In just a few years, Registered Nurse (RN) prescribing in Ontario has moved rapidly from concept to practice. Legislation passed in 2023 made RN prescribing possible, prompting CNO to develop an approval process for nursing programs to teach RN prescribing and approve the first continuing education programs later that year. CNO also developed a practice standard, guidance and a drug list to govern and support safe RN prescribing practice. As of 2025, approved entry-level baccalaureate nursing programs can now teach RN prescribing, and employers in eligible practice settings can provide RNs authorized to prescribe with opportunities to use that authority.
Together with the provincial government, educators, employers and RNs with prescribing authority, CNO is working toward an important goal: using RN prescribing to strengthen access to care across the province. In practice, this can be especially meaningful for patients who have difficulty getting timely care.
Strengthening access to care
“It decreases the barriers,” she said. “[Patients] don't have to come in, wait to be seen by a doctor or Nurse Practitioner, get the prescription and so on. When I can prescribe for them as an RN, it’s just one less stop, one less step." — Erin Porter, RN
For Erin Porter, RN, a prescriber at Guelph Community Health Centre (CHC), the impact is immediate. Located near Guelph’s downtown core, CHC serves many people experiencing homelessness and substance use disorder—patients who often have limited trust in the health system and little tolerance for delays. Once they do seek care, RN prescribing can help to remove critical barriers.
“They are a population that doesn't have a lot of patience for waiting,” said Porter. “So, it has helped where I can see walk-ins and I don't have to wait for a physician to prescribe something like a topical antibiotic for something horrible like an injection-site infection.”
Porter’s confidence in her prescribing practice comes from years of observing and collaborating with physicians and Nurse Practitioners. When RN prescribing education became available, she enrolled right away and found that much of the learning reinforced what she already knew. That confidence, she said, is essential to building trust with vulnerable patients.
“It decreases the barriers,” she said. “[Patients] don't have to come in, wait to be seen by a doctor or Nurse Practitioner, get the prescription and so on. When I can prescribe for them as an RN, it’s just one less stop, one less step.”
Resources for today, preparing for the future
“RN prescribing allows them to receive counselling and treatment during the same encounter rather than having to repeat their story to multiple providers.” — Ruby Amoncio, RN
Since RN prescribing became a reality, CNO has done more than establish a regulatory framework. It has also developed resources to support safe, effective prescribing, including a webcast, a decision tree and comprehensive FAQs.
But broader adoption depends on uptake within the profession. Ruby Amoncio, RN, who works in children’s mental health at Starling Community Services in Waterloo, has emerged as one of those championing this adoption. Since gaining prescribing authority in 2024, she has made RN prescribing a regular part of her practice with children and youth ages six to 17.
Amoncio can prescribe vaccines and over-the-counter medications, as well as smoking cessation treatments and contraception for older adolescents. She said strong clinical decision tools, grounded in evidence and developed collaboratively, have been critical to supporting safe implementation.
Amoncio said prescribing authority also strengthens her therapeutic relationships with patients.
“If a teenager, for example, discloses that they are becoming sexually active and seeking contraception,” she said, “RN prescribing allows them to receive counselling and treatment during the same encounter rather than having to repeat their story to multiple providers.”
Amoncio’s commitment extends beyond individual encounters. She developed a comprehensive prescribing policy for Starling and founded the RN Prescribing Community of Practice within the Registered Nurses’ Association of Ontario’s Staff Nurse Interest Group, creating space for collaboration and peer learning across the province.
Building from the ground up
“We certainly want our nurses to be empowered to work in wound care clinics, to be empowered to do more sexual health. We want them to prescribe authorized medications without the medical directives that are currently in place.” — Danielle Manley, RN
As director of Carleton University’s nursing program, Danielle Manley, RN, helps prepare the next generation of RN prescribers. When Carleton launched its Bachelor of Science in Nursing with RN Prescribing in 2025, it built the program from scratch.
That, Manley said, has been a real strength. RN prescribing is introduced early and integrated throughout the curriculum, which includes 37 prescribing competencies in addition to 101 entry-to-practice competencies. It’s also not an elective—it’s embedded in the program’s identity.
“We certainly want our nurses to be empowered to work in wound care clinics, to be empowered to do more sexual health,” she said. “We want them to prescribe authorized medications without the medical directives that are currently in place.”
Manley emphasized that RN prescribing relies on the same core principles of competence and self-assessment in nursing practice. “Think about all of the specializations in nursing,” she said. “It's just the same principles.”
Ultimately, she sees the expansion of RN prescribing as a matter of change management—aligning education, infrastructure and attitudes so nurses can meet Ontario’s evolving health care needs.
The employer’s perspective
“When RNs [with the authority to prescribe] practice to their full scope, Nurse Practitioners and physicians can focus on patients with more complex health needs." — Kayla Hobart, RN
Employers (and collaborative health care teams) play a decisive role in whether RN prescribing moves from policy to practice. The Public Hospitals Act, 1990 prohibits RN prescribing in hospitals. Community-based settings such as family health teams and clinics are leading implementation.
One example is Kingston Family Health Team. Kayla Hobart, RN, who works in Programs & Services Support, said supporting RN prescribing aligns with the organization’s response to primary care pressures.
“Supporting our nurses to work to their full scope of practice improves both patient care and job satisfaction,” she said.
Kingston Family Health Team developed a clear policy outlining expectations for RN prescribers, including obtaining CNO authorization and accessing physician or Nurse Practitioner consultation when needed.
Hobart said RN prescribing has had tangible benefits. She described a routine blood pressure visit during which a patient mentioned needing an EpiPen refill. The RN was able to prescribe it directly, eliminating delays and follow-up steps.
“When RNs [with the authority to prescribe] practice to their full scope, Nurse Practitioners and physicians can focus on patients with more complex health needs,” she said.
What’s next?
CNO sees RN prescribing as an evolving, long-term shift in practice, one that can strengthen patient access to timely care and improve outcomes, particularly in rural and remote communities. As RN prescribing education and implementation develop, CNO will continue to adapt its regulatory approach to ensure the public remains protected.
Aside from CNO’s position, the nurses working in this space have their own hopes for the future. Looking ahead, Manley sees mental health as a key area for RN prescribing. “We have a significant mental health crisis,” she said, adding that expanded scope could help address unmet demand. “I think Registered Nurses are so well positioned.”
Hobart hopes to see gradual expansion of the RN prescribing drug list, along with authority to order diagnostic tests. “Ultimately, I want to see the scope of nurses’ practice expanded,” she said.
Porter also supports expansion, pointing to oral antibiotics to treat urinary tract infections and certain types of prenatal vitamins that require a prescription because they’re dosed a certain way. “I know I would be confident prescribing those,” she said.
For Amoncio, RN prescribing sustainability depends on structures and systems. “Employer readiness, clear policies and strong clinical supports will be essential,” she said. “I believe it should always be evidence-informed and aligned with patient safety and regulatory standards because sustainability depends on that structure.”