FAQs: RN prescribing

The following are answers to questions you may have about the work CNO is doing to enable RNs to prescribe certain medications and communicate diagnoses for purposes of prescribing.

We will be updating this page as more information becomes available. Please check back often.

Why is CNO working on RN prescribing?

The Ontario government made changes to Ontario law (the Nursing Act, 1991) that will permit registered nurses to prescribe certain medications and communicate diagnoses for purposes of prescribing. RNs do not have the authority to perform either of these activities until government approves CNO’s proposed regulations.

Diagnosing and prescribing are high-risk activities; CNO is accountable for providing regulatory oversight that protects the public’s right to safe nursing care.

What is the status of CNO’s proposed regulation?

After pausing this work due to the pandemic, CNO received confirmation from the Minister of Health that the Ministry is resuming its review of this regulation. Under the regulation, RNs must complete education approved by CNO’s Council to become authorized to prescribe medication. CNO invited universities and colleges that offer Council-approved RN education to express interest in developing education for RN prescribing. CNO is communicating with schools of nursing that expressed interest. Schools interested in proceeding will complete CNO’s review process. CNO council will approve all RN prescribing education. Stay tuned for more updates as this work progresses.

You can review the draft competencies to support curriculum development and safe nursing practice when RNs are authorized to prescribe. CNO is also developing a practice standard to outline the accountabilities of RN prescribers. Additional updates will be made to new and existing resources to reflect the broader accountabilities of all nurses once the regulation has been approved. These will be finalized after the regulation is approved.

If the new authority also includes “communicating a diagnosis” why do CNO materials 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.

Will RNs be required to complete education before being authorized to prescribe medication?

Yes, RNs will be required to complete education approved by Council to become authorized to prescribe medication. For more information about what we will be looking for in our review and approval process, please see the draft competencies that will need to be included in curriculum to support safe RN prescribing.

Details about the education is not yet available. We will communicate updates as they are available.

Will all RNs be required to complete the education?

No, CNO does not plan to require all RNs to complete RN prescribing education. Only RNs who want to be authorized to prescribe will be required to complete the education.

Once an RN completes the approved education that qualifies them to prescribe, will they be 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 patients) 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. If your practice setting does not support the performance of RN prescribing, you will not be able to prescribe in that environment. Please keep in mind that if you chose to get the education and you remain in a setting where you are not allowed to prescribe, you may not be able to maintain your competence in prescribing.

Nurses are expected to understand and practice in accordance with the standards of practice and relevant legislation. They are also expected to work with their employers to ensure their practice environment supports the safe performance of procedures.

Can CNO enable RNs to prescribe medication for hospital patients?

No, this is a government decision.

I am an RN and do not want to prescribe medication. I have heard that if I do not complete CNO’s requirements for prescribing medication, restrictions will be added to my certificate of registration on the public Register.

We do not intend to put a restriction on the register in this situation. The public Register, Find a Nurse, exists to communicate information about nurses registered with CNO. The public and others (such as employers, pharmacists) will need to know if an RN is authorized to prescribe medication; so, there will be information on the register to indicate that an RN is authorized to prescribe medication.

If you are not interested in becoming authorized to prescribe, these changes will not affect how your information appears on the Find a Nurse.

What medications will RNs be authorized to prescribe?

Pending government approval, the following is a starting point for RN prescribing in Ontario.

Immunization	Vaccines for prevention of bacterial and viral disease
Contraception	Hormonal contraceptives for systemic use Intravaginal contraceptives *Excludes intra-uterine contraceptive
Travel Health	Aminoquinolines for malaria prevention Biguanides for malaria prevention Methanolquinolines for malaria prevention Anti-bacterials for systemic use for malaria prevention Anti-bacterials for systemic use for traveller’s diarrhea
Topical Wound Care	Corticosteroids, plain for topical use Antibiotics for topical use Metronidazole for topical use Anesthetics for topical use Medicated dressings
Smoking Cessation	Bupropion for smoking cessation Varenicline
Over-the-counter medication	Any drug or substance that may lawfully be purchased or acquired without a prescription and is available for self-selection in a pharmacy or retail outlet. Although these medications do not legally require a prescription, some patients can only access them if they are prescribed by an authorized prescriber. For example, a patient who receives Ontario Drug Benefits. This excludes any medication available “behind” the pharmacy counter (i.e., where consultation with a pharmacists is necessary to obtain the medication).
Miscellaneous	Epinephrine for anaphylaxis

Why did CNO decide on these medications?

CNO is accountable for developing and implementing a regulation that will support competent and safe RN prescribing. This decision was informed by multiple factors, including:

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

CNO intends to work with stakeholders to evaluate this first phase of RN prescribing before adding more drugs.

Why did CNO list these drugs within the regulation?

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

CNO’s proposed drug schedule includes a combination of individual drugs and drug categories focused on the areas described in the chart above. The drug categories are based on the World Health Organization classification system.

Will RNs be authorized to prescribe controlled substances?

No. Controlled substances are high-risk medications and are governed by federal laws, which do not permit RNs to prescribe these medications.

A controlled substance is one that is included in Schedule I, II, III, IV or V of the federal Controlled Drugs and Substances Act. Controlled substances are used in healthcare to treat a wide variety of conditions including, but not limited to, pain, anxiety, epilepsy and sleep disorders. They include opioids, benzodiazepines, amphetamines, sedatives, anti-emetics and hormonal therapies, among others.

Controlled substances are restricted because they present a high risk for potential misuse, addiction and diversion.

Can CNO enable RNs to prescribe lab and diagnostic tests?