Policy Implementation: Nurse Prescribing

I have been involved in a number of projects and initiatives aimed at implementing policy directives.

I provide one example below, that highlights my role in leading a team to create and deliver a training and education pathway for nurses to prescribe controlled medications. The objective of this policy change was to enhance the treatment capacity of the health system by increasing the number of qualified health care providers authorized to prescribe evidence-based treatments for opioid use disorder. Ultimately, the goal was to improve access to care and treatment among those with opioid use disorder.  

Background

In September 2020, the BC Public Health Officer issued a public health order authorizing registered nurses (RNs) and registered psychiatric nurses (RPNs) to prescribe treatments and pharmaceutical alternatives to help separate individuals from the toxic drug supply.

Key Elements for Success

As part of a phased approach, I led a team at BCCSU to develop an education and training pathway to support RNs and RPNs in prescribing buprenorphine/naloxone (first line treatment for opioid use disorder). I performed the following:

  • Supported the team in developing a work plan across a number of departments, adapting as needed to many changing variables and shifting timelines

  • Worked closely with a number of stakeholders regarding the policy directive: BC College of Nurses and Midwives, Ministry of Health Nursing Policy Secretariat, Ministry of Mental Health and Addictions, nursing professional practice leads in each regional health authority

  • Provided leadership in the recruitment of nursing leaders (academic, clinical) to populate an education committee

  • Provided leadership to program managers on my team in the development of a decision support tool for RNs and RPNs to guide prescribing of buprenorphine/naloxone in specific circumstances, following completion of the training program (and where a number of other criteria were met)

  • Provided feedback and advice on early evaluation planning activities, led by government

  • Provided guidance to staff and supported implementation activities, including:

    • Stakeholder engagement with regional and provincial health authorities to gain buy-in of the approach

    • Working closely with stakeholders to ensure the online curricula and preceptorships would meet education needs and that the decision support tool could be adopted in each regional health authority

    • Delivering the first educational webinar, in collaboration with nurse practitioners involved in the project, the regulatory college and other BCCSU staff

At the time of writing, over 50 RNs and RPNs have been fully trained, with representation from each regional health authority in British Columbia. Efforts are ongoing to identify additional RNs and RPNs to fill critical opioid use disorder care gaps in a variety of communities in the province.

The decision support tool can be found here.

The nursing stream of the Provincial Opioid Addiction Treatment Support Program is free and accessible, hosted by UBC Continuing Professional Development here.