The College of Nurses of Ontario (CNO) has regulated Registered Nurses in the Extended Class (RN(EC)s) since 1998. These RN(EC)s are nurses who have the independent legal authority to communicate diagnoses, order certain laboratory tests, x-rays and ultrasounds, and prescribe certain drugs.

On August 29, 2007 new regulations were passed to legally protect the title “nurse practitioner” and the abbreviation “NP” and to limit their use to RN(EC)s. This means that pharmacists may start to receive prescriptions signed by nurses identifying themselves as NPs, in addition to those signed by nurses who continue to use the RN(EC) terminology. CNO has confirmed that use of either title is permitted. NPs may also choose to further indicate their specialty designation; that is, whether they are an NP in the Adult, Paediatrics or Primary Health Care specialties. All NPs must document their CNO registration number on each prescription.

CNO has spent the past several months – before and after the regulations were passed – educating its members about title protection. Nurses who are not in the extended class, but historically used the NP title, have been required to stop the use of the NP title until such time as they are registered in the extended class. It is up to nurses, as self regulating professionals, to use their legal titles ppropriately.

As always, if pharmacists need to verify whether a nurse is an NP, they can do so by contacting CNO’s customer service line at: 416 928-0900 or 1 800 387-5526 (toll free in Ontario) A prescription received from an NP for a drug that he/she is legally authorized to prescribe is not to be confused with prescriptions you may receive written through the use of authorizing mechanisms, such as directives. A directive is most often authorized by a physician.

Nurses may use directives to implement prescriptions under conditions that have been defined by physicians. The directive reflects the physician’s prescription and must clearly state the physician’s name, address and contact information.

Nurses who use directives must identify themselves as either an NP or RN. A template for prescriptions written pursuant to a directive can be found at: http://mdguide.regulatedhealthprofessions.on.ca/pdf/RecommendedFormat.doc