Ontario’s registered nurses are getting new prescribing powers — and some doctors aren’t happy about it

Posted on November 7, 2023 in Health Policy Context

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TheStar.com – News/Canada
November 7, 2023.   By Megan Ogilvie Health Reporter, Kenyon Wallace Investigative Reporter

Registered nurses will be able to independently prescribe and administer some medications — such as those for smoking cessation, immunizations and topical anesthetics for pain relief and wound care.

Ontario’s registered nurses are poised to take on prescribing powers for specific medications, a move the province says will help patients get their prescriptions faster.

But the organization that represents physicians in Ontario says it has doubts about the change, stating that allowing nurses to prescribe medications, including birth control and topical antibiotics, will lead to “fragmented care for patients.”

On Monday, Health Minister Sylvia Jones announced that registered nurses will be able to expand their scope of practice to independently prescribe and administer some medications, such as those for smoking cessation, immunizations and topical anesthetics for pain relief and wound care.

Nurses who wish to participate must complete additional specialized education, for which registration is expected to begin in January.

The government says the change — part of a series of recent moves that will expand the role of some health professionals, including pharmacists and midwives — will help make it easier for patients to get care while also reducing wait times at community clinics and hospitals.

Nursing organizations welcomed the new prescribing powers, which they say will benefit patients.

But the Ontario Medical Association, which represents 43,000 practising and retired doctors as well as medical students, says it has concerns about granting other health-care providers, including nurses, the ability to prescribe medications.

The OMA says the resulting situation will deny patients “the comprehensive care that a primary care physician offers” and may lead to “negative consequences to both health outcomes and to costs to the health system.”

“The government should instead be investing in team-based primary care where physicians and other health-care workers each have a unique role and are working to the full extent of their training and scope, complementing one another versus competing with one another,” said the OMA in a statement provided to the Star late Monday.

“We need to invest in the whole pie, not just slices of it.”

The expanded role for registered nurses comes at a time when millions of Ontarians do not have access to primary care, and wait times at emergency departments remain stubbornly high.

As of March 2022, more than 2.2 million people lacked a family physician in Ontario, according to research by INSPIRE Primary Health Care, a network of researchers and medical stakeholders in Ontario. That lack of primary care forces patients to turn to hospitals and walk-in clinics, further stressing the system.

The provincial government has, in recent months, made several moves to expand the scope of practice for some health professionals in a bid to help ease pressures on the system.

Earlier this year, Ontario pharmacists were authorized to start prescribing medications for 13 minor ailments. That list got bumped up to 19 ailments as of Oct. 1, with pharmacists now able to prescribe some medications for mild acne, canker sores, pinworms and threadworms, and nausea and vomiting in pregnancy. The province is also considering expanding the list of drugs that midwives can prescribe and administer.

In addition, last year, the province moved to allow nurses educated overseas to register in a temporary class with the nursing college so that they can work while becoming fully registered here.

Nursing leaders in Ontario have been advocating to expand their role for more than a decade. Six other Canadian provinces, including Nova Scotia, Quebec and Alberta, already allow registered nurses to prescribe certain medications, albeit on a limited basis.

Silvie Crawford, executive director and CEO of the College of Nurses of Ontario, which regulates nurses in the province, called the scope expansion “an important development for the delivery of health care in Ontario.”

In a statement to the Star, the college said its board will in December “consider approving registered nurse prescribing education programs and practice standards.” Following approval, schools can begin to offer the education to nurses.

The province says registration for the additional RN education, to be offered at certain colleges and universities, will open next January and will be optional.

In its statement, the college said the new prescribing powers will help patients get safe and timely care because “they will not need to wait for a physician or a nurse practitioner to prescribe certain medications.”

In a retirement home, for example, a registered nurse will be able to “more easily administer vaccines” to residents without requiring a medical order from a doctor or nurse practitioner, the college said.

Doris Grinspun, CEO of the Registered Nurses Association of Ontario, called Monday’s news “excellent,” but noted her organization had been calling for this expanded role for nurses for 12 years.

She said the RNAO is now pushing for the College of Nurses of Ontario to direct colleges and universities to integrate the qualification courses into the current four-year Bachelor of Science in Nursing degree, so that nurses graduating next year will be able to diagnose and prescribe right out of the gate.

Integrating the additional educational requirements into university curriculum would also mean nurses, and their employers, won’t have to pay for the courses down the road, she said.Fullscreen

“With RNs graduating with this competency, it will transform the system overnight,” Grinspun said. “We can get ahead of the curve and free up physicians for more complex prescriptions.”

Megan Ogilvie is a Toronto-based health reporter for the Star.


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