Rural and isolated practice endorsement
The term ‘authorised registered nurse’ means a registered nurse (Division 1) whose registration is endorsed by the Nursing and Midwifery Board of Australia, under s. 94 of the Health Practitioner Regulation National Law with the Scheduled Medicines (Rural and Isolated Practice) endorsement.
The endorsement allows Rural and Isolated Practice Registered Nurses (RIPERNs) to provide a limited range of medicines where there is no, or limited, access to general practitioners, nurse practitioners, paramedics or pharmacists. In Victoria, scheduled medicines approved by the Minister have been restricted to specified medicines in Schedules 2, 3 and 4.
RIPERNs – skills and capabilities
The RIPERN role is best implemented through a collaborative, team-based model of care. The model allows 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 advanced skills and capabilities provided by RIPERNs allow health services to provide a wider range of services to improve access to timely, safe and appropriate care.
In Victoria, RIPERNs use the health management protocols contained in Queensland’s Primary clinical care manual, 8th edition, as the clinical standard to guide their practice, and reinforce safe and effective nursing practice.
RIPERNs must work within state or territory legislation relating to medicines. In Victoria, the Drugs, Poisons and Controlled Substances Act 1981 authorises any registered nurse whose registration is endorsed to supply and administer approved medicines.
These medicines, the clinical circumstances for which they are used and the health services in which RIPERNs may practise must be approved by the Minister for Health and are in the gazetted approval.
For further information to assist RIPERNs and health services in understanding their obligations under the legislation, see ‘Licences and permits’.
RIPERNs – policy framework and toolkit
The RIPERN function brings with it specific legislative and clinical governance responsibilities for the health services that use the services of endorsed nurses, and for the RIPERNs 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.
Clinical governance is, at its core, about being accountable for providing timely, appropriate and safe care to patients, and is fundamental to continuous improvement in patient safety. Public health services and public hospitals must comply with the Victorian clinical governance policy framework.
Accordingly, the approach taken to adopting and managing RIPERNs must be underpinned by the principles articulated in the clinical governance policy framework.
The report Medico-legal issues: Rural Collaborative Practice Project explores the medico-legal issues and considers strategies to manage these issues.
RIPERNs – 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).
Currently, Queensland Health and the University of Southern Queensland provide the only RIPERN training programs (accredited by the NBMA). Once the NMBA has established the new accreditation standards for RIPERN training, more programs may be developed.
If you are working in a Victorian public health service, you may be eligible for a scholarship to support postgraduate study in areas of clinical practice that your employer nominates as important to their service.
Administration and supply of medicines approved by the Minister
Whereas other registered nurses are authorised to possess scheduled medicines for administration to patients under their care (in accordance with the Regulations), most are not authorised to supply scheduled medicines or to initiate treatment with prescription-only medicines.
An authorised registered nurse (RIPERN) on duty in an approved rural hospital 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 Rural Collaborative Practice Model, under which health practitioners continuously negotiate their roles based on their respective skills and availability.
Accordingly, an authorised registered nurse may administer or supply scheduled medicines that have been approved by the Minister for Health in the lawful practice of their profession under the following conditions:
- The nurse is a registered nurse (Division 1), and the registration is endorsed for Scheduled Medicines (Rural and Isolated Practice).
- The nurse is employed and practising within a health service or class of health services approved by the Minister for Health (see page 3 for more information about health services).
- The nurse is acting under clinical circumstances approved by the Minister for Health, incorporating relevant health management protocols that set out the conditions and restrictions applying to the use and supply of medicines, as described in edition 8 of the Primary clinical care manual. The approved medicines, health services, clinical circumstances and route of administration are published in the Victorian Government Gazette.
Health Services Permit and Poisons Control Plan
The health services approved by the minister to engage the services of authorised registered nurses are certain rural hospitals in Victoria. Each rural hospital has a Health Services Permit (HSP) that authorises the hospital to possess scheduled medicines for the provision of health services.
Each HSP contains conditions that are specific to the type of health service provided – for example, the conditions for a hospital differ from those of a bush nursing centre. Each HSP has a corresponding Poisons Control Plan (PCP), which contains details of the manner in which the permit holder has undertaken to comply with legislative requirements.
The PCP might contain requirements that are more specific or additional to the legislative requirements that relate, in general, to other registered nurses.
Health services engaging the services of authorised registered nurses should update their current PCP to include Part 6, which applies to the use of authorised registered nurses.
Authorised registered nurses should refer to the HSP and the PCP of the participating rural hospital to examine details of the manner in which the permit holder is required, and has undertaken, to comply with legislative requirements.
The Director of pharmacy and/or the Director of nursing commonly manage the HSP and the PCP; in some cases, the poisons control plan might be available on the hospital’s intranet.
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 supplied by an authorised registered nurse
- ensure that the registered nurse has a current endorsement for Scheduled Medicines (Rural and Isolated Practice) under s. 94 of the Health Practitioner Regulation National Law
- ensure that the hospital’s Poisons Control Plan 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 using 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 8th edition of the Primary clinical care manual 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 uses and supplies only those medicines approved by the Minister for Health, in accordance with the relevant health management protocol in the 8th edition of the Primary clinical care manual
- 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.