Meet the practice nurse training to become one of Australia's first RN prescribers

Benjamin Jol is to become one of the first RNs to start prescribing S4 medications with the support of his GP colleague.

Currently, there are some 300 RNs going through the training, to be followed by clinical supervision, required to prescribe.

Mr Jol recently graduated from a nurse prescribing course run by the University of Melbourne, one of five tertiary institutions training nurses.

“One of the practice’s GPs, Dr Puneet Goyal, has been nagging me for years to go take the next level, become a nurse practitioner or go become a doctor or something,” Mr Jol told AusDoc.

“So I said, ‘If you think I should do this, then put your money where your mouth is and help me out with it.’”

And the practice did — paying him for time to study as well as providing on-the-ground medical knowledge to help with coursework.

Mr Jol and Dr Goyal met when they both began working in general practice at Ochre Medical Centre Casey in Canberra in 2016 and quickly hit it off.

“He’s really good at what he does,” Dr Goyal said.

“He’s a good guy. I always told him, ‘You have good knowledge, just get into medicine, do postgrad medicine in Canberra. It’s like a four-year degree and you’ll be a doctor.’”

But as a father of three young children, Mr Jol said neither medical school nor a nurse practitioner qualification was immediately practical.

“A special certificate of nurse prescribing run by Melbourne Uni for me was more manageable,” Mr Jol said.

Under the training model, Mr Jol passed the four-month part-time prescribing course, which involved a unit on pharmacokinetics and pharmacodynamics.

The second unit was more practical, covering therapeutic planning, prescribing governance, patient counselling and the practicalities of writing prescriptions.

The course also included workplace-based assignments, such as taking histories or creating a therapeutic plan, which Mr Jol would submit to Dr Goyal as well as to his teachers.

Last week, he secured endorsement from the Nursing and Midwifery Board of Australia, and he will now begin a mandatory six-month clinical mentorship period under Dr Goyal and other GPs at the practice.

At the end of this period, a formal written agreement will be drawn up with Dr Goyal, outlining what drugs he can prescribe and the circumstances under which he can do so.

“I think we need to take things slowly,” Dr Goyal said.

“Maybe he will start with, for example, very simple medical conditions where he can prescribe antibiotics without any supervision — things like UTIs and simple ear infections, and then with experience go up the ladder one step at a time.”

Both Mr Jol and Dr Goyal are taking on the role at a time when many of the details of nurse prescribing are yet to be resolved. One of the most significant elements in the prescribing reforms has been the decision to fund the drugs RNs prescribe under the PBS.

However, the PBAC is currently assessing the specific medications RNs can prescribe under the PBS.

Another key question is indemnity. Will Dr Goyal be responsible for any errors in Mr Jol’s prescribing? Both say they are unsure how the arrangement might affect their indemnity at this point.

Mr Jol, already an authorised nurse immuniser, hopes his scope will eventually allow him to prescribe the vaccines he administers and help improve immunisation rates.

He also wants to take a greater role in chronic disease management and in treating acute presentations when a doctor is not immediately available.

He ultimately wants to train as a nurse practitioner, but says that he still hopes consultations involving RN prescribers would eventually attract MBS funding.

Medical groups have been cautious about elements of the new prescribing pathway, such as those questions over indemnity and opposition to RNs being in theory able to prescribe S8 drugs.

Dr Goyal viewed the model as a more limited form of independent nurse practitioner prescribing with greater doctor oversight.

“I don’t know why [doctors] feel negative about it,” he said.

“If they don’t see any issue with nurse practitioners prescribing the same medication, I don’t see why they have an issue with this program.

“If a nurse wants to do further certification to advance his career, what’s so negative about it?

“He’s (Mr Jol) passionate about medicine. He’s passionate about his career. He’s a very excellent nurse and we all love him and he has potential, so why not?”

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