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.

CNO is developing a practice standard to outline the accountabilities of RNs authorized to prescribe. We are also creating new and updating 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.

“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.

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.

No, this is a government decision.

The public Register 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 public Register (Find a Nurse) to indicate that an RN is authorized to prescribe medication.

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.

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

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

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.

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

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

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.

For a list of medications, please click here.

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

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.

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.

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

No, this is a government decision.

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.

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.

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

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.

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.

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

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.

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.

Deprescribing is a structured and deliberate approach to medication management, focusing on reducing or eliminating unnecessary medications. Discontinuing a medication simply means stopping a medication without necessarily following a formal deprescribing process.

An RN may only deprescribe or discontinue a medication authorized in the RN prescribing medication list. If an RN is considering deprescribing or discontinuing a medication they did not prescribe, they should ensure continuity of care by communicating and working in collaboration with the primary care provider to ensure safe client care. 

References:

• Registered Nurse (RN) Prescribing practice standard
• Medication practice standard
• Deprescribing.org

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

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

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

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

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

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

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.

“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.

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.

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.

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.

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

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

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.

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.

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