A bitter pill to swallow: registered nurses and medicines regulation in remote Australia

Introduction: Access to essential medicines is a human right and an objective of the National Medicines Policy in Australia. Health workforce distribution characteristics in remote Australia implies Registered Nurses (RNs) may find themselves responsible for a broader range of activities in the medication management cycle than they would be elsewhere in the nation. The regulation of health professionals and their training requirements provides essential but complex protections for the public. These protections include the National Registration and Accreditation Scheme for health practitioners (NRAS) and the Australian Health Practitioner Regulation Agency (AHPRA). Other levels of control or regulation are also exerted over health professionals via mechanisms such as salaries and funding arrangements, insurance requirements, admitting rights to healthcare facilities and legislation controlling the use of medicines and therapeutic devices.
Objective: To examine national legislation and regulations concerning the use of medications from a nursing perspective, focusing on the context of health service delivery in remote areas.
Methods: Australian state and territory medicines legislation and regulations was interrogated for answers to the questions ‘Can a RN prescribe a medication?’, ‘Can a RN dispense a medication?’, ‘Can a RN supply or issue a medication?’ and ‘Can a RN administer a medication?’.
Results: Inconsistencies were identified nationally in the names and general structure of the legislation, the location of information relating to authorised roles with regards to medications and key terms used to describe medicines and the elements of the medication management cycle. Administering a Schedule 4 or Schedule 8 medicine according to an order from an authorised prescriber are the only nationally consistent roles RNs are authorised to undertake with regards to medicines. Twenty-eight variations were identified with regards to additional authorisations for RNs.
Conclusions: RNs make up more than half of the registered Australian health professional workforce and are the most consistently distributed across the nation, yet their legislated responsibilities in relation to working with medicines are inconsistent. Given the inconsistencies, RNs providing healthcare in remote Australia may be unable to undertake aspects of the medication management cycle that their work environment demands in the best interest of their patients and absence of other healthcare providers. The lack of legislative consistency nationally for medicines in Australia is likely to impede timely access to medications for patients. Regulatory inconsistencies may also result in RNs working well below or beyond their legal scope of practice, thereby creating clinical and workforce risks. Such risks are a significant matter for remote health service provision. Resolving these issues will require a collaborative national approach with consideration given to how the health workforce is distributed, current nursing responsibilities and relevant service delivery models for remote Australia.