Registered nurse prescribing in community health

Requirements for designated prescribers in community health

The Council is commencing a managed roll out of Registered nurse prescribing in community health in 2019. This follows a trial of a workplace-based education programme to prepare registered nurses to prescribe contraceptives and some short-term antibiotics for common conditions with Counties Manukau Health and Family Planning New Zealand.  

More information about the trial and evaluation can be found in the section below entitled 'Results of the trial and evaluation'.

The managed rollout will involve District Health Boards or other regional or national health provider organisations adopting the Counties Manukau Health Recertification programme with Council approval. Nurses must complete workshops, e-learning and prescribing supervision with a medical or nurse practitioner. Regional health providers must have the capacity to manage the programme on an ongoing basis across their region. The programme is modelled on PDRPs (Professional development and recognition programmes) and would be appropriate for organisations with this infrastructure and a strong clinical governance framework for prescribing.

More information including standards for programmes and a Tool-kit for providers of Recertification programmes for Registered nurse prescribing in community health can be found in the section below entitled 'Information for health provider organisations considering providing a recertification programme'.

Who can become a registered nurse prescriber in community health?

Registered nurses will only be able to apply for this prescribing authority if they are part of an approved programme.

Registered nurses practising in community health settings must complete a work-based education programme and then they can apply to the Council for prescribing authority for a limited number of medicines for minor ailments and illnesses in normally healthy people without significant health problems.

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 of colleagues. They will be responsible for asking for help when they need it and referring patients who have health problems beyond their abilities.

The Council has provided guidance on the boundaries of this prescribing authority below.

Guidelines for registered nurse prescribing in community health

What will registered nurses in community health be able to prescribe?

  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 for registered nurse prescribing in community health
  3. completed a period of supervised practice with a designated authorised prescriber (a medical practitioner or nurse practitioner) as part of the recertification programme
  4. a limited list of medicines from which they can prescribe within their competence and area of practice,ongoing competence requirements for prescribing.

Medicines list for registered nurses prescribing in community health 2019

What areas have approved RN prescribing in community health recertification programme

Counties Manukau Health

Family Planning New Zealand

Information for health provider organisations considering providing a recertification programme

Council standards and approval process can be found below:

  1. Standards for recertification programmes for registered nurse prescribing in community health 2019

Counties Manukau Health has made available its programme handbook and documents developed during the trial to be used for the implementation of the programme.

  1. Toolkit for health provider organisations intending to provide Registered Nurse Prescribing in Community Health Recertification programmes
  2. Counties Manukau Health Handbook for Registered nurse prescribing in community health recertification programme.

 

The trial and evaluation of registered nurses prescribing in community health

In March 2019 the Minister of Health agreed to a managed rollout of recertification programmes for registered nurse prescribing in community health. This follows a successful trial and evaluation of this limited prescribing model with Family Planning and Counties Manukau Health.

Results of the trial and evaluation

Fifty-six nurses participated in the trial. These nurses were from Family Planning clinics around the country, as well as practice nurses, school nurses and public health nurses in Counties Manukau.

All nurses were authorised to prescribe by November 2017.  

Their prescribing practice was evaluated for a minimum of three months. The evaluation concluded that:
•   registered nurses prescribed safely using treatment guidelines.
•   nurse prescribing increased patient accessibility to medicines, decreased patients’ out-of-pocket expenses, and freed up time for doctors to see more patients.
•   nurses had high professional and job satisfaction and felt more valuable to the system.
•   education and supervision prepared nurses effectively for prescribing, and after the trial almost all nurses remained highly confident in their
•   prescription abilities.most nurses felt well supported in clinics when they needed reassurance or help.

Some concerns were expressed about increasing the number of prescribers of antibiotics and Council is aware the benefits must be weighed against the risks for patients who presently have poor access to care.

Registered nurse prescribing in community health 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 funded 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 at increased risk of bacterial infections that can lead to more serious complications and hospitalisation.

More information and detail about the trial can be found in the summary report by the Nursing Council  Trial and evaluation of registered nurse prescribing in community health 2018.

The full evaluation report by Ko Awatea  Evaluation of the trial: Registered nurse prescribing in community health 2018.