Nurse prescribing offers a roadmap for reform

New avenues for nurse prescribing have the potential to reshape frontline care. For pharmacists, it’s a live example of how scope expansion translates into real impact.

Nurse prescribing is entering a new phase in Australia, and pharmacists should be paying close attention. 

While nurse practitioners and endorsed midwives have been able to prescribe Pharmaceutical Benefits Schedule (PBS) subsidised medicines since 2010, a new pathway will soon expand prescribing to a broader group of experienced nurses.

‘A lot of people wouldn’t even know that nurses are already prescribing medications that are funded on the PBS,’ said Denise Lyons, President of the Australian Primary Health Care Nurses Association. ‘But there are more than 3,000 nurse practitioners and endorsed midwives in Australia now who are already prescribing.’

Under a new registration standard which came into effect in September last year, suitably qualified registered nurses will be able to prescribe medicines in Schedules 2, 3, 4 and 8 in partnership with an authorised prescriber.

‘It took until this year for universities to start the course that enables registered nurses to meet [the new standard],’ Ms Lyons said. ‘Most are 6-month postgraduate courses … So it will probably be around July 2026 that we will see the first [wave] of nurses completing the educational requirement.’

For pharmacists, this shift offers a live view of how prescribing reform is built – through legislation, governance, defined scope and, crucially, access to the PBS.

What’s changing?

The new framework is deliberately cautious. To become a designated RN prescriber, a nurse must: 

• complete postgraduate training
• have significant prior clinical experience
• work within an agreed clinical governance framework with an authorised health practitioner under an active prescribing agreement
• complete a 6-month period of clinical mentorship.

 The written prescribing agreement with an authorised prescriber remains in place beyond the initial mentorship period.

‘An authorised prescriber could be a nurse practitioner, endorsed midwife, or it could be a GP,’ Ms Lyons said. ‘And that prescribing agreement is going to articulate what medications are within scope.

‘For example, say you had a registered nurse who has been working in paediatrics [throughout their] career… [They’re] going to be educated and competent to prescribe for some childhood illnesses, so that would be within [their] scope.’

For patients, expanded nurse prescribing could mean faster access to medicines, fewer delays for routine care and less reliance on GP availability.

‘You think about the amount of care that nurses deliver around [things like] aged care, palliative care, community care and sexual health,’ Ms Lyons said. 

‘There’s a lot of work done in the community by registered nurses who have a lot of knowledge and experience. And this is going to be a mechanism that lets them use that knowledge and experience in a really helpful way.’

Expanded nurse prescribing will be especially valuable in rural and remote communities, aged care and other underserved settings where nurses are often the main point of contact but medical access can be patchy, she added.

‘Pharmacists and nurses are often people’s first point of contact with the healthcare system, and it’s really good if we can work to the top of our scope and do what we know we can do, with the right guardrails in place.’

denise lyons 

PBS access is the make-or-break issue

While the regulatory framework and training pathway are now largely in place, the biggest unresolved issue is PBS access. Nurse practitioners and endorsed midwives already have it. Designated RN prescribers do not – yet.

Without PBS access, nurses may be able to issue prescriptions, but patients would still face out-of-pocket costs that undermine the practical value of the reform.

However, federal legislation now before the Senate would amend the National Health Act 1953 to allow designated RN prescribers to prescribe PBS-subsidised medicines. 

‘We’re really hoping the Bill comes through the Senate with no amendments and that it passes into legislation,’ Ms Lyons said. ‘If we don’t manage to get access, and the subsidies on the PBS lag behind practice, that will be a real barrier.’ 

Ms Lyons also highlighted the need for national coordination. State and territory variations in drugs and poisons legislation create confusion for both clinicians and patients, as pharmacists know all too well.

‘The work that’s being done to harmonise [that] legislation across the states and territories is going to be really important, and we need to all work on that together,’ she said.

Implications for pharmacists

As nurse prescribing expands, pharmacists are likely to see more prescriptions coming from a wider mix of clinicians, potentially changing how care is coordinated in everyday practice.

Rather than care sitting primarily with a single prescriber, it will increasingly be shared across a team – with nurses assessing, prescribing and monitoring within their scope, and pharmacists supporting safe and effective medicines use.

That means collaboration needs to be more deliberate, Ms Lyons said.

‘With quality use of medicines, there [need to be] clear principles around closed-loop communication, agreed-upon goals, rapid feedback on issues and shared protocols,’ she said.

The progress of the nurse prescribing model also provides a useful advocacy roadmap. The model has gained traction by focusing on what it delivers for patients – faster access, fewer delays and more complete care at the point of contact. 

That focus is particularly relevant in pharmacy, where prescribing arrangements currently vary by state and territory, and where the absence of PBS access continues to limit how much patients can benefit.

Like nurse prescribing, expanded pharmacist prescribing will only be truly effective if it’s consistent, supported by clear frameworks and enables affordable access for patients.

‘Pharmacists and nurses are often people’s first point of contact with the healthcare system, and it’s really good if we can work to the top of our scope and do what we know we can do, with the right guardrails in place,’ Ms Lyons said.