing practice standard to understand the accountabilities of RNs who have the authority to prescribe. 

Can RNs and RPNs accept an order from an RN who is authorized to prescribe?

RNs and RPNs can accept an order from an RN with prescribing authority if sector specific legislation and practice setting policies permit it. For information about practice expectations when providing medication to client, please review the Medication and Scope of Practice practice standards.

All RNs and RPNs are expected to understand, and practice in accordance with the standards of practice and relevant legislation.

I work in a hospital, can I accept an order from an RN authorized to prescribe?

No. The Public Hospitals Act prevents RNs from ordering treatments for hospital clients.

As an RN or RPN, do I have to check that an RN has authority to prescribe?

All nurses are accountable to ensure client safety. To confirm that an RN has the legal authority to prescribe in certain circumstances. To verify if a nurse has the authority to prescribe, visit CNO’s public Register Find a Nurse.