Nurses will soon be able to prescribe a wide range of medicines under reforms that came into effect this week – a shift hailed as a breakthrough for patient access, but one that GPs warn could fragment services and add clinical risk.

From 30 September, suitably trained nurses can apply for endorsement to prescribe Schedule 2, 3, 4 and 8 medicines – such as antibiotics, antihypertensives, diabetes treatments and palliative care drugs – provided they enter a partnership with an authorised prescriber, typically a GP or nurse practitioner, according to information published by Ahpra [link here].

The change is part of a national effort to ease pressure on overstretched primary care services and boost access to medicines in rural and aged care settings.

“Registered nurses are the largest healthcare workforce in Australia,” the NMBA said in a fact sheet [link here]. “Enabling suitably educated and qualified RNs to prescribe… will enhance access to high-quality, reliable medicines for all Australians, especially those in rural and remote areas.”

The regulator said the model would also help “alleviate pressure points in both acute and primary care, where access to appointments is a challenge for healthcare consumers”.

“This prescribing model improves resource use and strengthens care coordination,” it added. “It allows designated RN prescribers to manage medicines in prescribing partnerships, freeing up other healthcare professionals to focus on more complex areas of patient care.”

But unlike nurse practitioners, who are autonomous prescribers, these registered nurses must operate within a tightly scoped agreement under clinical governance. That includes a postgraduate course and six months of clinical mentorship with an independent prescriber before they can begin prescribing.

Although no training programs have been approved yet, the Australian College of Nursing expects enrolments to ramp up quickly once courses are accredited in late 2025.

“I think initially there’ll be several hundred [RNs] through the education and programs that are available, but we expect to see that grow over time,” said Francis Rice, the College’s Chief Nursing Officer, speaking to ABC Radio National.

Describing the reform as a “game changer,” Ms Rice said the model could prevent unnecessary hospital admissions, particularly in aged care facilities where GPs are often unavailable.

GPs raise red flags on safety and duplication

The RACGP said it supports nurses working to the top of their scope, but warned the prescribing model could fragment patient care.

“Once you have multiple healthcare professionals offering the same services, it reduces the opportunity for coordinated and comprehensive care,” said RACGP president Dr Michael Wright in a statement to the limbic.

“We know that fragmenting healthcare has been shown to be less safe and more expensive than models that facilitate continuity of care.”

He said good primary healthcare should be “coordinated, collaborative, and continuous”, cautioning that if not properly managed under GP supervision, the expanded nurse role could result in “confusion, unsafe prescribing or treatment, and duplication of services”.

The college has advocated for other nurse-led models, such as allowing nurses to administer vaccinations without direct GP oversight, but maintains that prescribing carries a higher level of clinical risk.

Ms Rice said concerns about patient safety had been factored into the design.

“I think there are safety mechanisms built into the system for this. Registered nurses will have the same regulations applied to their prescribing practice that all other prescribers do,” she said.  

“The important part of this process is that the registered nurses are working in a partnership with another authorised prescriber, most likely a doctor or a nurse practitioner. As part of that process, they need to have a written agreement that describes what medical conditions they can prescribe for… so they’re working in partnership with their prescriber.”

She added: “Nurses are a highly safe and highly qualified profession. We are the most trusted profession for many, many years running. I don’t see that changing because of an expansion to our scope of practice.”

For instance, in rural and palliative care contexts, Ms Rice said it may be appropriate for nurses to prescribe Schedule 8 medicines such as opioids, depending on who they are working with and the protocols in place.

“When people are on their journey to the end of their life… it may be appropriate for nurses to have this in their scope, particularly in rural and remote areas where people have decreased access to healthcare and services,” she said.

No PBS access or guaranteed pay – yet

Despite the new responsibilities, endorsed nurses are not yet eligible for Medicare or Pharmaceutical Benefits Scheme (PBS) rebates. Nor is there any automatic increase in pay.

“That’s always a risk,” Rice said. “A lot of nurses are in the game for what they can give back to the community – but that doesn’t mean it shouldn’t be rewarded.”

She said remuneration would depend on individual employers and that industrial bargaining for the reform will be led by the Australian Nursing and Midwifery Federation.

“We are still waiting for information from the Commonwealth around PBS access,” she told the ABC.

Implementation oversight underway

Although the NMBA standard is now in effect, the legal authority to prescribe depends on state and territory legislation, with additional requirements around drug and poisons control.

To support a consistent national rollout, an Implementation Oversight Group, co-chaired by the Chief Nursing and Midwifery Officers (CNMOs) of NSW and South Australia, has been established. It includes representatives from the NMBA, AHPRA, ANMAC and the Commonwealth, and will provide quarterly updates to the Health Workforce Taskforce.

The NMBA said the group will work to ensure RN prescribing is embedded into safety frameworks, aligned with jurisdictional legislation, and supported by clear prescribing agreements with doctors and nurse practitioners.

The standard and accompanying guidelines will be reviewed regularly to track their impact and identify opportunities for improvement.