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
The Nursing Council of New Zealand (the Nursing Council) 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. A new regulation was passed in 2016: Medicines (Designated Prescriber–Registered Nurses) Regulations 2016.
Suitably qualified registered nurses can apply to the Nursing Council 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.
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.
Updates to the medicines list
Diabetes medicine classes added to registered nurse prescriber list
Timely access to treatment for diabetes in the community has been made easier, with two classes of medicines added to the registered nurse prescriber list. These are:
- glucagon-like peptide 1 agonists (GLP-1 agonists), eg, dulaglutide, liraglutide
- sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors), eg, empagliflozin, dapagliflozin.
Both classes of medicines may be used to improve blood glucose lowering therapy in patients who do not respond to first line therapy or who have other risk factors.
The medicines were legally added to the specified medicines list for designated nurse prescribers on 15 August 2024 after a consultation in May 2024 with the sector at the recommendation of the Nursing Council. Of the 83 submissions received, more than 97% agreed with the proposed additions to the schedule.
The most common reasons given for support was that it would improve equitable access to diabetes medicines, benefit Māori and Pacific patients and rural and remote communities and optimise treatment for patients preventing complications. Some submitters acknowledged that the additional classes would enable nurse prescribers working in diabetes and with long term conditions to prescribe appropriate medicines and reduce workloads for other prescribers.
Individual medicines in these classes have been on the list for nurse prescribers since 2022 but unfortunately these have not always be available because of medicine supply issues. This has meant that some patients have had to wait to see another prescriber in the team. The addition of classes to the list will help in the future if new medicines in these classes become available and are approved by Medsafe.
The decision to enable registered nurses to prescribe medicines is independent from Medsafe’s decision to approve a medicine for use or Pharmac’s decision to fund a medicine or apply eligibility criteria.
A summary of the consultation is available below.
List updated in 2022
In August 2020, the Nursing Council 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.
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.
