Designated registered nurse prescribing

The trailblazing nurses whose scope is set to expand 

Melanie Irwin, Primary Times managing editor 

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When the new standard for designated registered nurse (RN) prescribing took effect late last year, some RNs were quick to jump on board. Several new postgraduate courses are now underway, with the first cohorts working towards endorsement. This expanded scope is an exciting opportunity for nurses, but how will it work in practice? We hear from two of these trailblazing nurses about how the changes will expand their scope and improve their patients’ access to care. 

Australia’s primary health care system is struggling to provide timely access to GP services, particularly for people in rural and remote areas. Recent data from the Australian Bureau of Statistics show that more than one in four Australians delay GP care when needed and many people, including those with long-term health conditions, are putting off – or skipping entirely – their prescription medication due to cost.¹ 

Following extensive public consultation over the course of a decade, in December 2024, Health Ministers approved a new registration standard to allow suitably experienced and qualified RNs to administer, obtain, possess, prescribe, supply and/or use Schedule 2, 3, 4 and 8 medicines in partnership with an authorised health practitioner, such as a doctor or a nurse practitioner (NP), under a prescribing agreement. This new registration standard was published on 30 September 2025 by the Nursing and Midwifery Board of Australia (NMBA).² 

Designated RN prescribing is a major healthcare reform that will improve access to timely and affordable health care, especially in rural and remote areas where it is needed most. RNs make up approximately half of the overall healthcare workforce and are the most widely distributed health profession across Australia. This new expanded scope of practice will increase health equity and empower RNs to provide quality care directly to their communities. It will also free up other clinicians so they can focus on more complex care. In addition to this, greater job satisfaction for RNs is likely to result in stronger retention rates within the nursing workforce. 

APNA President Denise Lyons (right) says this is a really positive change: ‘This is something APNA and other nursing organisations have advocated for over a long period. It can make a tremendous difference for patients in primary health care by improving access, reducing delays in care and better utilising nurses’ capabilities.’ 

Denise has been meeting with the Designated RN Prescribing National Implementation Oversight Group to understand and support the reform’s national rollout. She says educating the public about this new nursing role will be an important part of the transition. 

‘So far, there’s some confusion about the difference between an NP and a designated RN prescriber,’ Denise says. ‘The key difference is the level of education and clinical experience required for an NP compared with an RN prescriber. An NP is able to diagnose conditions and prescribe medications autonomously, whereas a designated RN prescriber will be able to prescribe scheduled medicines within their scope of practice under a prescribing agreement with an authorised health practitioner.’

 

Becoming a designated RN prescriber 

The first step towards becoming a designated RN prescriber is having general registration with no conditions and the equivalent of 3 years’ full-time post-registration clinical experience (5,000 hours) within the past six years.³  

RNs with this experience will then need to complete NMBA-approved units of study (or equivalent units of study) leading to endorsement for prescribing scheduled medicines. 

Five new NMBA-approved postgraduate courses are currently underway with the first cohorts of RNs working towards endorsement. The courses are being offered at Edith Cowan University, La Trobe University, Queensland University of Technology, the University of Melbourne and the University of Tasmania. Other education providers are also developing new courses for RN prescribing, so keep an eye on AHPRA’s Approved Programs of Study tool to stay up to date.⁴ 

Once these units are completed, graduates can apply to the NMBA for endorsement as a designated RN prescriber. With this endorsement, RNs will then be authorised to prescribe scheduled medicines in accordance with the relevant medicines and poisons legislation in their state or territory, subject to any additional jurisdictional requirements.3 

In some jurisdictions, legislative change is needed for this to take effect; however, Denise is optimistic that the states and territories will find a way forward.  

‘We’re hoping these regulatory changes will be in place by the end of 2026, at least in some states,’ she says. ‘There will probably be variations from one state to the next in regard to which medicines RNs are authorised to prescribe.’ 

