Advancing the national implementation of designated Registered Nurse prescribing

Background:
The Nursing and Midwifery Board of Australia have developed a Nursing Standard of Practice to support designated Registered Nurse (RN) prescribing under supervision of an authorised prescriber. There are more than 303,000 RNs in Australia however, most do not have prescribing rights. A range of nurse prescribing models have been adopted globally, leading to improved patient outcomes and increased nurse work satisfaction. Implementing new nursing roles in Australia have historically faced extensive challenges. This expanded scope of practice will have significant impact for patients but also for frontline nurses, authorised prescribers, health service managers and policy makers.

Design:
This program of research explores the context, barriers and enablers to designated RN prescribing using a range of research methods. The aim of this program is to develop contextually appropriate recommendations and strategies for implementation of designated RN prescribing across Australia.

Findings:
An integrative review provides global perspectives of prescribing under supervision. Highlighting the expansion of this practice and varied approach to nurse prescribing internationally. The Australian context was explored with RNs (n=4,424) and nurse practitioners (n=229) from all jurisdictions, geographical locations and healthcare settings. Findings indicates strong desire by RNs (82%, n=3,645) to expand their scope of practice to include prescribing. Nurse practitioners agree (90%, n=205) that RN prescribing will optimise use of RN knowledge however, to be successfully adopted nationally, there are challenges and barriers that must be overcome. Early stakeholder engagement at a systems-thinking level has provided insights to support this initiative.

Conclusion:
RN prescribing, if implemented effectively, is an opportunity for the nursing profession to improve systems of care and access to medicines while scaffolding succession planning for advanced practice nursing roles. Recommendations and strategies have been generated by this program of research and next steps to enable implementation of designated RN prescribing will be presented.