Skip to main content

Introduction

The new Standards for Prescribing standards, limits, and conditions set foundational requirements for current and future scope of practice prescribing by RNs. These Standards for Prescribing apply when RNs prescribe a medication to be dispensed to or for an individual client or give a client-specific order for a medication to be administered to, or dispensed to or for, an individual client.

Prescribing

A nurse prescribes when they authorize another health professional to dispense a specified medication for use by a specific client.

The nurse who prescribes assumes full responsibility and accountability for issuing the prescription or giving the order; however, risk to the client is reduced by having at least two health professionals involved in the medication-related activity to ensure the appropriateness of the medication for the client and assess any risks.

In addition to the Standards for Prescribing, and prescribing limits and conditions, RNs who prescribe medication must comply with the Medication practice standard and the Acting within Autonomous Scope of Practice standard, as w​ell as any other BCCNM standards, limits or conditions.

General requirements to prescribe

What do I need to do to be able to prescribe medications, other than buprenorphine/naloxone?

Nurses require supports and resources to support safe prescribing. There are governmental, organizational, and regulatory pieces that need to be developed and put in place before RNs can begin prescribing. These include:

  • Organizational/employer developing policies, processes and resources to support safe nurse prescribing. These must include:
    • Determining what the additional education will be and how to access it
    • Process to recognize RNs as prescribers
    • Outlining the accountability and responsibility of the prescribing nurse
    • Processes for consulting with and /or referring to other health professionals about the prescribing decision as needed to meet client needs
    • Processes for ensuring continuity of care for clients
  • Facilitating PharmaNet access
  • Facilitating Medical Services Plan (MSP) access for RNs if needed
  • Developing a process for RNs to obtain a prescriber ID from BCCNM

As well, there are several steps that nurses must ensure are in place before they prescribe:

  • Formal recognition as a prescriber by your organization/employer
  • Successful completion of your organization’s/employer’s required additional education
  • Acquire a prescriber ID from BCCNM (Process in development)
  • Obtain PharmaNet access
  • Obtain an MSP number if needed
What additional education do I need to complete to be able to prescribe?

Since prescribing is not an entry level competency, additional education needs to include basic prescribing competencies. BCCNM does not determine or develop the education needed for nurses to safely prescribe in their practice. Organizations/employers are in the best position to determine the specific client populations and settings for RN prescribing. Therefore, your organization/employer will provide guidance on the required additional education for prescribing, including identifying the necessary competencies for safe prescribing. Organizations/employers will also determine the condition for which the medication is prescribed as well as the medication to be prescribed.

It is difficult to say when the education will be in place to support RN prescribing. We are committed to keeping you informed about this process.

When I am identified as a prescriber, what medications can I prescribe within my autonomous scope of practice?

Per the regulations, RNs can prescribe Schedule II medications and a limited number of Schedule I medications. 

However, organizational/employer policies may limit medications you can prescribe at their organization. Note, organizations/employers cannot expand your scope beyond that of the regulations or BCCNM standards, limits and conditions. 

RNs cannot prescribe dermal fillers.

Buprenorphine/naloxone prescribing

The Provincial Health Officer (PHO) issued an order temporarily authorizing RNs to diagnose and treat a problem substance use condition or substance use disorder. This public health order follows a recent Health Canada decision granting a temporary exemption under the Controlled Drugs and Substances Act to allow RNs in B.C. to prescribe buprenorphine/naloxone (i.e., Suboxone or its generic form) for the treatment of opioid use disorder subject to specific conditions. BCCNM Acting Within Autonomous Scope of Practice, Medication, and Prescribing standards, limits and conditions set foundational requirements for RN prescribing of buprenorphine/naloxone.

While the public health order allows RNs to prescribe buprenorphine/naloxone for opioid use disorder, it does not allow RNs to issue a client-specific order for another nurse to administer or dispense buprenorphine/naloxone to a client if that other nurse is also not a prescriber.

When can I start prescribing buprenorphine/naloxone ?

You can begin prescribing once you have met all the following criteria:

  • Your organization/employer recognizes you as a prescriber

  • You successfully complete additional education and the preceptorship requirements  established by the B.C. Centre on Substance Use (BCCSU) (in development)

  • Your organization/employer has policies, processes and resource in place to support RN prescribing

  • BCCNM has provided you with a prescriber ID (Process in development)

  • You participate in the B.C. Controlled Prescription Pro​gram (CPP) and obtain the duplicate prescription pads required to prescribe buprenorphine/naloxone. Email cpp@bccnm.ca with any questions.

  • You obtain a Medical  Services Plan (MSP) number allowing you to order diagnostic tests specific to the prescribing of buprenorphine/naloxone (process in development; information is coming)

  • You obtain Pharmanet access

  • You are in good standing with BCCNM

What do I need to do to be able to prescribe buprenorphine/naloxone (Suboxone)?

There are several steps that that need to be completed successfully before you can begin to prescribe:

  • Complete​​ the BC Centre on Substance Use (BCCSU) additional education and preceptorship

  • Acquire a prescriber ID from BCCNM (Process in development)

  • Be recognized by your organization/employer as a prescriber

  • Obtain Pharmanet access

  • Obtain a Medical Services Plan (MSP) number

  • Ensuring that organizational/employer policies, processes and resources are in place to support safe nurse prescribing and knowing what they are. 

What additional education do I need to complete to be able to prescribe buprenorphine/naloxone?

The BC Centre on Substance Use (BCCSU) has developed the education required for nurses to prescribe buprenorphine/naloxone. Nurses require recognition by their organization/employer as a buprenorphine/naloxone prescriber prior to enrolling in this education.

Which nursing designations are authorized to prescribe buprenorphine/naloxone (i.e., Suboxone or its generic form) for opioid use disorder?

RNs who:

  • Are recognized by their organization/employer to prescribe buprenorphine/naloxone
  • Successfully meet the BCCNM limits and conditions for prescribing buprenorphine/naloxone

As per regulations, LPNs are not authorized to prescribe medications.

When I am identified as a prescriber, what opioid agonist medications can I prescribe within my autonomous scope of practice?

At this time, RNs are not allowed to prescribe any additional OAT medications other than buprenorphine/naloxone.

Who is developing the processes to support nurse prescribing (prescriber numbers, triplicate pads, etc)?

BCCNM’s Registration and QA departments are working with PharmaNet to develop the transfer of information to ensure RNs are eligible to prescribe.

When BCCNM receives confirmation from the BC Centre on Substance Use (BCCSU) that a registrant has completed the educational requirements, and the registrant signs BCCNM’s Declaration for Prescribing Buprenorphine/Naloxone form confirming they have met the regulator’s requirements, BCCNM issues a prescriber number and provides the details on how to enroll for PharmaNet. BCCNM administers the Controlled Prescription Program for all prescribing registrants. Registrants obtain the duplicate prescription pads required to prescribe buprenorphine/naloxone by logging into their BCCNM account.