Once endorsed by the NMBA, a designated RN prescriber will need to practice in accordance with their employer’s clinical governance framework. Designated RN prescribers will be able to prescribe medications only when there is an active prescribing agreement in place with an authorised health practitioner. They will also need to:  

• complete a six-month clinical mentorship with an authorised health practitioner³ 

• comply with the NMBA’s guidelines,⁵ including the requirements of the NMBA’s Registration standard: Professional indemnity insurance arrangements6 

• adhere to the relevant prescribing policies of their state or territory, employer and/or health service. 

See Figure 1 (below) for more details about this process. 

Figure 1: There are multiple steps involved in becoming a designated RN prescriber

 

Expanding scope 

Benjamin Jol (pictured right) is an APNA member and an RN with 10 years’ experience working in general practice settings. He works at Ochre Medical Centre Casey in Canberra.  

Ben is part of the first cohort of RNs to enrol in the University of Melbourne’s Specialist Certificate in Registered Nurse Prescribing. He says his current scope in general practice is fairly broad, but he’s frustrated by the systemic issues in health care that prevent nurses from working to their full scope.  

Ben has seized the opportunity to become a designated RN prescriber for his own professional development, and so he can contribute to a more sustainable healthcare system in the long term. 

‘I want to expand what I can do,’ Ben says. ‘This is a way to do new exciting things, and there's clearly a need for it within the community. We already have a GP shortage, but it's anticipated to significantly worsen over coming decades.’  

Ben combines his studies with 30 hours of work per week. He mainly attends lectures online, and he occasionally travels to Melbourne to take part in classes in person.  

He says his fellow students are working in a range of different nursing areas, including aged care, correctional facilities, cosmetic clinics, hospital wards and emergency departments.  

‘There are quite a few practice nurses, which makes me proud,’ he says, ‘because I’m a practice nurse and I hold that as a very special place for nursing.’  

Ben mentions chronic disease management, immunisation and wound care as nursing activities in general practice where designated RN prescribing will improve access to care.  

‘Immunisation is already an area where nurses have a very key role in primary health care,’ says Ben. He describes a scenario where a patient has come in for their regular immunisations, and they mention that they’re travelling to Bali soon. A designated RN prescriber would then be able to offer them a hepatitis A vaccine without having to send them back to the doctor. 

Emergency medicine is another key area, Ben explains: ‘If you don't have quick access to a doctor within the practice, increasing our scope to administer first-line emergency medications, such as glyceryl trinitrate for a suspected heart attack or acute coronary syndrome, or salbutamol for people that come in with a bronchospasm or asthma exacerbation. You don’t want to be waiting for a doctor while you've got a patient wheezing.’ 

Nurse prescribing overseas 

Nurse prescribing is already delivering successful outcomes overseas in countries such as Canada,⁷ New Zealand, the United Kingdom and Sweden.⁸  

‘It’s not a new thing,’ says Denise. ‘It’s just new to Australia!’  

Ben notes that in New Zealand, nurse prescribers have a broad scope: ‘They can prescribe up to 451 different medications. Their scope is quite massive.’ 

He cites recent evidence specifically on chronic disease management and RN prescribing: ‘Internationally, it's resulted in equal or better outcomes,’ he says. ‘It also reduces the burden on the healthcare system, increases continuity of care for patients and improves medication adherence.’  

Designated RN prescribing in practice: Rural and remote opportunities 

One of the benefits of this new expanded scope for nurses is addressing workforce shortages around the country. Denise identifies rural and remote locations as an example of settings that can significantly benefit from designated RN prescribing. She also acknowledges that many RNs in outback settings are already supplying and administering scheduled medicines and she wants to see their existing expertise recognised. 

‘Experienced rural and isolated practice nurses have done years – often decades – of clinical decision-making in complex, resource-constrained environments,’ she says. ‘These nurses should be able to transition into this new endorsement without unnecessary barriers. Some nurses will be eligible to become NMBA-endorsed designated RN prescribers through recognition of prior learning if they have completed equivalent units of study approved by the NMBA. A few nurses have already been endorsed via this pathway.’  

