The Ministry of Health approved regulations on Nov. 6, 2023.  to expand the RN scope of practice to permit RNs to prescribe medication and to communicate diagnosis for the purposes of prescribing. Under the regulations, RNs must complete education approved by CNO’s Council to become authorized to prescribe medication.

In December 2023, Council started approving  RN prescribing education programs in Ontario. Each program curriculum includes these competencies to support safe RN practice.

CNO is developing a practice standard to outline the accountabilities of RNs authorized to prescribe. We are also creating new and updating existing resources to reflect the broader accountabilities of all nurses once the regulation has been approved. These will be finalized after the regulation is approved.

“RN prescribing” is the terminology that is best understood by the public and other stakeholders. CNO’s work on RN prescribing includes regulatory mechanisms needed for an RN to safely prescribe medication and communicate a diagnosis for the purpose of prescribing.

Yes, RNs will be required to complete education approved by Council to become authorized to prescribe medication.  CNO Council will review and consider approval of these programs in December 2023.

No, CNO will not require all RNs to complete RN prescribing education. Only RNs who want to be authorized to prescribe will be required to complete the education.

No. Even if an RN has completed the education approved by Council to become authorized to prescribe, their practice environment may not allow for it. This may be determined by law (for example, the Public Hospitals Act prevents RNs from ordering treatments for hospital patients) or by employer preferences and requirements.

Employers are responsible for determining the roles and responsibilities of their employees, including determining whether nurses can perform certain activities and procedures in the practice setting.

No, this is a government decision.

The public Register exists to communicate information about nurses registered with CNO. The public and others (such as employers, pharmacists) will need to know if an RN is authorized to prescribe medication; so, there will be information on the public Register (Find a Nurse) to indicate that an RN is authorized to prescribe medication.

No. If you are not interested in becoming authorized to prescribe, these changes will not affect how your information appears on the public Register, Find a Nurse.

CNO is accountable for developing and implementing a regulation that will support competent and safe RN prescribing. The medications list was informed by multiple factors, including:

• evidence from other jurisdictions that have implemented RN prescribing
• consultation findings from Ontario stakeholders (for example, patients, RNs and employers)
• government direction that this change in scope of practice is meant to enable RNs to manage “non-complex” patient care needs
• current legislative parameters, specifically that government laws do not permit RNs to order diagnostic and lab tests

CNO intends to work with stakeholders to evaluate the first group of medications of RN prescribing before adding more medications.

The Nursing Act, 1991 requires that we specify, in regulation, the medications that RNs are permitted to prescribe; we may specify individual medications or categories.

The drug schedule includes a combination of individual medications and categories. The categories are based on the World Health Organization classification system.

No. RNs are not permitted to prescribe these medications.

No, this is a government decision.

As regulated health professionals, all nurses are accountable for their practice – which is what makes a health professional independent. RNs who prescribe are solely accountable for their prescribing decisions and for complying with CNO standards.

No. There is no change in the class or category of registration when a nurse becomes authorized to prescribe.

Yes. The regulation enables RNs who are authorized to prescribe to also perform the controlled acts of "administering a substance by injection/inhalation” and “dispensing a drug” so that they can provide a medication they prescribe.

If the RN does not prescribe a medication, they would continue to require an order from an authorized health professional to administer or dispense it.

Yes. The regulation enables RNs who have prescribing authority to provide an order for another nurse (RPN or RN) to administer or dispense a medication that they prescribe.

No. RNs with prescribing authority cannot delegate the controlled acts of prescribing a drug and communicating a diagnosis.