Nothing to fear? Nurses and doctors react to AHPRA allowing RNs to prescribe S4 and S8 drugs
Prescribing RNs entered Australian healthcare last week, at least conceptually.
AHPRA unveiled a registration standard for RNs to gain an “endorsement for scheduled medicines”, which will allow them to prescribe S4 and S8 drugs under conditions agreed upon with a supervising prescriber — a doctor or nurse practitioner.
Prescribing RNs must have three years of clinical experience under their belts, complete a postgraduate qualification, and undertake a six-month mentorship program with a prescriber.
The training rules mean that the first real-life prescribing nurses will only emerge in 2026, especially as the postgraduate courses will require approval from the Australian Nursing and Midwifery Accreditation Council, which has yet to approve anything.
Dr Zach Byfield (DPS), from the Australian College of Nursing, said that prescribing nurses could work in GP practices doing wound care, for example.
He suggested that nurses who saw patients regularly to change dressings could assess whether wounds were becoming infected and prescribe S4 treatments, without the patient having to wait for a GP appointment, while keeping the GP informed.
“We’ve heard a lot, particularly since COVID-19, about the pressures that the healthcare system is under,” Dr Byfield, the college’s national director of nursing education, told AusDoc.
“Designated RN prescribing is another step in that pathway of seeing healthcare professionals closing these gaps.”
He said that workforce demands would ultimately decide where prescribing nurses worked, especially as they would probably be offered better pay than other nurses.
However, he said he expected health regulators to stop clinics from exploiting the new workforce to churn out scripts for lucrative treatments based on short nurse consultations.
“Any time there is a change in the profession, there are always those potentially unintended consequences,” he said.
“We’re lucky in Australia to have such a rigorously regulated healthcare system that can ensure new models of care meet standards to ensure they are safe.”
The impact on indemnity was unclear, but nursing indemnity providers had indicated they would develop new offerings for prescribing nurses, he added.
Nurse Charlotte Coulson was once a prescriber in the UK before moving to Australia, where she now works as a Victorian palliative care nurse educator.
She told AusDoc that UK RNs had been prescribing independently since the 1990s — so moving to Australia in the 2010s was a shock for her.
She said that, in palliative care, allowing experienced nurses to amend management plans without waiting for medical review could prevent unnecessary suffering.
“GPs have limited time and multiple priorities,” she said.
“Not all GPs within Australia have experience in providing palliative care and are occasionally reluctant to prescribe adequately due to lack of confidence and knowledge.”
Based on her UK experience, she did not expect Australia’s new RN prescribers to push the boundaries of safety or quality care.
“In the ’90s, British nurses were acutely aware that one mistake would cause us to lose our rights to continue,” she said.
The AMA is broadly in favour of the RN prescribing plan, with a sticking point: it says S8 drugs should remain off-limits.
Its stance has prompted backlash from doctors in social media communities such as r/ausjdocs, with claims the association is supporting scope creep.
However the AMA has insisted this is not the case.
“At first glance, this development may appear to challenge the role of doctors or suggest ‘scope creep’,” the AMA said last week.
“However, thanks to sustained AMA advocacy, this standard differs significantly from pharmacist prescribing models developed by state and territory governments without robust and meaningful consultation.”
The AMA said it had successfully demanded the requirements for RNs to have a documented agreement with a supervising prescriber, complete a six-month mentorship, and the ban on newly graduated nurses immediately trying to prescribe.
“It’s not perfect, but it’s significantly better than the initial model we were consulted on more than two years ago,” AMA president Dr Danielle McMullen said in an update to members.
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