APNA member Karen Martin (pictured right) is a rural RN with decades of experience. She works in general practice and aged care settings in Cootamundra, NSW. Karen has enrolled in the Graduate Certificate in Registered Nurse Prescribing at La Trobe University and attends her classes online. She says she was motivated to expand her scope to take pressure off the doctors she works with and mentions repeat prescriptions and basic antibiotics as examples of the prescribing she hopes to provide for patients.  

Karen is enjoying the course so far. She says the lecturers are supportive and she has connected with other nurses from across the country, but she’s a bit worried about the future. At this stage, there are some uncertainties for nurses like Ben and Karen about how designated RN prescribing will work in practice. 

One thing Karen is concerned about is the potential administrative burden associated with prescribing agreements. She works with multiple doctors across different general practice and aged care settings and may need to establish individual prescribing agreements in each setting. She also has concerns about how this requirement would work in remote settings. Remote nurses often work as part of large multidisciplinary teams that are spread out across vast distances and in some places the telecommunications networks can be unreliable. A designated RN prescriber won’t need to be in the same location as their prescribing partner, but for those working in remote locations, there may be additional technical challenges to overcome.  

Affordable medicines and valuing nurses’ work 

APNA has been advocating for federal legislation to pass that will enable designated RN prescribers to prescribe medicines under the Pharmaceutical Benefits Scheme (PBS). This bill will ensure that the medicines prescribed by RNs will be affordable for patients. Denise is optimistic that this legislation will pass soon: ‘This will be another enabler in the implementation of this reform,’ she says. 

Ben is pleased that this move is being prioritised: ‘It took many years for NPs to get PBS prescriber numbers in Australia,’ he says. ‘It seems like the government really wants to get RN prescribing underway as soon as possible.’ 

APNA has always advocated for recognising the value of primary health care nursing, and is supporting the case the Australian Nursing and Midwifery Federation is currently undertaking at the Fair Work Commission to increase award wages for nurses and midwives.  

‘So far, the union has had quite good success,’ Denise says. ‘They’ve achieved a higher award wage for aged care nurses and they’re working to extend this recognition to all nurses and midwives. I’m optimistic that if nurses take on more responsibility, such as prescribing, their remuneration will reflect that.’ 

Karen hopes to see funding support for designated RN prescribing that works well for rural and remote healthcare teams and their patients. 

‘Patients might be travelling long distances to come in,’ she says. ‘They don’t want to come in today for the ulcer on their leg and again tomorrow for their asthma. If we add prescribing to that care, we need to ensure the model properly supports the work being done.’ 

A higher award wage will be a good starting point for ensuring that extended scopes of nursing practice, such as prescribing, are rewarded. Ongoing collaboration between nurses, employers, nursing organisations and policymakers will be important to ensuring that designated RN prescribing can be integrated into existing healthcare services.  

‘This is a completely new nursing role,’ Karen says. ‘We’ll be somewhere between an experienced RN and an NP. That’s the tricky thing about being in the first cohort. We’re not sure how all of this will work in practice yet.’ 

Implementing the reform 

It’s still early days in the implementation of this reform and APNA is pleased that nurses like Ben and Karen have signed up to become designated RN prescribers. 

‘It's a great opportunity for nurses to work at the top of their scope,’ says Denise, ‘but it's important to be in a supportive work environment.’ 

Karen agrees with this and offers the following advice for other RNs: ‘Negotiate with your employer first. Find out what's going to happen.’ 

Ben says that even though he’s not sure exactly when he’ll be able to start prescribing, his studies have already increased his skills, and a lot of the course content is relevant to his existing scope. 

‘So much that I've learned has already significantly affected the way that I practise every day: talking to patients, history taking, assessing patients, reviewing patient medication histories.’ 

