Should registered nurses prescribe drugs?


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56 comments

  1. Mike Aebescher

    This article ignores an important issue. There are many RN’s that are directly/indirectly employed by pharmacies and pharmaceutical companies to support patient care (examples include Pulm HTN, HCV, Biologics). Pharmacies and Industry would LOVE RN’s to prescribe and cut out the pesky MD. I wonder how the regulatory framework will evolve to address this issue if RN’s can prescribe given the obvious bias and possibility that treatment is prescribed for financial benefit. Is there an appetite amongst nursing regulatory bodies to address bias, maintenance of competence, and prevent RN’s being paid for by treatment monies from prescribing, While MD bias certainly can exist, at least they generally cannot be employed for patient care by those who stand to benefit most by the prescribing of medications while RN’s do right now.

    • Jill King

      Reality check! Take a look at the “new age” 21st century registered nurses. For years registered nurses traditionally worked only in hospitals, health care institutions, public health settings, research, and government services, where they had significant contact and professional interactions primarily with other health care professionals.
      Today’s decision makers need to recognize “new age” registered nurses. Statistically 40% registered nurses work in independent practice delivering a huge diversity of nursing health care services. These independent practice nurses connect people to health care system by navigating them to correct resource, by education or work as clinicians providing required health care. These “new age” nurses in independent practice are a significant change from the traditional hospital registered nurse. Public education booklet http://www.ipnig.ca/cottagecountry-2015/Nurses-OnlineMagazine-JUN2015.pdf
      Today’s society is shifting towards a new trend to meet health care needs. There is a growing demand for comprehensive community, family and individual Primary Health Care PHC model of health care delivery. Important to note that PHC model of health care delivery is distinctly different then primary care that is a person first entrance to medical care system at their doctor or hospital.
      Public demand is increasing daily for an even greater diversity of available health care services and available skilled health care providers to meet the needs of a “new health conscious society”. Many independent practice registered nurses have stepped up to meet this need delivering professional specialized nursing health care in the community where people ” live, work and play.”
      The “new age” nursing services focus on enhanced health, prevention, education, protection, health maintenance and chronic care. Experienced skilled registered nurses, utilizing new and innovative health care technology provide evidenced based nursing skills to meet the health care needs of all people.
      It is time for independent practice registered nurses to enhance their full nursing capabilities in their specialized nursing scope of practice with the addition of independent registered nurse prescription. The public are ensured all registered nurses often with nursing certification accreditaion are bound by regulatory legal nursing scope of practice soon to include independent RN prescription

      • cheryl yost

        fantastic message. Send out far and wide. You are a great advocate for quality care and the direction of nursing. Stop RN replacements now. Make a capital investment today.

    • Samantha Petkou

      Many MD’s are supported by big Pharma dinners lunches research don’t single out RN’s the money is benefited by all parties with a smile. That is not the issue being discussed though.

  2. Mary Catherine Lindberg

    The difficulty with RN’s prescribing is the same with MD and NP that most do not prescribe appropriately. There is plenty of evidence that indicates the over use and inappropriate us of prescription drugs is happening and adding another prescriber to the mix is the wrong solution for the problem that is identified. The misuse of anti-infective drugs is common and unless there is an effective way to get all prescribers to follow protocol we will see this problem continue. There need to be a rethink of the whole area of diagnosing and prescribing long before we just extend a professional privilege to another profession.

    • carolyn ingram

      Ms. Lindberg, I think you are spot on. I think we should treat antibiotics the same as we treat opiates. (almost the same)

    • Kansas

      It occurs to me, on reading your comment, that the opportunity to inject the up-to-date education into the system (of which nurses make up the majority) could make a huge impact on this very issue. Empowering nurses to prescribe opens wider the dialogue around use of medications as nurses categorically emphasize non-pharmacological intervention in nursing practice. We promote healthy lifestyle, prevention at all levels, community health, chronic illness management, symptom management – we focus on the non-pharmacological. It stands to reason that RNs could really shift the system away from over-use.

  3. Ron

    No. It would set a dangerous precedent. Nurses have not gained the privilege to prescribe. To legislate such a change would be failing patients.

    • kansas

      RNs are held to professional standards, and they should be here, too. I think there are very appropriate rationales for extending nursing practice into the realm of limited prescribing privileges and our practice standards would keep patients safe as they do now.

