Recent revisions to the College of Nurses of Ontario’s (CNO) Scope of Practice and Medication practice standards bring changes to who nurses can receive orders from for medication administration. Nurses can now administer oral and topical medications with a prescription from other regulated healthcare professionals with prescribing authority, like pharmacists. This fosters a more integrated approach to patient care and improves access to care for patients.
Many practice settings will benefit from these changes, including retirement homes, long-term care homes and community settings. Consider a visiting home care nurse whose patient requires a topical medication for a skin condition. Previously, a nurse would need to wait for an authorized provider’s order, such as a physician or nurse practitioner (NP), to administer the medication, potentially causing delays in treatment. With the updated standards, a nurse can now also accept a prescription from a local pharmacist for oral and topical medications and administer the medication promptly. This change not only speeds up treatment but also enhances the collaboration between the nurse and the pharmacist, which may contribute to better patient outcomes.
However, these changes are not applicable in all settings. For instance, the Public Hospitals Act restricts nurses from administering medications in public hospitals without an order from specified care providers such as physicians and nurse practitioners. It is also important for nurses to note that if a medication practice requires a controlled act, such as injections and inhalations, nurses are still limited to only accept orders from a physician, nurse practitioner, midwife, chiropodist, dentist or RN prescriber (section 5(1) of the Nursing Act, 1991 and General, O. Reg. 275/94).
CNO worked closely with the Ontario College of Pharmacists to ensure that the updated practice standards reflect the evolving scopes of practice for both nurses and pharmacists.
The revisions were approved by CNO’s Council on March 19, 2025.