Policy and Political Action

Policy & Political Action

RNAO Submission on RN Prescribing Competencies to the College of Nurses of Ontario

RNAO welcomes the opportunity to provide feedback to the College of Nurses of Ontario (CNO) on RN prescribing competencies. RNAO has long advocated for independent RN prescribing. RNs are autonomous health professionals who practise independently and collaboratively within interprofessional teams. With more than 100,000 RNs registered to practise with the CNO, RN prescribing has huge potential to increase access to care across the province.

RNAO believes the independent RN prescribing model is the right framework to improve access to care because it recognizes the broad depth of RN expertise and ensures RNs are fully accountable for their practice. In Ontario, RNs enter practice with knowledge of pharmacology, immunology, microbiology, anatomy, physiology, pathophysiology, epidemiology, genetics, and nutrition. RNs are proficient in interpreting and applying evidence in their practice, and will approach independent prescribing in the same manner.  Independent prescribing will allow RNs to prescribe medications under their own authority within a regulated scope of practice and within their clinical competency area.

RNAO supports a phased-in approach that will lead to the implementation of independent RN prescribing.

RNAO Feedback on the Introductory Sections of RN Prescribing Competencies

RNAO welcomes the CNO's draft RN prescribing competencies as a benchmark for the knowledge, skill, and judgment of RNs who prescribe. RNAO is pleased with how the CNO laid out the assumptions underlying RN prescribing competencies.

In the background section, RNAO recommends ensuring the description of the changes to the Nursing Act, 1991 more directly aligns with the wording in the legislation.

  • Background, paragraph 2.  We suggest replacing "…the Nursing Act to permit registered nurses (RNs) to perform two new controlled acts: 1) prescribing certain medications…" with "…the Nursing Act to permit registered nurses (RNs) to perform two new controlled acts: 1) prescribing drugs designated in the regulations…" [emphasis added to clearly show RNAO's recommended change].

Recommendation 1. Ensure the description of changes to the Nursing Act, 1991 reflects the wording in the legislation.

RNAO Feedback on the Organization of RN Prescribing Competencies

As the RN prescribing competencies build and expand upon the existing competencies required of RNs, RNAO recommends organizing the RN prescribing competencies using consistent headings and consistent language where possible across all competency documents.

To this end, RNAO recommends that, where appropriate, prescribing competencies build on the framework for Entry-to-Practice Competencies for RNs by aligning with the headings: Professional responsibility & accountability, Knowledge-based practice, Ethical practice, and Self-regulation. This is appropriate because the RN prescribing competencies expand on the RN entry-to-practice competencies.

Furthermore, prescribing competencies can align with the Entry-to-Practice Competencies for NPs through the use of the heading: Client care. This heading is not found in the Entry-to-Practice Competencies for RNs, however, fits well with RN prescribing competencies by outlining competencies related to the full continuum of client care specific to prescribing.

Recommendation 2. Align and ensure consistency of RN prescribing competencies with existing College of Nurses of Ontario competency frameworks.
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