  4. Susan Monaghan

    As a nurse practitioner, this is what I thought I had signed up for but now they are proposing that RNs do our job and that NPs do the same jobs as the doctors, see medically complex, less run-of-mill patients. Because this is currently what I have been doing and the government seems to have finally realized it, I hope our salaries are going to reflect that we see medically-complex, less run-of-mill patients with the roll out of the 85 million. I’m tired of practicing like a doctor yet receiving the pay of a nurse!

    I think RNs in public health should be able to prescribe medications pertinent to their practice such as in travel immunization and sexual health clinics. I think RNs should be able to extend prescriptions for long-term medications. I am less in agreement with acute, episodic because what is booked by reception as an acute, episodic illness often turns out to be more complicated, for example, the patient has recurrent UTIs, poor renal function and allergies to three commonly used antibiotics or the person with the supposed cold is an elderly person in heart failure. Receptionists don’t have time to ask patients a lot of questions to triage the patient well. What you are basically asking is for the receptionist to make the diagnosis of acute, uncomplicated UTI over the phone in less than 30 seconds and the diagnosis usually comes from the patient saying, “I have a bladder infection”. The patient arrives and the problems is more complicated and the doctor and nurse practitioners are already booked with people who probably could have waited until the next day to be seen but now they will be double booked having to deal with their own scheduled patient and now a complicated UTI.

    • Mike R

      If you wanted to practise and be paid like an MD, why didn’t you go to medical school?

      • EB

        Mike,

        The medical model and nursing model are different. One is not better or worse than the other, just different. I prefer the nursing model of care over the medical model.

        What she is referring to is that hospitals are using NP’s as physicians because NP’s are paid less. It’s ironic that medical associations like to tout NP incompetence (without evidence to support the argument) and yet in practice, use NP’s to the full extent of their education – at a bargain. In the acute care setting, NP’s are cheap labour. The only way to avoid that difference is to work only in private practice – but even there, the reimbursement rates are lower for NP’s for the same diagnosis.

        The issue largely surrounds the perception that Nurses are just a bunch of pretty girls. RN education is intense with a failure rate that approaches 50%. A further 50% of new RN’s quit the profession within the first year and never return due to physician and patient abuse. NP and MD education are both graduate level studies. They are difference because one is the nursing model of care and the other is the medical model. To argue that an NP should be an MD for equal pay makes little sense. Physician Assistants are paid more than NP’s and have less education and experience at the onset of their careers. PA’s also do not practice under their own license. They must have physician oversight. This is about control, not patient safety or practice competence.

        NP’s choose their profession because that is their chosen career, and not because they could not get into medical school. If NP’s are being used to the full extent of their license and education, then they should be reimbursed at the same rate as MD’s for the same diagnosis.

        EB

    • Hans

      Writing a prescription isn’t scalable. Every patient is unique. The prescription is a recommendation by a physician that, after a careful consultation, the patient requires x drug.

      It is not so simple as “the diagnosis usually comes from the patient”, otherwise our brilliant forefathers would have given RNs the privilege to prescribe long ago.

      Your comment is a classic case of “a little knowledge is a dangerous thing”.

    • Jess

      As an no I can tell you that no one is proposing we see medically complex patients. If you have been doing this in the past, it opens you up to litigation.

  5. Samantha Petkou

    Health care is changing our roles are changing RN’s are more prepared than ever to practice at full scope. We need to be inclusive nurturing collaborative and work as a health team respecting our roles and the capabilities we bring to the system for the patient.
    We will all be paitents and want an efficient affordable system.

  6. Judith Shamian

    The International Council of Nurses (ICN) congratulates Ontario for moving forward with authorizing registered nurses (RNs) to prescribe medications. We are pleased to provide you with feedback to support this initiative, given our international experience.

    Globally, health systems are in a state of change. Jurisdictions, which historically had a down-stream and illness focus, are shifting towards more upstream and wellness-based cultures of health promotion. We are aware that Ontario is in the midst of striking improvements to make your health system more person-centred. RNs have an opportunity to play an immensely important role as catalysts for positive change.

    ICN knows that healthy public policy embraces teams, autonomy and draws upon the diverse strengths of all groups within a community. Interprofessional health service delivery, through the full utilization of all health professionals, translates into healthy public policy. Independent RN prescribing advances global health equity as it greatly improves access to health services, especially for those who face some of the greatest challenges accessing service.
    Moreover, independent RN prescribing enhances patient safety through clear accountability and will stimulate the development of a global nursing knowledgebase, including clinical practice resources to continually enhance RNs’ competency, knowledge and skill.

