Contact Rural and Regional Health for implementation advice
For information relating to authorised registered nurses with a Scheduled Medicines (Rural and Isolated Practice) endorsement, please refer to the department Rural and Regional Health
section, which administers this system.
Legislative issues for nurses
The Drugs and Poisons Regulation section of the website contains a range of documents, in the section for 'Documents to print or download
', which summarise the legislative requirements for nurses, in general, and for nurses whose registration is endorsed to authorise additional capabilities. These documents include the following:
- Nurses and midwives - key legislative requirements in Victoria
- Nurse practitioners - key legislative requirements in Victoria
- Authorised registered nurses - rural and isolated practice
Rural and isolated practice
The Nursing and Midwifery Board of Australia has an endorsement 'Registered Nurse - scheduled medicines (rural and isolated practice)'.
The endorsement authorises Rural and Isolated Practice Endorsed Registered Nurses (RIPERN) to administer or supply a limited range of medicines where there is no, or limited, access to medical practitioners, nurse practitioners, paramedics or pharmacists.
The term 'authorised registered nurse' relates only to nurses acting under that endorsement and the 'Approval of the Minister'.
Approval of the Minister
The 'Approval of the Minister' is an approval for medicines, health services and clinical circumstances made under section 14A of the Drugs, Poisons and Controlled Substances Act 1981 (the Act).
The Approval of the Minister for authorised registered nurses in rural and isolated practice applies only to the following conditions:
- The nurse is a registered nurse (Division 1) whose registration is endorsed for Scheduled Medicines (Rural and Isolated Practice); and
- The nurse is employed and practising within a health service or class of health services included on the list of health services approved by the Minister for Health; and
- The nurse is acting under the clinical circumstances approved by the Minister for Health. The clinical circumstances incorporate relevant Health Management Protocols that set out the conditions and restrictions applying to the use and supply of medicines as described in the Primary Clinical Care Manual 9th edition.
In summary, an authorised registered nurse on duty in an urgent care setting in an approved rural health service may perform triage and assess a patient's condition to determine whether a medical practitioner is required. The decision to call a medical practitioner to attend the patient will be based on the policy of the health service. In developing its policy, the health service is to take account of clinical need and the Collaborative Practice Model whereby health professionals continuously negotiate their roles based on their respective skills and availability. An authorised registered nurse's scope of practice will be supported by an employer's clinical governance framework. It will also be guided by the Nursing and Midwifery Board of Australia's professional practice framework, which details how professional decision-making within a sound risk management, professional, regulatory and legislative framework is to be managed.
Approved health services, clinical circumstances and medicines
The Minister for Health has approved specific health services in relation to authorised registered nurses.
The health services approved by the Minister to engage the services of authorised registered nurses are certain rural hospitals, bush nursing hospitals and one rural emergency stabilisation department in Victoria.
Each approved health service has a Health Services Permit, issued with conditions. It authorises the health service to obtain and possess Schedule 2, Schedule 3, Schedule 4 or Schedule 8 poisons for the provision of health services.
A health service engaging the services of authorised registered nurses should update the content of their Health Services Permit documentation (including any internal procedural documentation) to include references that apply to the activities of authorised registered nurses.
Health services should notify Drugs and Poisons Regulation in the Department of Health and Human Services of their intention to engage authorised registered nurse(s) by using the online form 'Propose changes or review an EXISTING licence or permit'. A health service completing the form should select 'nurse with a rural and isolated practice endorsement' as being a health practitioner who may initiate administration in the 'Health practitioner activities' section. The form is available on the Licences and Permits for industry and health page.
Authorised registered nurses should refer to the Health Services Permit documentation held by their health service (or health services if they are employed at multiple approved health services) to examine how the permit holder has undertaken to comply with relevant regulatory requirements.
Note: Health Services Permit documentation is specific to the establishment to which it applies. It describes how that permit holder has undertaken to comply with legislative requirements; its provisions may be more stringent than those contained in the Drugs, Poisons and Controlled Substances Regulations 2017. The Director of Nursing commonly manages the Health Services Permit documentation.
Clinical Circumstances and Medicines
The Minister for Health has also approved the clinical circumstances in which Schedule 2, 3, 4 and 8 poisons may be used, sold or supplied. The clinical circumstances are those set out in the health management protocols in the Primary Clinical Care Manual 9th edition. The approvals allow for authorised registered nurses in approved health services to practice to their full scope in accordance with the 9th edition of the manual. Details may be found on www2.health.vic.gov.au/public-health/drugs-and-poisons/health-practitioners/nurses-and-midwives/nurse-practitioners-and-others-registration-endorsements/authorised-registered-nurses-rural-and-isolated or in the Victoria Government Gazette 4 January 2018, Drugs, Poisons and Controlled Substances Act 1981 Approval under Section 14A at http://www.gazette.vic.gov.au/gazette/Gazettes2018/GG2018G001.pdf#page=13
- Two Schedule 8 poisons, morphine and fentanyl, may now be used by authorised registered nurses in accordance with the Primary Clinical Care Manual 9th edition.
- Some of the Schedule 2, 3, 4 and 8 poisons in the Primary Clinical Care Manual 9th edition are approved only for administration and not for supply. The Schedule 8 poisons may only be administered by an authorised registered nurse within the urgent care setting and not supplied to the patient.
- In the event of an inconsistency between the Approval of the Minister and information published by the Nursing and Midwifery Board of Australia, the Victoria Government Gazette notice of 4 January 2018 represents the lawful situation for authorisation of RIPERNs in relation to Schedule 2, 3, 4 and 8 poisons in Victoria.
Administration and supply of Schedule 3, Schedule 4 and Schedule 8 poisons are addressed within the Drugs, Poisons and Controlled Substances Regulations 2017:
- Supply of a Schedule 4 poison (regulation 39)
- Administration of a Schedule 4 and a Schedule 8 poison (regulation 92)
- Administration or supply of a Schedule 3 poison (regulation 142)
The manner in which an authorised registered nurse is required to comply with the regulations (including storage and recording requirements) will be contained in Health Services Permit documentation held by the approved listed health service at which the authorised registered nurse is employed.
Rural health services - checklist
Rural health services wishing to employ the services of an authorised registered nurse must:
- ensure that the health service has been approved by the Minister for Health as one in which medicines can be administered or supplied by an authorised registered nurse
- ensure that the registered nurse has a current endorsement for Scheduled Medicines (Rural and Isolated Practice) under section 94 of the Health Practitioner Regulation National Law
- ensure that the Health Services Permit documentation reflects the endorsed nurse function
- develop and follow policy that identifies which health management protocols are relevant to the authorised registered nurse scope of practice in relation to administering and supplying the medicines approved by the Minister for Health
- make readily available in the emergency or urgent care area(s) the current controlled version of the Primary Clinical Care Manual 9th edition to support the authorised registered nurse practice
- ensure that, if the authorised registered nurse is unable to contact a medical practitioner or nurse practitioner, the nurse administers and supplies only those medicines approved by the Minister for Health, in accordance with the relevant health management protocol in the Primary Clinical Care Manual 9th edition
- ensure that the authorised registered nurse maintains their competency and evidence of competency, sufficient to meet the annual declaration of competency/recency relevant to their clinical scope of practice.