Can RN prescribing lead to new professional liability risks?
A growing number of jurisdictions across Canada are expanding the scope of practice of registered nurses to enable certain RNs to diagnose and prescribe within their expertise, practice setting and patient population. The circumstances in which RNs can diagnose and prescribe vary from one jurisdiction to another.
In Quebec, for example, authorized RNs may order laboratory tests and prescribe medications for wound care, public health matters (including contraception, smoking cessation and treatment of sexually transmitted diseases) and other common health issues. Saskatchewan nurses who hold a licence known as RN with Additional Authorized Practice may diagnose and treat specific common medical disorders when working in primary care in remote areas. The provincial governments and regulatory bodies of Ontario, Manitoba and Alberta are in the process of introducing RN prescribing. Other regulators are exploring this option.
In British Columbia, RNs may not prescribe but, with the appropriate certification from the regulatory body, may diagnose, treat and dispense medications for contraceptive management, sexually transmitted infections or minor illnesses.
The decision to expand the scope of practice of RNs was made after a careful assessment of the risks and within a framework to optimize patient safety. RNs who are authorized to diagnose and prescribe must generally complete additional education and undergo an evaluation process to ensure they have the necessary competencies. RN prescribers also benefit from supportive measures such as guidelines, clinical decision tools and access to physicians or nurse practitioners for consultation. Despite these measures, complications may still occur.
If a patient believes that the complication is the result of negligence in the provision of care, the patient (or someone on the patient’s behalf) may initiate litigation for financial compensation. While any health-care professional who participated in the care may be named in the litigation, the professional who recommended the course of treatment is most often the primary focus. Accordingly, an RN who assessed and diagnosed the patient and prescribed the treatment may be more likely to be named in a litigation resulting from that treatment than an RN who cared for a patient but did not recommend the course of treatment that was ultimately administered.
Professional liability protection
RN prescribers generally practise in a facility that has legal obligations to its patients or clients. For instance, health-care facilities, including private clinics, are generally expected to supply the instruments used to assess patients and implement processes to communicate test results and followup care. It is important for RN prescribers and the facility where they practise to each have adequate professional liability protection. Because the amounts of compensation awarded by the courts tend to increase over time, the amount of liability protection available should be reviewed and adjusted to ensure that it remains sufficient.
Nurses have traditionally relied on the facility where they work to have adequate liability protection to respond on their behalf in case of litigation. In a changing landscape where different health-care delivery models are being introduced, that assumption is no longer a reliable one. RN prescribers should inquire about and know the sources and amounts of professional liability protection available to them in the event of litigation, along with any applicable limitations. They should also find out if the facility itself has adequate professional liability protection, especially when they are working in privately owned facilities.
Information on how to reduce the risk of adverse outcomes and litigation when prescribing medication can be found in the CNPS infoLAW on RN prescribing.
CNPS beneficiaries can call 1-844-4MY-CNPS (1-844-469-2677) to obtain legal advice and guidance on this issue. They are also invited to register for an upcoming webinar on RN prescribing and risk management. More information and a complete listing of webinars are available at cnps.ca.
Disclaimer: This article is for information purposes only. Nothing in it should be construed as legal advice from any lawyer, contributor or the CNPS. Readers should consult legal counsel for specific advice.