https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/02/17/prescription-infirmieres-choisir-avec-soin
Recommendations help ensure that safety and best practices guide all nursing actions within expanded scope of practice
By Jacqueline Follis & Mikhaila Alegria
February 17, 2026
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Regardless of the province, or what is ordered or prescribed by nurses, it is essential from a safety perspective that current evidence and best practices guide all nursing actions within their expanded scope of practice.
Takeaway messages
- Nurses have a longstanding responsibility to stay informed about best practices in patient care.
- Choosing Wisely Canada offers recommendations that support safe, evidence-informed practice.
- Nurses can advocate for change at the individual patient level by referring to Choosing Wisely Canada’s recommendations as evidence.
- Nurses can lead advocacy for system changes by embedding Choosing Wisely Canada’s recommendations in their care environments.
The scope of practice of registered nurses (RNs) has increased across Canada to include RN prescribing under specific circumstances. This expanded scope emphasizes the need for RNs to stay current with best practice guidelines and recommendations related to patient care.
As crucial members of the health-care team, nurses have to be aware of recommendations or guidelines concerning medication orders placed by authorized providers. RNs understand that to administer or follow an order placed by another health-care professional, the nurse must have the requisite knowledge, skill and judgment. It is within the nursing scope of practice to advocate for appropriate care for their patients, including declining medically unwarranted orders.
Prescribing across Canada
In Canada, RNs who complete specialty education and certification now have an expanded scope to enable them to prescribe medications in the following provinces: Alberta, British Columbia, Manitoba, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Saskatchewan and Quebec. In 2023, an amendment was created for RNs registered with the College and Association of Nurses of the Northwest Territories and Nunavut that introduced the development of nurse prescribing for RNs and registered practical nurses. Consequently, nine out of the 13 provinces and territories in Canada now permit some form of RN prescribing.
Each provincial and territorial nursing college has established standards outlining what these specialty-certified nurses are allowed to prescribe. In some provinces, this scope includes the ability to order diagnostic tests. RN prescribing varies widely across the country, both in breadth and application. The following three provincial examples illustrates the variability. Please consult the appropriate regulatory body for your province to verify the standards and scope for RN prescribing and ordering.
In Alberta, the following conditions must be met for a nurse to be able to prescribe Schedule 1 drugs and order diagnostic tests:
- Educational requirements: Before being authorized, a nurse must successfully complete an approved nursing program for prescribing and ordering diagnostic tests.
- Clinical practice hours: Before being authorized, a nurse must complete a minimum of 3,000 hours of RN clinical practice that satisfies the registrar, with at least 750 hours within the specific clinical practice area where they will order diagnostic tests and prescribe.
- Collaborative practice: A nurse must practise in collaboration with other health-care providers.
- Scope of practice: A nurse must only prescribe medications and order diagnostic tests as described in the clinical support tool (College of Registered Nurses of Alberta, 2023).
In Nova Scotia, registered nurses may become registered nurse authorized to prescribe (RN-AP) when they meet NSCN’s regulatory requirements and receive employer support, as RN prescribing is enabled through employer authorizing mechanisms and policies (Nova Scotia College of Nursing [NSCN], 2022). RN-APs prescribe within their area of competence and only for employer-identified client health conditions, and may prescribe medications, devices, and order relevant screening or diagnostic tests as permitted by their role (NSCN, 2022, 2025). They must complete additional education and satisfy NSCN’s registration requirements to obtain authorization to prescribe (NSCN, 2022). RN-APs are not authorized to prescribe medical cannabis, methadone, investigational agents, or medicines listed under the Controlled Drugs and Substances Act (NSCN, 2022).
Ontario is the most recent province to pass legislation allowing RN prescribing in authorized practice settings. The scope of RN prescribing is further limited for the following purposes:
- Immunization
- Contraception
- Travel health
- Topical wound care
- Smoking cessation
- Anesthetics (topical only)
- Epinephrine for anaphylaxis
- Over-the-counter medication (College of Nurses of Ontario, 2024)
Choosing Wisely Canada
Regardless of the province, or what is ordered or prescribed by nurses, it is essential from a safety perspective that current evidence and best practices guide all nursing actions within their expanded scope of practice.