    Independent RN prescribing is evidence-based and critical to enhancing the resiliency and capacity of health systems to respond to emerging threats, including infectious disease. Research shows that RN prescribing has a significant impact on the health of the public. For example, it is advancing the management of HIV in Africa (see Monyatsi et al 2012; Barton et al 2013). The United Kingdom has 17+ years of experience with independent RN prescribing
    and demonstrates strong outcomes for the public.

    ICN advises in the strongest possible terms that Ontario adopts an independent model of RN prescribing through an enabling legislative and regulatory framework. Doing so will contribute to a global movement that maximizes the role of the RN to improve health outcomes for all.

    • Samantha Petkou

      Thankyou Judith for your thoughtful professional respectful response.

    • Pat Sevean

      Thank you for your strong evidence-based response to RN Independent Prescribing. In support of health outcomes for all, Stop RN replacement, Start RN Independent Prescribing.

    • Hilda Swirsky

      Thank you Judith, for your insightful comments. RN Independent Prescribing within our area of expertise after successfully passing an approved course will safely enrich and enhance our patients’ health outcomes.

    • Kansas

      Yes, thank you for this evidence that RNs are capable and responsible clinicians who are well positioned to deliver safe and effective healthcare.

  7. Grace Harper

    I think RNAO and ONA have more important things to champion. St Jose’s in Hamilton just layed off 84 Reg N’s in favour of RPN. The last time Cambridge Hospital layed off RN’s and replaced with PSW’s the paper read’ “Better Care.” Our Hospital Grand River, is replacing some RN lines for RPN’s.
    Dialysis has RPN’s working, but it is not very effective, for patient care.
    Who is the watchdog to ensure that Patients are receiving safe, efficient and ethical care.??
    The CNO has criteria to determine the right nurse for the right job.. So why are the policy makers allowing the shift in Registered Nurses.??
    I am sooo glad I am at this end of my career. I wonder what Nursing will look like in the very near future, and the impact it will have on our precious patients.

  8. Concerned Maggie

    Absolutely not! We’re asking them to full fill a role that they want but lack the education, skills and experience to carry out.

  9. Victoria Smye

    I would support the position of Barb Mildon – yes, but circumscribed (in a limited range of settings). I do not see that option here in the vote. I also would say that this has implications for nursing education. Let’s proceed cautiously.

  10. Jordan

    absolutely not. as it stands, it takes nurse practitioners 1 hour to see a patient a GP would normally see in a quarter of that time, and even then, their diagnoses are likely less accurate, regardless of what various articles, most published in nursing journals (?conflict of interest), will say. how could a registered nurse possibly be able to do the job an NP is already not trained to do?

    • Samantha Petkou

      Using different models of practice require different time frames and more patients in less time does not mean betree care. Again respectfully roles are different and bring much to the patient experience, we can all be part of this change and responsibly and respectfully discuss how to include RN prescribing.

      • Han

        Know your limits.

        Prescribing is not easy. It is a decision made after careful consideration of all facts and possibilities. It is the end-result of a consultation by a highly educated and responsible professional.

        RNs do not have the necessary training, or dare I say academic fortitude, to be given the privilege of prescription.

  11. Michelle

    I feel that if it’s come to the point where we are discussing giving RNs the privilege of prescription, then I feel it is also important to discuss giving OTs/PTs, pharmacists, acupuncturists, and heck, even naturopaths prescribing rights (I think I read something about them wanting to prescribe too). All in the interest of expanding roles that need not be expanded in the first place. There is such a thing as enhancing one’s skills, but there is also such a thing as respecting boundaries of practice. Why continue to blur the lines? Why make things more confusing for patients? Why should patients be the ones to pay for these mistakes?

  12. Dana Boyd.

    We need to support a voluntary, independent RN model of prescribing including the ability for RNs to order diagnostic testing and communicate a diagnosis to provide care. There are 96,000 RNs working across Ontario – This is the bold direction our health system needs.

    When an RN feels confident and has worked in a specialty area for many years, allowing the RN autonomy to practice at a more efficient and higher scope of practice makes sense. After working many years in a sexual health clinic, I felt very comfortable and could see myself prescribing medications for sexually transmitted infections (I did it everyday, but, had to have the Physician sign for the meds I dispensed daily under his authority/order) I used my knowledge to recommend the mediactions, and the physician I worked with supported my judgement (for ordering lab tests too)
    By increasing the capacity of the RN (with an additional 300-hour course as recommended by RNAO) It will assist with:
    • Timely access to quality patient care
    • health system effectiveness
    • Vulnerable populations will be able to gain access to primary care.
    • Residents in long-term care will still experience unnecessary transfers to the emergency departments
    It just makes sense.
    ~Dana Boyd RN MN, Public Health Nurse, Windsor, Ontario, Canada

    • private

      by this logic, if you’ve followed a cardiologist around long enough, there is no need for the cardiologist. RNs can just do the job of the cardiologist. i mean they’ll have their 300 hour course, so that’s equivalent to the 4 years of medical school and 6 years of residency of the cardiologist.

