In British Columbia, registered nurses (RNs) can dispense or give client-specific orders for medications. Only RNs with certified practice are authorized to prescribe.

What's the differ​​​ence?

​Dispensing

• An RN dispenses when they prepare and give medication for a client to take later. Before dispensing, the nurse must take steps to ensure the pharmaceutical and therapeutic suitability of the medication for its intended use and to ensure its proper use.

• RNs can only dispense Schedule II medications and a very limited number of Schedule I. medications, with or without the involvement of a pharmacist.

• When dispensing medications, no prescription is provided to the client.

Giving a client-specific order

• An RN gives a client-specific order when they issue an instruction or authorization — not a prescription — for another regulated health professional to carry out restricted or non-restricted activities for a client. This could include giving instruction for a medication-related activity, such as compounding, dispensing, or administering, to be acted on by another nurse (not a pharmacist).

• RNs can only give client-specific orders for Schedule II medications and a very limited number of Schedule I medications, and only when they meet the requirements for acting within autonomous scope of practice.

• Only RNs with certified practice in opioid use disorder may give a client-specific order for Schedule IA medications.

• When giving a client-specific order, no​​ prescription is provided to the client.

Prescribing

Only RNs with certified practice (RN(C)s) can be authorized to prescribe. An RN (C) prescribes when they issue a prescription for a pharmacist to dispense a specified medication for use by a client.

• RNs with certified practice in opioid use disorder are automatically authorized to prescribe.

• All other RN(C)s must complete approved education and apply for prescribing authority.

• RN (C)s are only​​ authorized to prescribe medications outlined in the decision support tools for their certified practice designation.

Prescribing controlled drugs and substances

• Only RNs with certified practice in opioid use disorder can prescribe Schedule IA medications.

• When prescribing controlled drugs and substances, RN(C)s in opioid use disorder must use Controlled Prescription Program duplicate prescription pads or EMR printer-friendly sheets issued by BCCNM.

App​lying for prescribing authori​ty

RNs with certified practice in opioid use disorder are automatically authorized to prescribe. All other RN(C)s must apply for prescribing authority after successfully completing the Safe Prescribing for Registered Nurses with Certified Practice course. Learn more»

Decision supp​​ort tools and drug schedules by certified practice

Contraceptive Management

Decision support tool	Diseases, disorders + conditions	Drugs schedules and therapeurtic classes
NNPBC Certified Practice Reproductive Health — Contraceptive Management Decision Support Tools	May prescribe, dispense, administer, insert, or remove contraception.	Schedule I: Sex Hormones (hormonal contraception) Schedule II/III/unscheduled

​Opioid Use Disorder

Decision support tool	Diseases, disorders + conditions	Drugs schedules and therapeurtic classes
BCCSU Certified Practice Opioid Use Disorder Decision Support Tools​	May​ diagnose and treat opioid use disorder	Schedule IA: opioid agonist opioid partial agonist Schedule I alpha-adrenergic agonist Schedule II/III/unscheduled

Remote practice

Decision support tool	Diseases, disorders + conditions	Drugs schedules and therapeurtic classes
NNPBC Certified Practice Remote Practice Decision Support Tools	May diagnose and treat the following diseases, disorders, and conditions for pediatric and adult clients unless indicated as adult only: Eye: conjunctivitis, minor corneal abrasion Ear-nose-throat: acute otitis media, pharyngitis, ceru​minosis (adult only), dental abscess (adult only) Genitourinary: urinary tract infection Respiratory: acute bronchitis (adult only) Integumentary: abscess and furuncle (a​​dult only), cellulitis, impetigo, bites, Pain: use of nitrous oxide/oxygen for pain managemen​t (adult only)	Schedule I: Antibacterials Antivirals Antiprotozoals Antihistamines Bronchodilators Schedule II/III or unscheduled

​RN First Call

Decision support tool	Diseases, disorders + conditions	Drugs schedules and therapeurtic classes
NNPBC Certified Practice First Call Decision Support Tools	May diagnose and treat the following diseases and disorders and conditions for pediatric and adult clients unless indicated as adult only: Eye: conjunctivitis, minor corneal abrasion Ear-nose-throat: acute otitis med​​ia, pharyngitis, ceruminosis (adult only), dental abscess (adult only) Uri​nary tract: Lower urinary tract infection (adult only).	Schedule I: Antibacterials Antivirals Antiprotozoals Antihistamines Schedule II/III or unscheduled

​Sexually transmitted infections

Decision support tool	Diseases, disorders + conditions	Drugs schedules and therapeurtic classes
NNPBC Certified Practice Reproductive Health—Sexually Transmitted Infections Decision Support Tools	May diagnose and treat the following diseases and disorders: Chlamydia Trachomati Neisseria Gonorrhea Mucopurulent Cervicitis Trichomoniasis  Bacterial Vaginosis Urethritis Recurrent Urethritis  Lower Urinary Tract Infection  Genital Warts Treatment of contacts of those with sexually transmitted infec​​​tions	Schedule I: Antibacterials Antivirals Antiprotozoals Antimitotics Schedule II/III or unscheduled

Preventing fraud and misuse 

The BCCNM Controlled Prescription Program reduces the likelihood of inappropriate prescribing and/or prescription forgeries by requiring that prescriptions for c​​​ontrolled drugs be written on a specific duplicate prescription pad. Learn more about the program or order prescription pads. 

Related standards, responsibilities, and accountabilitie​​s 

Scope of Practice stand​ards

• Acting within autonomous scope of practice

• RN (certified) standards for prescribing medications 

Practice stand​ards

• Boundaries in the Nurse-Client relationship
• Consent
• Medication
  
• Privacy and C​onfidentiality​ 

Responsibilities and accountabilities

• Opioid use disorder prescribing — consulting and referring

Learning resources

• Prescribing controlled drugs and substances​ (CDS) ​​​​ ​​