For him, designated RN prescribing is potentially a stepping stone towards becoming an NP one day. If he decides to pursue this, he’ll receive credit for the pharmacology unit that he’s currently enrolled in. 

When asked if he feels like a trailblazer, Ben smiles and says yes. 

‘I think the first NPs are the real trailblazers, though,’ he says. ‘A lot of people still don’t know what an NP is. It took them a long time to get prescriber numbers. A lot of the work to normalise the idea of nurses as independent practitioners has come from those trailblazers.’ 

Both Ben and Karen are strong advocates for their profession and for their communities, and they’re both dedicated to the long-term sustainability of the Australian healthcare system. 

‘In GP land in a rural community, you can actually make a difference’, Karen says. She describes the satisfaction she gets from caring for multiple generations of local families. 

‘You get that family continuity,’ Karen explains. ‘If I’m treating the grandparents, I know what to look out for in the younger generations. If your grandparents are diabetic, we'll keep a closer eye on your diabetes potential. If they've got heart issues in their 70s, we’ll look out for that early on in you. It's that real preventative health care that makes a difference.’ 

Ben has a similar perspective: ‘We need good primary health care. If we don't have primary health care, the only place for people to go is hospital, and the last thing that our healthcare system needs is more burden on the hospitals. So, good preventative primary health care is what we need.’ 

Designated RN prescribing is an exciting opportunity to improve access to timely and affordable care for all Australians, wherever they live. This new expanded scope will empower nurses and has the potential to improve job satisfaction and retention rates for the nursing workforce.  

Australian communities will start to benefit from designated RN prescribing soon as nurses complete the relevant qualifications and regulatory frameworks are put in place. The next few months will be an important period for establishing the foundations for a smooth transition. With thoughtful implementation, trailblazing nurses like Ben and Karen will be well placed to expand their scopes of practice and provide improved access to care where it’s needed most. 

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If you’d like advice or updates on designated RN prescribing regulations, call APNA’s Nurse Support Line (1300 303 184) or contact the NMBA at rnprescribing@nursingandmidwiferyboard.gov.au. 

The author is grateful to the interviewees, Ben Jol, Denise Lyons and Karen Martin, for sharing their perspectives. She would also like to thank the following people for their support with this article: Dianne Crellin, Tarek Dale, Rebecca Manski, Tracy Murphy and Melissa Zanlunghi.

 

Photo credits

Benjamin Jol by Nirasha De Zoysa 

Karen Martin by Sarah Hughes 

 

References 

1. Australian Bureau of Statistics (ABS), Patient experiences, ABS website, 18 November 2025, accessed 18 May 2026.  

2. Nursing and Midwifery Board of Australia (NMBA), Registration standard: Endorsement for scheduled medicines - designated registered nurse prescriber, NMBA website, 30 September 2025, accessed 18 April 2026.  

3. Nursing and Midwifery Board of Australia (NMBA), Fact sheet: Registration standard: Endorsement for scheduled medicines - designated registered nurse prescriber, NMBA website, 30 September 2025, accessed 18 April 2026.  

4. Australian Health Practitioner Regulation Agency (AHPRA), Approved programs of study, AHPRA website, n.d., accessed 18 May 2026. 

5. Nursing and Midwifery Board of Australia (NMBA), Guidelines for registered nurses applying for or with the endorsement for scheduled medicines – designated registered nurse prescriber, NMBA website, 30 September 2025, accessed 18 April 2026. 

6. Nursing and Midwifery Board of Australia (NMBA), Registration standard: Professional indemnity insurance arrangements, NMBA website, 1 June 2016, accessed 20 May 2026.  

7. J Follis and M Alegria, ‘RN prescribing: leveraging Choosing Wisely Canada for evidenced-based practice’, Canadian Nurse, 17 February 2026, accessed 18 April 2026. 

8. M Gerdtz, ‘With extra study, nurses will be able to prescribe medications. Here’s what to expect’, The Conversation, 2 October 2025, accessed 18 April 2026.