Rural and isolated practice endorsed registered nurses (RIPERN) are authorised nurses by the Nursing and Midwifery Board of Australia with the endorsement 'Registered Nurse- scheduled medicines (rural and isolated practice)' and work in Victoria under the 'Approval of the Minister'.
The endorsement allows RIPERN to administer and supply a range of approved medicines where there is no or limited access to general practitioners, nurse practitioners, paramedics or pharmacists.
In Victoria, approved medicines have expanded to Schedule 2, 3, 4 and 8 drugs as listed in the 10th edition of the Primary Clinical Care Manual (State of Queensland (Queensland Health) and the Royal Flying Doctor Service (Queensland Section) 2019).
New changes to low dosage codeine scheduling and the Primary Clinical Care Manual 9th edition
The Commonwealth Department of Health has made changes to low dosage codeine scheduling from 1 Februray 2018. The Editorial Committee of the Primary Clinical Care Manual (PCCM) 9th edition has approved and requested the removal of low dose codeine preparations from the current (9th) edition of the PCCM. This means that Victorian RIPERN can no longer administer or supply low dose codeine products from 1 February 2018.
Information outlining changes to address this issue has been sent to each Victorian rural and regional public health service and bush nursing hospital.
New changes to patient access for medicines containing codeine from 1 February 2018.
Visit the Codeine Information Hub for more information and access to fact sheets.
Role and legislative framework
The RIPERN role is best implemented through a collaborative, team-based model of care. The model allows for health services, local doctors, pharmacists, nurses, paramedics and local communities to work together to achieve the best mix of services to meet the needs of the community.
The rural and isolated practice endorsement for registered nurses is established under section 94 of the Health Practitioners Regulation National Law (Victoria) Act 2001 (the national law).
In Victoria the Drugs, Poisons and Controlled Substances Act 1981 authorises registered nurses whose registration is endorsed to supply and administer approved medicines.
RIPERN in Victoria use the health management protocols contained within Queensland’s Primary clinical care manual 10th edition (PCCM) as the clinical standard to guide their practice and reinforce safe and effective nursing practice.
These medicines, the clinical circumstances for which they are used and the health services in which RIPERN may practice, must be approved by the Minister for Health and are listed in the Gazettal Approval.
For further information to assist RIPERN and health services in understanding their obligations under the legislation, see Drugs & Poisons Controls.
Rural and Isolated Practice Endorsed Registered Nurse project evaluation
An evaluation of the scheduled medicines and supply function of RIPERN nurses operating within rural health services in Victoria was conducted between July and December 2014 by Merrilyn Sneddon Project Services. Some of the key findings were:
- increased skill and confidence of the endorsed nurses
- Better work-life balance for participating general practitioners and improved collegial relationships between general practitioners and nurses working in urgent care centres
- Broad acceptance of the model by the community.
See RIPERN evaluation report, for the complete evaluation findings.
National Safety and Quality Health Service Standards
All health services or networks have access to a credentialling and definition of scope of practice system for the RIPERN role that meets the National Safety and Quality Health Service Standards and the national law requirements. For information on the national accreditation standards, see Public hospital accreditation.
Policy framework and tool kit
The RIPERN function brings with it specific legislative, regulative and clinical governance responsibilities for the health services that use the services of endorsed nurses, and for the RIPERN themselves.
The Nurse endorsement policy framework 2012 specifies what is minimally required of health services and nurses who adopt the endorsed nurse model. The Nurse endorsed tool kit 2012 accompanies the policy framework and provides practical steps and tools for health services to aid implementation of the model.
Here is an example of the RIPERN position description used by health services that have implemented the RIPERN role: Example RIPERN position description.
The sample document templates required at health services with RIPERNS refer to:
Communication tools are also available:
More information is also available in the RIPERN FAQ sheet.
Clinical governance is about being accountable for providing timely, appropriate and safe care to patients, and is fundamental to continuous improvement in patient safety. All health services listed in the Minister for Health's Gazettal Approval for RIPERN must comply with the Victorian clinical governance framework.
The approach taken to adopting and managing a RIPERN's scope of practice must be underpinned by the principles articulated in the clinical governance framework and supported through their health service.
The DLA Phillips Fox report Medico-legal issues: rural collaborative practice project explores the medico-legal issues and considers strategies to manage these issues.
Training and accreditation
To be authorised to work as a RIPERN in rural and regional Victoria, registered nurses must complete a study program that has been accredited by the Nursing and Midwifery Board of Australia (NMBA).
At present, RIPERN training programs accredited by the NBMA are provided by Queensland Health and the University of Southern Queensland (Links available under 'more information').
If you are working in a Victorian public health service, you may be eligible for a scholarship to support you to do postgraduate study in areas of clinical practice that your employer nominates as important to their service.
For further information on postgraduate nursing scholarship, see Nursing in Victoria.
RIPERN health services forum
A forum was held on 11 June 2013 to showcase the work being done by rural health services to integrate RIPERN into urgent care services across Victoria.
Presentations from the forum include an overview, model, action plan and Ambulance Victoria report.