Registered nurse prescribing in community health

A new level of prescribing for registered nurses working in community health is being cautiously introduced in a trial with Counties Manukau Health and Family Planning starting in July.

Evaluation of the six-month trial will enable the Nursing Council to ensure that this level of prescribing is safe, and that the education of nurses is appropriate, before it’s rolled out more widely in 2018.

Registered nurses practicing in community health who become designated prescribers will be authorised to prescribe following completion of a Council-approved recertification programme, provided by a national or regional health provider organisation.

They will be able to prescribe from a limited list of prescription and other medicines, for a range of common conditions. They will be able to prescribe for and treat common skin conditions, ear infections, sore throats and common sexually transmitted infections as well as providing contraceptives, low-level pain relief and both preventative and ongoing treatment for rheumatic fever. Most of the drugs they will use are already supplied and administered by nurses under standing orders.  Antimicrobial stewardship is included in the education programmes.

Community prescribing supports the New Zealand Health Strategy by enabling registered nurses to fully use their skills and training to provide the right care at the earliest opportunity.

Many nurses work in community settings where there is no doctor or immediate access to medicines. This can mean unnecessary cost and delay for people to get the medicines they need. This new prescribing authority will improve access to health care for people in vulnerable communities, including children in lower socio-economic circumstances who are more at risk of infections that can lead to more serious complications and hospitalisation.

Requirements for designated prescribers in community health

Registered nurses prescribing in community health will be prescribing for normally healthy people using decision support tools, current best practice information and with the support from colleagues. They will be responsible for asking for help when they need it and referring patients who have health problems beyond their abilities. Guidance for nurses participating in the trail can be found here:

Guideline for registered nurse prescribing in community health trial May 2017 (PDF, 518 KB)

Registered nurses authorised to prescribe in community health will have:

  1. a minimum of three years’ clinical experience with at least one year in the area of prescribing practice
  2. completed a Nursing Council approved recertification programme

    Standards for recertification programmes for RN prescribing in community health September 2016 (PDF, 39 KB)

  3. completed a period of supervised practice with a designated authorised prescriber (a medical practitioner or nurse practitioner) or a suitably qualified senior nurse, as part of the recertification programme
  4. a limited list of medicines from which they can prescribe within their competence and area of practice

    Medicines for registered nurse prescribing in community health Effective July 17 (PDF, 400 KB)

  5. ongoing competence requirements for prescribing.

Background

The Council developed this second level of prescribing for registered nurses working in community health following significant consultation in 2013 and refinement of the proposal in response to feedback. The move also follows the success of nurses prescribing in diabetes health and the introduction in 2016 of Registered nurse prescribing in primary health and specialty teams which requires nurses to have a post-graduate diploma. It will be introduced under the same regulations allowing suitably prepared nurses to be designated prescribers.

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