RN Prescribing in Nova Scotia

Presented by

Tim Guest RN, BScN, MBA

Vice President Health Services & Chief Nurse Executive

Objectives

1. What is RN Prescribing?

2. How is Nova Scotia moving forward:

• Why?

• How?

• Where?

• When?

RN Prescribing

• In place for over 20 years

• Implemented in the UK in 1992 initially with community-based

nurses

• Evolving roles of interdisciplinary team members

• Growing expectation workforce should be maximized

• Increase in trend for non physician prescribers

(pharmacist, nurse, dietician)

• Public demand for efficient and effective care

• Nurses are ready for additional opportunity to care for the

public

RN Prescribing

Common models:

• Independent

• Prescriber is accountable for the assessment and decisions

regarding clinical management

• Supplementary

• Physician or NP makes initial assessment, diagnosis, and creates a

clinical management plan

• Plan includes list of drugs RN prescriber can use

• Patient group directive

• clinical decision-making tools illness, patient population or

situation specific

• Authorized list of drugs that can be prescribed

RN Prescribing

Safely and Effectively implemented in areas such as:

• Primary Health Care

• Home Care

• Long Term Care

• Community and Public Health

• Mental Health & Addictions

• Wound Care

• Women’s Health

• Diabetes Health

• Communicable Diseases

RN Prescribing Outcomes

• Improved patient access to care

• Increased flexibility

• Point of care access 24/7

• Improved patient satisfaction with holistic/caring consultations

• Improved adherence to prescribed health care

• Safe

• More seamless RN care provision

• Increased RN satisfaction

• Increased teamwork

• Improved efficiency in care delivery

RN Prescribing in Nova Scotia - Why

• Access to primary care a provincial government priority.

• Significant public demand in the media for increased access to care,

high public confidence in knowledge, skills and abilities of RNs.

• The Canadian Nurses Association (2015) suggests optimizing the RN

role to include prescribing as one way to improve access to care in the

spirit of the right provider at the right time and right place.

• The Provincial Nursing Network identified the opportunity to explore

RN prescribing in Nova Scotia when updating the Nursing Strategy in

2015.

• Nurses in Nova Scotia recognize the benefit RN Prescribing would

have and are willing to take on the role.

Provincial Nursing Network

• Brings together a network of nurse leaders

representing direct care, employers, regulators,

educators, unions and government.

• Purpose is to engage in strategic dialogue to

advise the Department of Health and Wellness on

how nurses can contribute to health innovation

and key strategies to address overall population

health through a nursing lens.

• Applying the best available evidence, advises on

strategies to ensure an adequate number, mix and

distribution of nurses in the province.

• Advance broad system opportunities to optimize

the contribution of the profession to improve the

health of Nova Scotians.

• The diverse membership gives the network the

strength and credibility to carry out its important

function.

• Success is a direct result of the ongoing

collaboration of the network’s membership and its

relationships with key stakeholders in Nova Scotia

and across Canada.

CNA RN Prescribing Framework

1. RN PROFESSIONAL PRACTICE

• Entering into professional and interprofessional practice in a new way.

• Understanding how we work with our patients, families, communities and each other.

• Utilizing explicit leadership capabilities in the evolution and expansion of the role.

2. STRUCTURES

• Project Steering

Committee formalized

in March 2018

• Engagement of Key

Stakeholders-Ongoing

• Initial

Communications Plan

in April 2018

• Project Charter & High

Level Work Plan in

April 2018

• New Nursing Act,

proclaimed in June

2019, enables the

College’s Board to

approve particular

registrants to practice

in an expanded scope

of practice where they

have the appropriate

education and

competencies. RN

prescribing is one

example.

3. COMPETENCE

• RN Scope of practice

and definition of

competence

• Provincial RN

Prescribing Education

Model developed in

January 2019

• Education design

underway in April 2019

• Competencies, practice

education, supervision,

learner assessment and

qualifications

components

• First Cohort of RN

Prescriber candidates

to begin education in

2020

4. PRACTICE

• Population

idenitification for

program/service

selection

• Initial implementation

sites determined as

Primary Care, Sexual

Assault Nurse

Examiner Team,

Mental Health &

Addications, Wound

Care & Fracture

Liaison in May 2019

• First RN Prescriber

Cohort (10-12

individuals)

identification

• Process identification

and improvement

action plans

• Evaluation metrics

2020Today

2017 2018 2019 2020

Exploration of RN Prescribing in NS Start

4/2017

Project Management Start

11/2017

Provincial RN Prescribing Education Model Approved

Mar 2019

RN Prescribing Sites Determined

Apr 2019

New Nursing Act proclaimed in force

June 2019

RN Prescriber Cohort Education Program Start

Sep 2019

RN Prescriber Practice Start

May 2020

RN Prescribing in Nova Scotia: How

• Initial funding for project management was made available by the

Department of Health and Wellness for 2 years as part of the

provincial Nursing Strategy. $300K

• In-kind support is provided by the same system partners that make up

the Provincial Nursing Network:

• Employers – Leadership of the initiative and allocation of professional

practice staff resources

• Educator – Dalhousie University through research expertise and course

development

• Regulator – The Nova Scotia College of Nursing through development of

RN Prescribing standards and guidelines and enabling legislation

• Government – Ongoing support through targeted Nursing Strategy

funding allocations

RN Prescribing in Nova Scotia: How

Stakeholder Engagement

• Public

• NSHA & IWK Registered Nurses

• Family Practice Nurses of Nova Scotia

• NS College of Physicians & Surgeons

• NS College of Pharmacists

• NS Nurse Practitioners Association

• NS Clinical Nurse Specialists Association

• NS Dieticians Association

• Doctors Nova Scotia

• NSHA Continuing Care NS

• Victorian Order of Nurses

• Provincial Nursing Network – DHW, Educators, Employer Leaders, Unions

• Health Association Nova Scotia Continuing Care Council (LTC Leaders)

Initial Site Selection - Criteria

• Identified need for timely access with optimization of all

interprofessional roles, enhanced continuity, and quality of care

provision.

• Align with DHW, IWK, and NSHA strategic priorities.

• Participation of interprofessional teams and support of all

leadership levels (physician or NP mentorship, change

management transitions to practice, role support and

development).

• Practice Infrastructure Capacity: access to provincial clinical

portal(s), health information systems, Drug Information System

(DIS), laboratory services and reporting, diagnostic imaging,

auditing and evaluation (see Evaluative Measures) etc.

Next Steps

• Communication of initial implementation sites to stakeholders

• Finalize and put in place supports for the initial cohort of RNs

• Finalize access to systems (NS Pharmacare/Medavie Blue Cross,

insurer approval, Drug Information System access, Laboratory and

Diagnostic Imaging system access) that support RN prescribers

• Finalize materials and orientation needed to provide practice support

for RN prescribers

• Finalize the metrics required pre and post implementation to evaluate

the initial implementation of RN prescribers in the Province of Nova

Scotia

Questions?

May we hope that, when we are all dead and gone, leaders

will arise who have been personally experienced in the

hard, practical work, the difficulties, and the joys of

organizing nursing reforms, and who will lead far beyond

anything we have done!

-Florence Nightingale