FAQ – RN Prescribing

How does an RN gain authority to prescribe?

RNs must obtain required regulatory approved education, have employer sponsorship, and be able to obtain and maintain competence in prescribing to apply to the College for authorization to add RN prescribing to their scope of practice. In addition, RNs seeking authorization to prescribe must meet with a College Nursing Consultant to discuss their expanded scope of practice and the requirement for an individualized guidance document.

Who should be selected to obtain authorization to prescribe?

The employer should choose an RN who has individual competence, knowledge of, and experience in the illnesses/conditions or client population for the practice setting where the client(s) has an identified need.

How will it be determined that a particular practice area is appropriate for introducing RN prescribing?

The potential for RN prescribing to be introduced to a particular practice area is decided through discussion with the RN(s), employer sponsor, and collaborative team (e.g., pharmacist, most responsible provider(s) (MRPs) – Nurse practitioners (NPs) and/or physicians, clinical educator, etc.), and RN prescribing has been identified as a need that would be beneficial to the clients served in that practice area.

What does RN prescribing involve?

RNs with authority to prescribe involves:

• assessing individuals within an employer sponsored area(s) of need, which has conditions/illnesses requiring nursing care within the RN’s competence and authorization to prescribe and establishing a plan of care which may include:
  • prescribing medications, ordering laboratory and diagnostic screening tests (including but not limited to ultrasound, x-ray, CT, etc.) and/or other non-pharmacological interventions, and/or making referrals to specified health care professionals.
• referring to an individualized guidance document for specific information/parameters for prescribing, ordering, and making referrals for identified conditions/illnesses.

What is a guidance document?

A guidance document is an evidence-informed document used in the identified area of need/setting/context to guide decisions related to ordering of diagnostic and laboratory tests, and other nonpharmacological interventions, making referrals, and prescribing medications. This document may be n the form deemed appropriate by the employer (e.g., protocol, algorithm, policy, practice procedure, guideline, etc.). The guidance document must be contextualized to the RN’s authorized client population/context and to the RN’s individual competence and experience with the illnesses/conditions in that practice setting.

Does each RN with prescriptive authority have the same guidance document?

Although there may be some similarities or common protocols/parameters, each guidance document must be individualized based on the RN’s competence and nursing experience related to the treatment of the conditions/illnesses relevant to the specific practice area or client population(s).

What parameters must be included in the guidance document?

A guidance document must provide parameters for the role of the RN prescriber. The College does not approve the guidance document; however, there are several parameters that must exist within each guidance document to support safe prescribing by an RN. These parameters are outlined in Appendix A of the College’s RN Prescribing Framework and include the following:

• a process to determine how laboratory/diagnostic tests and other non-pharmacological interventions are ordered.
• a process for prescribing medications, including a process for selecting the appropriate mediations.
• a reference to processes for medication reconciliation and monitoring
• a reference to processes for continuing medication management
• actions that are to be taken when the laboratory and diagnostic results are outside the expected range and the follow-up required when results are not received within a reasonable period of time.
• processes to receive and respond to critical diagnostic tests results.
• having an appropriate health-care professional review diagnostic test results in a timely manner if the RN authorized to prescribe cannot personally attend to provide follow up care.
• an after-hours emergency contact.

The employer sponsor may choose to provide more detailed parameters, such as medication dosage, frequency, etc. depending on the level of risk (e.g., high-alert medications) or the complexity of the client(s) (i.e., a client with multiple co-morbidities or chronic diseases).

Does RNs with prescriptive authority need to be part of a collaborative team?

Yes, RNs with the authority to prescribe must be part of a collaborative team with access to an NP or Physician and other health care providers as appropriate. An RN would not be able to prescribe in practice settings where a most responsible provider is not available; however, the MRP can provide support virtually if deemed appropriate.

What is the difference between implementing a care (medical) directive and prescribing according to a guidance document?

RNs may implement care (medical) directives from an authorized prescriber for clients who meet the specific criteria set out in the directive. For example, RNs may be authorized to arrange a chest x-ray or administer an analgesic before an NP or physician sees the client when specific clinical conditions are met and situational circumstances exist, which must be included in the care (medical) directive. For more information on care (medical) directives, please refer to the College’s current version of Care (Medical) Directive document.

RNs who have the authority to prescribe are given a wider authorization through their individualized guidance document to order specified laboratory and diagnostic tests, and/or nonpharmacological interventions, prescribe medications, and/or to make referrals to specified health care professionals.

Is dispensing medications the same as prescribing medications?

No. The Pharmacy Act identifies dispensing as a practice of pharmacy and defines dispense as a “means to provide a substance or item ordered by prescription but does not include the administration of that substance or item to a person or animal”. RNs who practice within the Provincial Health Authority (PHA) may be required to dispense prescribed medications in specific circumstances. For example, RNs may dispense prescribed medications for clients who live in an area of the province with limited or no access to pharmacy services. In order to dispense medications, RNs require an authorizing mechanism by the PHA, such as a care (medical) directive, with appropriate policies in place to ensure medications are dispensed safely and in accordance with accepted standards, which can be found on the College of Pharmacy of Newfoundland and Labrador (CPNL) website.

Are there any limitations on what an RN can prescribe?

Currently there are several limitations. These limitations may change as the College evaluates the rollout of RN prescribing and client outcomes. RNs with prescribing authority are not permitted to:

• prescribe outside of their individual competence or the parameters of their guidance document (employer authorization)
• prescribe any medication regulated by the Controlled Drugs and Substances Act (CDSA) and related regulations, unless receiving specific authorization from the employer sponsor and College
• prescribe if self-employed (e.g., independent, contract, or private practice)
• prescribe for themselves
• prescribe for family members, and others close to them (e.g., personal relationship) EXCEPT if:
  • the prescribing decision is specific to the clinical practice area where they have been authorized, and
  • there is no other authorized prescriber available, and the nurse has taken reasonable steps to transfer
• the care and transfer of care occurs at the earliest opportunity
• prescribe medications for study protocols
• accept or distribute medication samples from pharmaceutical companies
• transfer their prescriptive authority to another practice setting or unit.

What is the difference between an RN’s prescriptive authority and that of a nurse practitioner?

An RN with prescriptive authority prescribes according to their individualized guidance document. An NP is authorized to practise and prescribe autonomously for any client(s) with varying health care needs. For further information, please review the College’s RN Prescribing Practice Guidelines.

Can the employer/RN add to their guidance document?

Yes. However, it is recommended that adding new conditions/illnesses to an RN guidance document be staged. As the RN prescriber gains new competence and knowledge in the practice setting through continuing education and experience, new conditions/illnesses with corresponding prescribing/ordering actions and parameters can be added with support from the employer and collaborative team. Regardless, all guidance documents should be reviewed on a regular basis to ensure the document meets evidence-informed best practices.

What role does the NP have in supporting RN prescribing?

The NP within the collaborative team where an RN is seeking authorization to prescribe may be asked to help create a guidance document. The NP within that team may also be contacted by the RN for consultation, referral, or transfer of care when the needs of the client are outside of the RN’s scope of practice/individual competence and the parameters of the RN’s guidance document.

Updated: December 2025