The complexities of RN prescribing

The College has been working out the finer details of RN prescribing so we can draft a new regulation. In recent months, our Council has been discussing policy issues associated with this addition to RN scope of practice.

Based on 2017 changes to Ontario government legislation, RNs who meet specific requirements will be permitted to prescribe certain medications and communicate diagnoses for the purposes of prescribing medication. Nurses won't be able to use this authority until the College drafts a new regulation, and the government approves it.

However, drafting a regulation that ensures public protection is complex. For one, how will this authority affect other aspects of nursing practice such as administering and dispensing medication, and delegating controlled acts? Right now, RNs require an order from another health professional (such as a physician or NP) to administer medication by injection or inhalation, or dispense medications. We also know that in the future, when an RN prescribes a medication, another nurse may need to administer or dispense that medication to a client.

Finally, the current regulation prohibits nurses from delegating certain controlled acts when there is a high risk of harm to the public. For example, NPs cannot delegate the controlled act of prescribing medication. (What is delegation?)

With these considerations in mind, Council supports a future RN prescribing regulation that:

• enables RNs who prescribe medication to also administer (by injection or inhalation) and dispense those medications without an order from another health professional

• enables other RNs and RPNs to administer (by injection or inhalation) and dispense medications that an RN prescribes

As well, the future regulation will prohibit RNs from delegating the controlled acts of prescribing a medication and communicating a diagnosis for the purpose of prescribing. This restriction will not interfere with RNs’ ability to provide an order for a medication they are authorized to prescribe. Delegation and orders are different. For more information, read Authorizing Mechanisms.

Note: Laws governing Ontario hospitals do not permit RNs to prescribe medications for clients in hospitals; therefore, these future regulation changes will have no effect in hospital settings (in-patient or outpatient).

Learn more about our journey to RN prescribing at www.cno.org/journey-to-rn-prescribing.