Key messages
- Victoria has changed its drugs and poisons regulatory scheme to safeguard the rural and isolated practice registered nurse (RIPRN) model of care.
- A legal mechanism called a Secretary Approval enables scheduled medicines practice – including conditions (such as experience, qualifications, location, type of medicines and clinical circumstances).
- There is no change to rural and isolated practice endorsement (RIP) registered nurses who will continue to provide vital healthcare access to Victoria’s rural and isolated communities.
- Following a post-implementation review in 2023, we have made minor changes to the policy guidance document. Some health services listed in the Secretary Approval have since changed their names and we are currently updating them.
Rural and Isolated Practice Registered Nurses (RIPRNs)
Rural and Isolated Practice Registered Nurses (RIPRNs) are important to rural and remote communities where:
- access to general practitioners (GPs) and pharmacy services is limited
- when urgent health care is required.
Increasingly, registered nurses are undertaking additional training to provide Victorian communities with greater access to primary care and emergency services.
RIPRNs are special registered nurses who work in Victoria's approved rural health services including:
RIPRNs can administer and supply medicines in health services that have department secretarial approval.
RIPRNs have been operating successfully in Victoria since 2012 and in Queensland for many years.
Rural hospital staff will continue the current practice of referring people to their local GP or pharmacist when these services are available.
RIPRN medicine administration and supply
Strict regulations apply around the administration and supply of medicines. A RIPRN:
- Cannot write prescriptions.
- Can only supply or administer medicines in accordance with the health management protocols in the latest edition of the Primary Clinical Care Manual .
- Is not legally able to supply a patient with any Schedules 2, 3 and 4 medicine to take home (unless a doctor's order is given either in person or over the phone).
- Is not able to supply Schedule 8 medications (in accordance with the PCCM).
RIPRN medicine safety handling
Controls on the handling of approved medicines by RIPRNs are included in the Drugs, Poisons and Controlled Substances Regulations . RIPRNs must:
- Keep a written record of any patient they have seen – including details on episode of care, medications administered or supplied.
- Provide every patient with current consumer drug information on medicines supplied.
- Encourage patients to arrange a follow-up appointment with their GP.
- Maintain a central register of medicines used and supplied for medication recalls and to monitor compliance with the latest edition of the PCCM.
- Label all medicines supplied.
Regulatory and policy changes affecting RIPRN practice
The following regulatory and policy changes affecting Victoria's RIPRN model of practice include:
- continuation of the rural and isolated practice (RIP) endorsement model of care
- Secretary approval provision under the Drugs, Poisons and Controlled Substances Regulations 2017
- new updates to the RIPRN policy and guidance.
Changes to rural and isolated practice (RIP) endorsement
Updated legislation governs the practice of registered nurses in Victoria who currently hold a scheduled medicines Rural and Isolated Practice Endorsement (RIP endorsement) from the Nursing and Midwifery Board of Australia .
Following national consultation, the NMBA has ceased the endorsement of registered nurses. Aspiring RIPRNs no longer need to apply to the NMBA for endorsement but will instead be subject to new Drugs, Poisons and Controlled Substances Regulations and Victorian Health Secretary Approval under the protocols of their health service.
From February 2022, Victoria changed its drugs and poisons regulatory scheme to safeguard the Rural and Isolated Practice Endorsed Registered Nurse (RIPERN) model of care.
RIPERNs are now referred to as RIPRNs.
These changes bring Victoria into line with other states and territories, ensuring national consistency to RN medicines practice and reducing regulation at a national level.
Medicines and poisons – Secretary Approval
The Drugs, Poisons and Controlled Substances includes a provision for the Secretary of the Department of Health to:
- Establish a new class of registered nurse – an approved registered nurse – according to specified criteria.
- Approve registered nurses to obtain, possess, sell, supply or administer Schedule 2, 3, 4 and 8 poisons in certain conditions and according to health management protocols in the latest edition of Queensland Health’s Primary Clinical Care Manual .
This is similar to previous circumstances, with additional conditions requiring evidence of professional experience and record keeping.
For authorising conditions and a list of approved health services, bush nursing centres and hospital sites refer to the Medicines and poisons – Secretary approvals webpage.
Rural and isolated practice registered nurse (RIPRN) policy and guidance changes
RIPRN policy and guidance has recently been updated (June 2023) to support approved health services and clinicians to adopt the Rural and Isolated Practice Registered Nurse (RIPRN) function. The guide supports implementation that is collaborative, safe and compliant with the law. It outlines:
- role and responsibilities
- the new regulatory framework and what it means for competency; education, experience, and additional conditions
- quality and safety
- governance
- supply and administration of medicines
- medico-legal issues and resources for introducing the RIPRN model to an approved site
- locations where RIPRNs can practice.
This document replaces the 2012 nurse endorsement policy framework and toolkit.
RIPRN model advantages
Registered nurses with scheduled medicines training have been practising safely in rural and isolated practice settings for many years. An evaluation of the Victorian collaborative practice model :
- increased skill and confidence of the endorsed nurses
- better work-life balance for participating general practitioners (GPs)
- improved collegial relationships between general practitioners and nurses working in urgent care centres
- broad acceptance of the model by the community.
RIPRN training
RIPRNs undertake additional training in pharmacology and clinical assessment. Two courses are available:
Reviewed 13 November 2023