Contents

• Message from the Chair
• Nurse practitioner regulatory framework
• How does recency of practice apply to RN’s with the Nurse Practitioner endorsement? 

Prescribing

• Nurse Practitioners, Prescribing and the Virtual Environment
• Nurse practitioners prescribing medicinal cannabis
• Cosmetic medical procedures and prescribed injections

Message from the Chair

We know that life has been unusually challenging over the last years, especially for nurse practitioners. On behalf of the Nursing and Midwifery Board of Australia (NMBA) I want to sincerely thank you for your ongoing commitment to providing safe and quality care to the Australian public. The NMBA values the important role of NPs. 

The NMBA has developed this Newsletter specifically for NPs to make sure you’re on top of a few key regulatory issues that could affect your day-to-day practice.  We will develop bulletins for NPs in future on an as-needs basis. 

In this edition you will find the latest recommendations for NPs in the prescribing space, specifically for medicinal cannabis, cosmetic procedures and online prescribing. Leanne Boase, President of the Australian College of Nurse Practitioners shares her thoughts and recommendations for nurse practitioners prescribing in a virtual environment. We also provide an update on the NMBA and the Australian Nursing and Midwifery Accreditation Councils (ANMAC) joint review of the NP regulatory framework. 

Finally, I would like to once again applaud the incredible work we have seen from NPs to support the delivery of safe and effective care during the pandemic. We understand that some of you may be feeling stressed or overwhelmed and we encourage anyone who is struggling to contact Nurse & Midwife Support on 1800 667 877 for free and confidential 24/7 mental health services.

Adjunct Professor Veronica Casey

Chair, Nursing and Midwifery Board of Australia

Nurse practitioner regulatory framework

The NMBA is currently working in partnership with ANMAC to streamline the review of the below documents.

• Registration standard: Endorsement as a nurse practitioner (the NP endorsement),
• Nursing Practitioner Accreditation Standards (the NP accreditation standards) and,
• Safety and quality guidelines for nurse practitioners (the SQG).

This review is in accordance with the NMBA and ANMAC’s commitment to the regular review of standards, codes and guidelines and follows a number of recent developments and increased Government interest in the education, scope of practice, further development of NP roles and funding of NPs.

What’s next?

The NMBA and ANMACs consultation phases will be progressed in partnership. Keep an eye out for invitations to participate and have a say in the future of your profession.

How does recency of practice apply to RNs with the nurse practitioner endorsement? 

The NMBA’s Registration standard: Recency of practice requires that an NP must be able to demonstrate that they have maintained adequate connection with the nursing profession, and recent advanced practice, since qualifying or obtaining their endorsement.

NPs must maintain and demonstrate recency of practice relevant to their context of NP practice at the advanced practice nursing level to the equivalent of 450 hours over the past five years. This practise must be direct clinical contact.

The NMBA’s definition of the advanced practice for the nursing profession is:

Advanced practice is where nurses incorporate professional leadership, education, research and support of systems into their practice. Their practice includes relevant expertise, critical thinking, complex decision-making, autonomous practice and is effective and safe. They work within a generalist or specialist context and they are responsible and accountable in managing people who have complex healthcare requirements.

Advanced practice in nursing is demonstrated by a level of practice and not by a job title or level of remuneration. Importantly, the advanced practice definition requires the NPs practice to:

• incorporate professional leadership, education, research and support of systems
• provide effective and safe care using their expertise, critical thinking, complex decision-making in autonomous practice
• be responsible and accountable in managing people who have complex healthcare requirements.

However most importantly, advanced practice in nursing is demonstrated by a level of practice, that meets all of the above and not by a job title or level of remuneration.  This means that an RN could be practicing at that advanced practice level and not be in a NP role or even in a clinical nurse consultant role.

Prescribing

Nurse practitioners, prescribing and the virtual environment

Leanne Boase, nurse practitioner

President, Australian College of Nurse Practitioners

Nurses are involved in prescribing decisions, administration of medicines, and monitoring and evaluating the effects of medicines. Nurse practitioners are very experienced and are educated at a Masters level to prescribe autonomously.  The role of the experienced and expert healthcare professional in prescribing is exceptionally important and non-medical prescribing can certainly help to meet the needs of the community and enhance health outcomes.

So, based on all of this, how does prescribing work in the virtual environment?  With the welcome addition of Telehealth as a permanent part of health care, nurse practitioners can provide health care more flexibly.  Nurse practitioners are also enabled to participate in Electronic Prescribing, improving timely access to medicines. Telehealth for patients of eligible nurse practitioners is subsidised by the MBS and there is no requirement for a prior face to face consultation, although this option should be available.

