Registered nurses, including audiometry and ear health nurses, may in future be able to prescribe antibiotics for otitis media under a new regulatory standard that gives registered nurses (RNs) prescribing powers.
The regulatory standard enables RNs to become registered nurse prescribers and prescribe certain medicines in partnership with nurse practitioners and medical practitioners. It began in Australia on 30 September 2025.
The Australian College of Nursing (ACN) said the change reflected a practice that was already in place in other countries, including the UK and New Zealand.
A La Trobe University nursing lecturer told Hearing Practitioner Australia (HPA) that the move would change audiometry nurses’ practice.
The ACN and the lecturer confirmed the change may allow nurses to prescribe for ear conditions, including with antibiotics, providing it was in partnership with a nurse practitioner or medical practitioner including an ENT specialist, and they completed the required training and endorsement.
This included completing the requisite education, period of supervision, and attaining endorsement from the Nursing and Midwifery Board of Australia (NMBA), the ACN said, in a media release on 30 September 2025.
Registered nurses who receive this endorsement will only be qualified to prescribe (and administer, obtain, possess, and supply) in partnership with an authorised prescriber (a nurse practitioner or a medical practitioner), in a model known as ‘partnership prescribing’.
RACGP opposed
However, the Royal Australian College of GPs (RACGP) is opposed to the move.
Dr Cathryn Hester, RACGP Queensland chair, and a board member of West Moreton Hospital and Health Service, is not in favour of registered nurses prescribing antibiotics for otitis media.
“This is not a good idea,” she told HPA. “Antimicrobial resistance to antibiotics is a major global health challenge and wanton prescribing of antibiotics results in patients suffering considerable harm when antibiotics are no longer effective against infections.
“GPs know that uncomplicated otitis media very rarely necessitates the use of antibiotics, and our advice to parents centres around comfort care, and red-flags for escalation.”
Biggest change in decades
The ACN said it was one of the biggest changes for the nursing profession in decades and had the potential to revolutionise the delivery of quality, efficient, and accessible care.
“There will need to be a concerted effort to ensure strong collaboration between employers, who will have to agree to the partnership arrangement; and authorised health practitioners to support and enable designated registered nurse prescribers to take up this opportunity,” said Australian College of Nursing chief nursing officer, Ms Frances Rice.
Ms Corinne Dunningham, senior lecturer and course coordinator for the Master of Nurse Practitioner at La Trobe University’s School of Nursing and Midwifery, is a nurse practitioner who prescribes autonomously.
“Registered nurses (RNs), who have the appropriate qualifications, training and endorsement as a registered nurse prescriber through the Australian Health Practitioner Agency (Ahpra), will be able to prescribe medications under a partnered prescribing framework with an autonomous prescriber such as a GP, nurse practitioner (NP) or for audiometry specifically – an ENT specialist or equivalent,” she told Hearing Practitioner Australia (HPA.)
“Antibiotics are an example of medications which designated RN prescribers may be able to prescribe.”
Antimicrobial stewardship
Dunningham said the exact medications and prescribing conditions would be determined by governance and partnership frameworks between the autonomous prescriber, RN prescriber and the health organisation they work for.
“However, within the legislation, antibiotics fall into category four medications, which RNs will be able to prescribe,” she said.
“As part of the nationally accredited RN prescriber training, RNs will learn antimicrobial stewardship and safe prescribing principles which are fundamental in safe and judicious prescribing under national guidelines.”
Before the change, RNs were responsible for dispensing prescribed medications only; not prescription writing, Dunningham said.
“The foundational work of the nurse will not change,” she said. “Instead, prescribing is another tool for RNs to provide holistic care for patients in situations where there may be delays in care or prescription access, including in rural and remote areas where access to clinicians (medical/nurse practitioners) is limited.”
Other examples of RN prescribing models outside audiometry included clinician limited clinics that were primarily nurse led (although prescribing governance frameworks must still be in place and an autonomous prescriber still needs to be present); primary care where GP wait lists are long for routine prescriptions; or in outpatient clinics where medications can be initiated before seeing the specialist clinician.
Dunningham said expanding RN scope of practice to designated prescriber did not take away from other medical and allied health clinicians. Instead, it ensured patients were getting around-the-clock access to medications in areas or situations where they might not have been able to access them previously.
“Those who become designated RN prescribers have undergone a robust, evidence-based and nationally accredited training program,” she said. “They are also subject to more oversight and professional development requirements than other nurses, specifically in prescribing and pharmacology.”
Patient safety is paramount
In any role expansion, patient safety was paramount, she added.
“This is why nationally accredited tertiary education, in combination with strong governance frameworks and robust prescribing partnerships, are required to be developed between organisations, designated RN prescribers and autonomous prescribing clinicians,” Dunningham said.
“RNs know their patients well and advocate for care when barriers or delays to care arise. This designated RN prescribing pathway was developed to respond to barriers in practice and care delays; therefore, it is a natural progression of the RN role of advocacy and timely access to care.”
The ACN said health ministers must ensure the new prescribing power was implemented smoothly and consistently across all jurisdictions, with comprehensive support from all parts of the healthcare sector.
ACN chief nursing officer Ms Frances Rice said the next steps were:
- a communications campaign to ensure awareness of the change across the healthcare sector and the public
- education for employers and authorised health practitioners on supervising and being in a partnership arrangement with a registered nurse
- and access to Pharmaceutical Benefits Scheme subsidies for prescriptions by registered nurse prescribers.
She said registered nurses could currently initiate medications from an extremely limited range of medicines, including mild analgesia and laxatives which hindered their ability to provide comprehensive care to patients.
Improve access
The new standard would enable them to prescribe from a broader range of medications defined by a prescribing agreement with their prescribing partner and defined by their scope of practice. An example could be adjusting a patients’ diabetes medication.
Dean, Nursing and Midwifery, at La Trobe University, and registered nurse, Professor Marie Gerdtz, said empowering RNs to prescribe medicines would improve access to care and support safer, more effective medicine use, especially in communities where seeing a doctor wasn’t always easy.
“Success will depend on high-quality education, robust clinical supervision, strong collaboration across health professions, and clear, nationally consistent standards,” she said. “Ongoing and transparent evaluation is essential to maintain safety, accountability and equitable access as these changes take effect.
“Implementation should be monitored by tracking nurse completion of accredited prescribing programs, ensuring education providers meet quality standards, and confirming graduates practise safely and competently.”
Professor Jane Mills, La Trobe University Pro Vice-Chancellor for Health Innovation (Regional) and Dean of the La Trobe Rural Health School, said RN prescribing would mean faster, local access to treatment, and no more unnecessary delays or long journeys.
“In rural and remote areas, nurses are often the first point of contact for healthcare; prescribing authority means faster access to essential medicines and continuity of care,” she said. “This change has the potential to reduce hospital admissions, lower costs and free up doctors for complex cases. “
Read the endorsement for scheduled medicines designated RN prescriber information.
