7.3: Looking Ahead to RN Prescribing in Ontario
In May 2017, the Ontario government made changes to the Nursing Act, 1991 to permit RNs to prescribe certain medications (Government of Ontario, 2017). As of September 2019, the College of Nurses of Ontario (CNO) has created a draft regulation for RN prescribing, but this regulation still needs to be passed by the government prior to RN prescribing authority being enacted in Ontario (CNO, 2019b).
RN prescribing will not be an entry-to-practice level competency for RNs in the general class in Ontario (CNO, 2018b). In order to gain the authority to prescribe medications, RNs will be required to complete additional CNO-approved education programs and are accountable for ongoing competence for safe prescribing (CNO, 2018b). Even after completing a CNO-approved education program, RNs will only be able to prescribe medications if their practice environment supports RN prescribing (CNO, 2019a). For instance, RNs in a hospital setting will not be allowed to prescribe medications because the Public Hospitals Act does not currently allow it (CNO, 2019a).
Future RN prescribers will be different from RNs who are registered in CNO’s extended class, commonly known as nurse practitioners (NPs). NPs currently practice autonomously with respect to assessment, diagnosis, and prescription, and an NP’s expanded scope of practice will continue to be broader than what is proposed for RN prescribers.
Points of Consideration
As a starting point towards RN prescribing, the CNO has authorized other medications in addition to vaccines that authorized RNs will be able to prescribe. This list was determined in consultation with Ontario stakeholders such as clients, RNs, and employers, and takes into consideration government direction and current legislative parameters. The list includes:
- Some contraceptives.
- Some travel medications such as anti-malarial and anti-bacterial medications.
- Some topical medications for wound care.
- Some smoking cessation medications.
- Over-the-counter medications.
- Miscellaneous medications such as epinephrine for anaphylaxis.
Controlled substances are governed under federal law, due to their high risk for misuse, addiction, and diversion. RNs are not permitted to prescribe controlled substances at this time.
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