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RN Rx

November 2013

RN prescribing has been gaining momentum in Canada. Several jurisdictions across the country are working towards establishing this as part of RN practice as a post entry-level competency. The move is viewed as a way to capitalize on the knowledge, skills and abilities of experienced RNs while increasing access to treatment for patients.

Presenter: Dawn Torpe
NANB Nursing Practice Consultant

RN prescribing has been gaining momentum in Canada. Several jurisdictions across the country are working towards establishing this as part of RN practice as a post entry-level competency. The move is viewed as a way to capitalize on the knowledge, skills and abilities of experienced RNs while increasing access to treatment for patients.

Numerous models have developed internationally allowing RNs to prescribe medications, however, their scope of practice or freedom to act varies considerably, depending on whether or not protocols and/or formularies are in place and if so, how restrictive these are. Background information on RN prescribing can be found by following the links listed below.

This virtual discussion is intended to open the debate and dialogue about the appropriateness of RN prescribing for New Brunswickers – both nurses and patients. We would like to hear your thoughts and ideas about the subject and hope the forum will allow participants an opportunity to learn from each other.

To stimulate debate please consider the following questions:

  • Is RN prescribing a natural progression of the RN scope of practice?
  • Can you identify settings and/or patient populations where RN prescribing would benefit patient care?
  • Is the time right for RN prescribing in New Brunswick?

Let’s get started!

References

Archived Comments


Anonymous

I think that this would be a perfect way for us to improve both access to timely care for patients and knowledge transfer at the Primary Care level. As Primary Care changes across the country, (and hopefully here in New Brunswick), into a more “team based” type of practice, I believe that Nurses should and will have a pivotal role to play. Working as an Outreach Diabetes Case Manager in the Primary Care setting I encounter many instances where it would be beneficial for both the patient and the PCP for me to have the legal authority to prescribe diabetes therapies. As the “diabetes expert” embedded into these types of settings I frequently recommend appropriate changes to therapy, however there can sometimes be a time lag between recommendation and implementation depending on the various circumstances surrounding the practices. As a Case Manager I have access to lab data and extensive health history for the patients who I see and believe that prescribing is definitely something that could be developed within my scope-of-practice. I maintain expertise and knowledge of the appropriate medical therapies for the treatment and management of diabetes and the risk factors for complications. Prescribing ability would allow for more timely advancement to therapy facilitating achievement and maintenance of Clinical Practice Guideline targets for the person living with diabetes.


Anonymous

I have practiced as a registered nurse both in New Brunswick and in other provinces since 1971.I think there are some instances where this practice would be extremely helpful but there must be extra education coupled with internship and regular monitoring to ensure safety for the population. I am currently working in a rural community clinic and there are so many times when this practice carefully monitored would be a benefit to our patients. Every time I tell someone to attend a walk in clinic for their problem I feel there must be a better solution. The drive is long and fuel is so expensive there are many times when our scope of practice should be expanded.


Anonymous

As a Registered Diabetes Nurse Educator and a Certified Diabetes Educator working in a rural Diabetes Education Centre I wholeheartedly agree with the comments above.


Anonymous

Oui je crois qu une infirmiere de l urgence surtout..devait etre capable de prescrire certains medicaments avec une bonne formation.


Anonymous

I will preface my comments by stating that I am an RN, not an NP. I think that we need to look at this very closely and carefully before we move forward. When I read through the national documents and the Info Nursing article, this move toward RN prescribing in the country is looking at more than just prescribing. It is looking at RN diagnosing, ordering and interpretation of tests, and prescribing. In my opinion, this is the role of the NP. While I agree that RN prescribing does have merit in certain practice settings with well defined guidelines and training, I don’t feel that we are ready for this in NB. There is still a need to clarify the role of the NP to both health professionals and the public. I think that introducing another professional to the public, at this point in time, with prescriptive authority will create more role confusion and may hurt the momentum that the NPs are gaining in the province. Please understand that I am not saying that RN prescribing has no place in our practice. I am saying that I feel we need to take our time and carefully consider what we add to our scope of practice and why. I am also saying that we need to further clarify and promote the Nursing roles we have in New Brunswick, especially with the Physician Assistant role being introduced (impacting NP job creation) and RN positions in our province being cut.


Anonymous

Hi, I agree, all health professionals must work to their full scope of practice. There is much work to be done to ensure this. I am cautious about RN prescription in that most RNs prepared at the Baccalaureate Level have had only an Introductory Course in Pharmacology. This basic course only begins to introduce pharmacotherapeutics and pharmacodynamics, typically appears in the second year of a four year program and is designed to present the application of the major classes of medications in the clinical setting. I teach Introductory Pharmacology at the undergraduate level. I am also an advanced practice nurse; a Master prepared Nurse Practitioner with a specialty in Diabetes Care and hold national certification as a diabetes educator. My role as an Adult Diabetes Nurse Practitioner allowed me to break the clinical inertia that exists and expedite clinical decision making, but with the guidance of additional education. I do recognize that many experienced RNs can anticipate the plan of care, however, prescriptive authority should only be granted after preparation in advanced pharmacotherapeutics and advanced pathophysiology. It is not just ordering the right medication but understanding and appreciating all the potential medication interactions, implications of the medications being prescribed, need for monitoring, challenges in securing pharmaceutical coverage, and how the medication may act across the lifespan and impact pre-existing co-morbidities. No drug is safe. No drug is simple. I would envision that prescriptive authority be held to those educated in advanced practice and whose training has prepared them to take on this responsibility. If prescriptive authority does become part of the scope of practice of a RN, I would hope that a national pharmacotherapeutics and pharmacodynamics education program be developed and delivered with yearly examinations to determine and ensure competency. In addition, changes will be required in the undergraduate BN curricula and RNs will need to carry additional liability insurance if they are to take responsibility for ordering medications. RNs who prescribe will also be making diagnoses because one can not prescribe without making a diagnosis. To suggest that diagnosing can be done without additional preparation places RNs at greater risk in their professional practice. Once again, greater liability insurance will be required. Canadian RNs have always been acknowledged by their superior training. Creating opportunities for RNs to work to full scope must be the priority of our nursing leaders. However, reducing the importance of education as a means to prepare for advanced practice is not the solution. Development of teams that pairs prescribers with RNs may be an alternative may be an interim approach until the logistics of adding this scope of practice are reviewed. Please know, I fully support RNs working to their full scope. I had that opportunity in my own career and when I needed more than what I had at my fingertips, we developed medical directives. When I decided to increase autonomy and responsibility I pursued education that would prepare me for the additional decision-making capacity.


Anonymous

I too think that there are speciality areas of Nursing and in some cases, the remoteness of the practice, that being able to prescribe would be beneficial. Change process that impacts legislation; regulation and educational preparation is often a very lengthy process and so I think that NANB should indeed start moving in this direction. If CNA and other jurisdictions are exploring this expansion in RN practice, then I believe NANB should join these other experts in looking at RN prescribing. I always try to keep in mind: “What is best for the patient and in the afore mentioned posts, client benefit is expressed repeatedly.