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments. This clinician-led initiative collaborates with national clinical societies and associations to develop recommendations on frequently overused tests and treatments that can expose patients to potential harm, consume valuable health-care resources, and contribute to the climate crisis. Choosing Wisely Canada mobilizes health-care providers and their organizations to adopt the recommendations and integrate them into routine practice.
The RN prescriber can access Choosing Wisely Canada’s recommendations and resources organized by specialty or practice environment and use them to help determine appropriate and necessary treatments. Here are two examples.
Crohn’s disease
A recommendation relevant to a patient presenting with Crohn’s disease, found under the Gastroenterology campaign, is: “Don’t prescribe oral corticosteroids in adults with Crohn’s disease of any severity in order to maintain complete remission” (Choosing Wisely Canada, 2025a). Read all 13 recommendations and rationales.
Antibiotics
Another example can be found within the broader Using Antibiotics Wisely in Long-term Care campaign: “Many older adults receive antibiotics for bladder infections even though they do not have symptoms” (Choosing Wisely Canada, 2025b)”. Read all nine recommendations and rationales.
Emphasis on patient safety
Choosing Wisely Canada’s message emphasizes improving patient safety, making judicious use of limited health-care resources, and supporting health-care practitioners in avoiding low-value care. Low-value care involves treatments and tests where there is no evidence of benefit that it will decrease the risk of adverse events related to unnecessary procedures and medications. By reducing low-value care, nurses act as “good stewards” to our limited health-care resources and help decrease the burden on our environment.
What can you do as a nurse in your care environment?
Are you an RN with an expanded scope of practice or a nurse who wants to ensure your patients receive high-value care?
Here are some steps you can take:
- Review the Choosing Wisely Canada recommendations for your care environment to identify commonly used tests and treatments that are not supported by evidence and may expose patients to unnecessary harm. Use this information to guide your prescribing practices.
- Advocate for change in your care environment by working with your quality improvement teams or change champions to embed Choosing Wisely Canada’s recommendations in your ordering guidelines and organizational practices.
- Join the Choosing Wisely Canada Nursing community of practice, which brings together nursing professionals engaged or interested in Choosing Wisely initiatives, providing a platform to discuss recommendations, share implementation success stories and challenges, and identify collaboration opportunities with nursing professionals across the country. For more information, reach out to info@choosingwiselycanada.org.
References
Choosing Wisely Canada. (2025a). Gastroenterology. https://choosingwiselycanada.org/recommendation/gastroenterology/
Choosing Wisely Canada. (2025b). Using antibiotics wisely for long-term care. https://choosingwiselycanada.org/long-term-care/antibiotics/#practice-statement
College of Nurses of Ontario. (2024). RN prescribing practice. https://www.cno.org/en/learn-about-standards-guidelines/rn-prescribing/#title2
College of Registered Nurses of Alberta. (2023). Competencies for registered nurse prescribing schedule 1 drugs and ordering diagnostic tests. https://www.nurses.ab.ca/media/drbhiehy/3-competencies-for-registered-nurse-prescribing-schedule-1-drugs-and-ordering-diagnostic-tests-2022.pdf
Nova Scotia College of Nursing. (2022). Standards of practice for RN prescribers (January 1, 2022). https://www.nscn.ca/sites/default/files/documents/resources/RN_Prescriber_Standards.pdf
Nova Scotia College of Nursing. (2025). RN prescriber practice guidelines (December 2025). https://cdn3.nscn.ca/sites/default/files/documents/resources/RN_Prescriber_Practice_Guidelines.pdf
Jacqueline Follis, MSN, RN, is the former nurse lead for Choosing Wisely Canada, retired adjunct lecturer with the University of Toronto’s Lawrence Bloomberg Faculty of Nursing, and a Fellow of the Centre for Quality Improvement and Patient Safety.
Mikhaila Alegria, RN, BScN, MScHQ, is the quality improvement specialist for the University Health Network’s Sprott Centre for Quality and Safety and a Fellow of the Centre for Quality Improvement and Patient Safety.
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