The manufacture, quality, licensing, possession, sale, dispensing, prescribing and administrating of medicines is regulated by a number of federal, state and territory laws.

The right to prescribe Schedule 4 and Schedule 8 medicines is governed by specific rules within state and territory legislation and has traditionally been assigned to doctors, vestiary surgeons and dentists.

However, there is an increasing trend for other healthcare practitioners to be authorised to prescribe medicines - albeit in limited circumstances - in order to improve client access to healthcare.

Registered nurses who meet the Nursing and Midwifery Board of Australia (NMBA) standard for endorsement as a nurse practitioner have been authorised to prescribe under section 95 of the Health Practitioner Regulation National Law in each jurisdiction (the National Law).

The scope of authority for prescribing is governed by state and territory legislation and varies between jurisdictions with respect to the nurse practitioner’s scope and context of practice, formularies and protocols, and any hospital/health agency prescribing arrangements.

An endorsed nurse practitioner is also eligible to apply for a Medicare provider number and a Pharmaceutical Benefits Scheme provider number, and where granted, must comply with the requirements for collaboration as stated in sections 5-7 of the National Health (Collaborative arrangements for nurse practitioners) Determination 2010 (NMBA 2021).

The nurse practitioner may enter a collaborative arrangement with a health service team or a medical practitioner. To maintain endorsement, the nurse practitioner must meet the NMBA’s approved standards for continuing professional development, recency of practice, criminal history registration standard and professional indemnity insurance arrangements. They must also meet any other relevant codes and guidelines approved by the NMBA. Nurse practitioners must also practice in accordance with the Safety and Quality Guidelines for Nurse Practitioners.

The Rural and Isolated Practice (RIP) endorsement for registered nurses to obtain, supply and administer scheduled 2, 3, 4 and 8 medicines appropriate to their scope of practice in rural and isolated practice is no longer required (NMBA 2022a). This is due to legislative changes in Victoria and Queensland (the only two states that required the endorsement) that now govern the medicines practice of rural and isolated practice RNs.

The use of medicines by RNs is now regulated by poisons legislation, health service policies and protocols, and local regulation in all jurisdictions in Australia. Therefore, RNs should be familiar with the legislative framework for medicines in their jurisdiction, as well las their local health policies and protocols.

Similarly, midwives who meet the NMBA registration standard for endorsement for scheduled medicines under section 94 of the National Law in each jurisdiction have been able to prescribe schedule 2, 3, 4 and 8 medicines since the 30th October 2015 in accordance with relevant state and territory legislation.

An eligible midwife applying for endorsement to prescribe scheduled medicines can do so ether across the continuum of care or in a nominated context of practice approved by the NMBA - antenatal, postnatal, and ante and postnatal (NMBA 2022b). To maintain endorsement, a midwife must meet the NMBA’s approved standards for continuing professional development, recency of practice, criminal history registration standard, and professional indemnity insurance arrangements. They must also meet any other relevant codes and guidelines approved by the NMBA. Privately practicing midwives must also meet the Safety and Quality Guidelines for Privately Practising Midwives.

The NMBA is in the process of developing draft guidelines to develop a new registration standard that will enable employed registered nurses (not those in private practice) who have undertaken relevant education to make diagnostic and treatment decisions to prescribe within their scope of practice and level of competence, and after a period of supervised practice.

The Endorsement for Scheduled Medicines Standard will enable registered nurses to prescribe in partnership with a medical officer or nurse practitioner in accordance with a clinical governance framework for the quality use of medicines.

What is Prescribing in Partnership?

A prescribing in partnership model will see a registered nurse endorsed to prescribe scheduled 2, 3, 4 and 8 medicines in alignment with their competence level and scope of practice.

An endorsed registered nurse would have the authority to obtain, possess, prescribe and supply scheduled medicines in partnership with one or more authorised prescribers, such as a medical officer or a nurse practitioner (NMBA 2018).

It is anticipated that an endorsed RN would prescribe medicines in line with legislation in their jurisdiction, standards and guidelines produced by the NMBA (including an additional 10 hours of CPD in relation to prescribing and recency of practice) and local health provider policies and protocols.

References