  13. Jamie

    This poll is quite concerning. Most of the people voting are no doubt nurses, given that this debate has been published almost exclusively on nursing sites. The fact that only 57% of voters, most of whom are probably RNs, seem to agree that RNs should be able to prescribe medications, tells me that people are not for RN prescribing. To be able to prescribe, it is first necessary to diagnose, and given the amount of training RNs receive, they simply do not have the skills to do this.

  14. Jim

    RN prescribing will save the health care system money. We will no longer have to hire NPs.

  15. Karen

    at the rate kathleen wynne is replacing RNs with RPNs, there will be no RNs employed to prescribe. out of curiousity, why not allow RPNs with experience in a certain area to prescribe?

    • jose

      as an RPN, i feel comfortable being able to prescribe if i have enough experience in a particular area.

  16. Keisha

    i have been an RN for twenty five years and am strongly against this proposition. there is risk involved in prescribing and i am concerned about the prospect of being sued.

  17. Beatriz Jackson

    I support Registered Nurses prescribing medications in their area of expertise.

    • susan hawes

      let’s say your area of ‘expertise’ is renal. so you think you can only Rx ‘renal meds?’ chances are, patients come in on cardio meds, renal meds, arthritis meds, diabetic meds, prostate meds—–all at the same time. so pray, tell me, what are speciality meds and how do you know the reactions to all the other meds patients are on?

  18. susan hawes

    pharmacology is a speciality. do any one of us truly know enough about it to safely prescribe meds? did your bscn or diploma teach you all the details of pharmacology and drug classifications? besides, aren’t we busy enough?!?! a stupid and unsafe idea frankly.

  19. cheryl yost

    move forward now. The efficiencies will be gained with the right team. Expanding access to care support full scope of practice.

  20. Claudette Holloway

    RNs in their area of expertise are poised to prescribe and thereby increase access to timely healthcare.

    • Greg

      RNs do not have a specific area of expertise and are not experts. They simply work in a particular area in a hospital or clinic. They never received in-depth training in general or specialty practice. And it is my thought that most RNs realize this. It is a distinct minority that believe otherwise.

  21. Pat Sevean

    Stop RN Replacement. Start Independent RN Prescribing.

    • Jimmy

      Maybe if RNs salaries weren’t so high, we wouldn’t have to replace them

  22. Judith Shamian

    Evidence shows that RNs that received the right training can prescribe and be as safe as others who have the authority to prescribe, see the track record in Ireland.

  23. David

    in addition to the numerous valid concerns about nurse prescribing mentioned above, it should also be mentioned that RNs are nearly never the most responsible health professional. having nurses prescribe medications would only make it more difficult and confusing for physicians to manage patients.

  24. matthew

    giving registered nurses prescribing authority isn’t really helping expand access to medical care. i have lived in a rural area all my life and have seen family physician and nurse practitioner. i only saw a nurse pracitioner when my family physician wasn’t available and i could definitely tell that family physicians were more knowledgeable. it’s true that the nurse practitioner spent more time with me, but that’s because she was very unsure of herself and how to manage my condition. i was sort of happy to be able to see a nurse practitioner, but then i had to run all of my problems by my family doctor again. i feel it was second class care. now registered nurses want the authority to prescribe. i’m not sure what class of care this will be, but it’s not fare to people in underservied areas to get care by less knowledgeable and experienced providers.

    • RAMESHAWER LAL SHARMA

      the nurse was unsure because she have noright to prescribe & manage your illness so she was afraid of any type of legal action which would be taken against her in the adverse situation but the physician is covered legislatively

  25. RAMESHAWER LAL SHARMA

    the basic educatinal qualification for enterence for medical graduate course & nursing is equal( 12 th std or puc in science subjects) the training period for nurse 3& 1/2 for mbbs 4&1/2 yrs the syllabus is almost same . then why the nurses are not allowed to treat minor ailments, communicble deseases, minor processors, deliveries without surgeory,etc&many more activities. in rural&remote areas where the nurse vaccinate achild incase any reaction by any vaccine occurs the shoud not wait for physician she shoud start immediate preventive act to save life of the suffrer. so it is neccesity for human wellbeing to authorise & protect nurses against legal action .thanks.

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