No changes to nurse prescribing: RACGP

Michelle Wisbey

11/08/2023 3:15:07 PM

Registered nurses should not be granted prescribing powers at risk to patient safety, according to a new college submission.

Nurse speaking to a patient.
The RACGP raised significant concerns the proposal could lead to fragmented care, lack of training, rising costs, and risks to patient safety.

The RACGP has raised doubts about a plan from the Nursing and Midwifery Board of Australia (NMBA) to allow registered nurses (RNs) to prescribe a range of medications.
Under the plan, RNs would be able to seek a specialise endorsement to prescribe some scheduled medications deemed to be within their level of competence and scope of practice.
However, the college holds significant concerns with aspects of the proposal and is adamant the changes are not needed, instead endorsing a plan to ‘retain the status quo prescribing practice’.
The RACGP is especially worried that it could lead to fragmented care, while it also cited issues with a lack of training, rising costs, and risks to patient safety.
Nonetheless, the college indicated it would potentially consider a second option in areas of identified need and subject to more detail.
This option would enable RNs to expand their scope of practice to prescribe only Schedule 2, 3, and 4 medicines under designation or supervision.
‘The increase in health system entry points, with multiple health professionals offering the same services, reduces opportunity for comprehensive care,’ the submission said.
‘Fragmenting healthcare has been shown to be less safe and more expensive than models that facilitate continuity of care.’
In its submission, the RACGP said more work is needed to maximise the already trained nurse practitioner (NP) prescriber workforce before introducing another group of nurse prescribers.
It also said more work is needed to improve the distribution of GPs and NPs to remote and rural Australia.
A Federal Government 10-year workforce plan is currently underway to increase to services of NPs across the country and grow their workforce.
Should nurse prescribing go ahead, the college has said it will only support it in identified areas of need, including in remote and rural communities, and under GP-supervised care attached to additional funding.
‘The RACGP remains concerned about approaching prescribing as a task that can be independently delegated,’ the submission said.
‘There is a conflation of diagnosing and prescribing skills, and the role of diagnosis in prescribing is being diminished.’
The submission pointed to several apparent flaws in the proposal, saying that while there is a health worker shortfall, role substitution is not the answer, saying nurses and NPs working independently would create a two-tiered system.
It also said a visit to the GP is not just about a prescription, and often additional healthcare needs are addressed in a singular visit, while RNs would need up to three years additional training to take on prescribing responsibilities.
‘All prescribers need extensive training and knowledge to manage the complexities of multimorbidity, polypharmacy, nonroutine aspects of the individual patient,’ it said.
‘This knowledge comes from the years of comprehensive training that far exceeds and is different to RN training. For medical students, training for 5–6 years results in an intern who only prescribes under close supervision.’
The submission also stated while nurse prescribing would likely lead to worse clinical outcomes, there is no evidence the plan would be cost-effective.
Overall, the college said the NMBA’s consultation paper was ‘written by the nursing profession for the nursing profession’ and did not believe it presents evidence to assure patient safety if the initiative is progressed.
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