RN Prescribing: Speeding Implementation, Evaluation, and Expansion

Initially introduced in the United Kingdom in 1986, Registered Nurse (RN) prescribing is driven by the need for improving access to care and the efficient use of health care resources. [1] RN prescribing has expanded globally, with many countries recognizing the value of RNs prescribing medications in enhancing equity and access to care. [2] This shift has been influenced by various factors, including physician shortages, increasing complexity of patient needs, and awareness of RNs valuable skillsets that can be utilized by expanding their scope of practice.  ​

Current research suggests that RN prescribing shows many benefits including a reduction in patient wait times, improved continuity of care, and cost-efficiency.[3] However, new nurse prescribers express experiencing anxiety regarding their expanded scope of practice, highlighting the critical need for initial support from primary care providers.[4] In November 2023, Ontario's Ministry of Health approved regulations allowing RNs to prescribe certain medications and communicate diagnoses for the purpose of prescribing. Findings from a survey conducted by the College of Nurses of Ontario (CNO) highlighted that more than half of its respondents (n=1,312) would be interested in pursuing education to prescribe, yet many did not consult with their employer. Respondents highlighted the need for more information on education (i.e., cost, delivery, and methods) [5] and clarity on employers' permission to prescribe. ​

The impact of RN prescribing is more difficult to assess in Canada, often due to the complexity of Canada’s Federated governance model, such that provinces and territories are independently responsible for delivering health care. In 2015, the Canadian Nurses Association developed a framework for RN prescribing to galvanize efforts, enable learnings across jurisdictions, reach a common vision, and improve negotiation in shaping policies. This framework was published at a time in which provinces and territories were at different stages in the implementation of RN prescribing. ​

As provinces and territories expand nurses’ scope of practice, it is essential to continue to assess its impacts on the health profession and health outcomes. There is a need to accelerate these endeavours to support an expansion of promising practices, especially given that Canadian research has been examining this topic for over a decade.

The W&W Team

Sources:

¹Royal College of Nurses, United Kingdom, 2014. 

²Kooienga & Wilkinson, Nursing Forum, 2017.

³Haririan et al. BMC Nursing, 2022.

⁴Pearson et al. Contemporary Nurse, 2020.

⁵College of Nurses of Ontario, 2023