No two prescribing decisions are the same.  Each person has unique and individual circumstances that must be considered and prescribing decisions take time, education and experience and a high-quality therapeutic relationship.  Skills in advanced patient assessment, advanced history taking, interpretation of assessment findings, clinical reasoning, patient education and ongoing evaluation are the essential underpinnings of any prescribing decision.  The same skills are employed in deprescribing, and in determining the most suitable treatment, including when medicines are not part of it.

All prescribers work collaboratively in the interests of patient safety and better health outcomes.  I always teach nurse practitioner students about the value of relationships and communication between the prescriber, the dispenser and the person administering or taking the medicine, in the interests of safety and quality.  I also focus on the role of the patient in consent and understanding their treatment.

Another key focus in prescribing practice is to regularly evaluate and monitor outcomes and reassess your patient education at every opportunity.  These are the most commonly missed elements in patient care in relation to medicines in my experience.

Three Key Tips:

• Reassess every time - Always reassess the need for a medicine. Ask about unwanted effects, changes in relation to the patient, their response to the medicine and their underlying health condition/s.Consider if investigations need to be repeated, or if they need to see any other health care providers, such as a specialist. Reassess understanding of their medicines and health at every opportunity.
• Communicate – Keep the patient, the other members of the health care team informed and keep detailed records of your assessment and the education you have provided.Plan follow up and evaluation. Use effective methods to check your patient’s understanding, such as the ‘Teach Back’ method.
• Assessment and Examination via Telehealth – do you need to perform a physical examination first, or can this be incorporated into your follow up plan?Try to use Video calls where possible rather than Telephone and consider digital photography through secure messaging where appropriate (the resolution can be better for Dermatology, etc.).Not all situations are suited to Telehealth, and flexibility in service delivery is absolutely essential, including availability of face to face consultations.

Nurse practitioners prescribing medicinal cannabis

The use of medicinal cannabis and what it can do for chronic conditions has become an area of increasing interest. The Therapeutic Goods Administration (TGA) has a Special Access Scheme (SAS) which allows prescribers (including NPs) to prescribe medicinal cannabis products for a single person in their care on a case-by-case basis.

The NMBA has worked with the TGA to assist them to ensure that NPs who want to apply through the SAS to be able to prescribe medicinal cannabis have the requisite underpinning education training and competence to diagnose and treat the relevant conditions for which medicinal cannabis is prescribed.

NPs seeking to apply through the SAS should ensure they:

1. have appropriate education, training and competence to diagnose and treat the relevant conditions for which medicinal cannabis is prescribed
2. have appropriate pharmacotherapeutic education and training to safely prescribe medicinal cannabis and can supply evidence of this, and
3. will only prescribe this medicine in accordance with the relevant state and/or territory drugs and poison legislative framework and the principles outlined in the National Prescribing Service's Prescribing Competencies Framework (2021), as well as the NMBA's Safety and Quality Guidelines for Nurse Practitioners (2016).

NPs should know that there are some states and territories that do not allow NPs to prescribe medicines that are not included in the Australian Register of Therapeutic Goods (ARTG) – it is critical therefore that NPs know the state and/or territory drugs and poison legislative framework in the jurisdictions that you practise.

NPs should also appreciate that the TGA has the option of forwarding a notification to the NMBA or Ahpra if a safety and/or quality issue is identified about a NPs practice.

Cosmetic medical procedures and prescribed injections

The NMBA has recently published an updated position statement for nurses working in the area of cosmetic medical and surgical procedures.

This position statement includes guidance for:

• all nurses working in the area of cosmetic medical procedures, including specific advice for enrolled nurses, registered nurses and nurse practitioners
• cosmetic injections – detailed expectations of prescribers and the role of the registered nurse and enrolled nurse, and
• supervision requirements for enrolled nurses

We recognise that nurses obtain and develop qualifications and expertise through the course of their careers. It is an expectation that nurses are educated and competent in their specific area of practice and hold the requisite skills required to meet the needs of their client group.

NPs are authorised to prescribe medicines in accordance with state and territory legislation and their context of practice. At all times, the prescribing practice of NPs must be supported by their education, skills and knowledge. This underpins the assessment of, or consultation with, the person receiving cosmetic injections. NPs must not prescribe Schedule 4 cosmetic injections unless they have a consultation with the person receiving the cosmetic injection either in person or via video conferencing. Remote prescribing of cosmetic injections by phone or email (or equivalent) is not acceptable.

The requirements for medical practitioners are set out in the MBA guidelines and mirror the above.

You can find the full position statement on nurses and cosmetic medical procedures on our website or you can contact us via email. 

Keep in touch with the NMBA

• Visit the NMBA website for registration standards, codes, guidelines and FAQs.
• Lodge an online enquiry form.
• For registration enquiries, call 1300 419 495 (from within Australia) or +61 3 9285 3010 (for overseas callers).
• Address mail correspondence to: Adjunct Professor Veronica Casey AM, Chair, Nursing and Midwifery Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

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