Registered nurse prescribing

Registered nurse prescribing improves people’s access to healthcare, including access to medicines, and improves care while maintaining safety.

Registered nurse prescribing makes the best use of the knowledge and skills of nurses for positive health outcomes. Demand for health care is increasing as the population ages and more New Zealanders are living with long-term conditions. Registered nurse prescribing contributes to addressing demand.

International evidence supports the use of nurse prescribing. Nurses with prescribing authority are increasingly common in overseas jurisdictions. International evidence indicates nurse prescribing patterns are similar to other prescribers and safe. Evidence suggests the benefits of extended nurse prescribing include:

  • improved access to treatment
  • enhanced care
  • more effective use of medical staff’s time
  • strengthened inter-professional working practices
  • increased professional satisfaction for nurses.

Registered nurse prescribing authority in Aotearoa New Zealand

Authority for registered nurses to prescribe medicines has been available in New Zealand since 20 September 2016. Suitably qualified nurses can apply to the Nursing Council of New Zealand for authorisation as a designated prescriber and prescribe from a list of medicines that are specified by notice in the New Zealand Gazette by the Director-General of Health as required under section 105(5A) of the Medicines Act 1981 and in amendments to the Misuse of Drugs Regulations 1977.

This means that people can obtain a prescription for these medicines when visiting a registered nurse prescriber rather than needing to see a doctor or nurse practitioner to obtain a prescription. Registered nurse prescribers work as team members in primary care or specialist clinics.

Update to the medicines list

Since the prescription medicines list came into effect in September 2016 there have been many new medicines introduced to the New Zealand Formulary. In August 2020, the Nursing Council of New Zealand proposed that 52 medicines be added to the list. The Ministry of Health then consulted about the addition of these medicines to the list, as required under section 105(5B) of the Medicines Act.

History of registered nurse prescribing authority in New Zealand

In 2013, the Nursing Council conducted sector consultation on a proposal for registered nurse prescribing authority, with most submitters in support of it.

The Nursing Council subsequently applied to the Ministry of Health in 2014 for designated prescribing rights for registered nurses practising in primary health and specialty teams. The application proposed that suitably qualified and experienced registered nurses would be allowed to prescribe for patients with some long term and common conditions within a collaborative team.

The Government agreed to the proposal for registered nurses working in primary health and specialty teams to become designated prescribers under the Medicines Act 1981. The Cabinet paper is provided in the link below.

Regulations enabling designated registered nurse prescribing

The Nursing Council sets the professional regulation and guidance for registered nurse prescribing in Aotearoa New Zealand. Relevant documents about registered nurse prescribing are on the Nursing Council website, including:

  • "Medicines List for registered nurse prescribing in primary health and specialty teams." This guidance lists all medicines in current use categorised by body system, and outlines restrictions, specific route or form and any other guidance. 
  • "Competencies for nurse prescribers (2016)." The competencies describe the activities that are essential for safe, appropriate and effective prescribing including patient assessment, clinical reasoning, monitoring and communication skills.
  • "Preparation and Guidance for Employers and RN Prescribers (2020)."

Reclassification of nirmatrelvir, ritonavir and molnupiravir for use in the treatment of COVID-19

On 27 July 2022 nirmatrelvir and ritonavir (Paxolvid™) and molnupiravir (Lagevrio®) were reclassified from Prescription-Only medicines to Pharmacist-Only (restricted) medicines when used in the treatment of COVID-19 pursuant to section 106(1) of the Medicines Act 1981.

Sector consultation summary of submissions

Consultation on the addition of the oral therapeutic COVID-19 medicines nirmatrelvir and ritonavir (Paxolvid™) and molnupiravir (Lagevrio®) to the list of specified prescription medicines for designated registered nurse prescribers.

The reclassification of nirmatrelvir and ritonavir (Paxolvid™) and molnupiravir (Lagevrio®), from Prescription-Only medicines to restricted (Pharmacist-Only) medicines when used in the treatment of COVID-19 on 27 July 2022 meant that their addition to the list of specified prescription medicines for designated registered nurse prescribers was no longer required. Therefore, following the consultation process there was no further action taken.

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