For those of us working at the coalface of ADHD assessment, this change is more than a technical tweak to regulations – it is a long‑overdue recognition of nurse practitioners’ expertise and an important step towards more timely, equitable ADHD care.
What is changing – and why it matters?
Medsafe’s new Gazette notice and Pharmac’s decision update remove the requirement that ADHD stimulant treatment must be initiated or endorsed only by psychiatrists or paediatricians, and instead allow nurse practitioners to diagnose ADHD and start methylphenidate, dexamfetamine and lisdexamfetamine within their scope. Pharmac has aligned funding rules so nurse practitioners can submit and manage special authority applications directly, rather than relying on a medical specialist’s signature. The explicit intent is to expand the prescriber workforce, improve timeliness of diagnosis and treatment, and relieve pressure on specialist services that have struggled to meet demand.
ADHD is common, impairing and treatable, yet many people in Aotearoa wait years for an assessment and even longer for funded medication. In everyday nursing practice, especially in community mental health and primary care, we see the impact of untreated ADHD: school exclusions, relationship breakdowns, job losses, injuries, and preventable co‑occurring depression, anxiety and substance use. When stimulants are carefully prescribed as part of a broader plan, the benefits can be profound – improved focus and organisation, reduced risk‑taking, better work and study performance, and a renewed sense of self‑efficacy for people who have spent years feeling like they are ‘failing’.
Allowing nurse practitioners to diagnose and prescribe will not, on its own, solve workforce shortages, but it removes a structural bottleneck that has forced many service users to wait for a single specialist signature. People can now access treatment through clinicians who already know them, their whānau and their context, and who are used to working across physical and mental health needs.
Recognising nurse practitioner mahi
The Ministry of Health’s (MOH) clinical principles framework emphasises that ADHD assessment and diagnosis should be undertaken by appropriately trained clinicians with expertise in ADHD, including nurse practitioners working within their area of practice. Medsafe’s consultation similarly acknowledged that nurse practitioners already hold advanced skills in assessment, diagnosis and prescribing for complex conditions, including controlled drugs. Across the motu, mental health nurse practitioners have been completing comprehensive ADHD assessments, coordinating multidisciplinary input and managing long‑term follow‑up, while having to rely on a psychiatrist’s approval to prescribe stimulants or renew special authorities.
This has been inefficient for services and frustrating for service users, who often perceive that the nurse practitioner ‘doing the mahi’ is not allowed to finish the job. Bringing prescribing and diagnostic authority into alignment with actual practice closes that gap. It formally recognises that nurse practitioners are autonomous clinicians who bring nursing philosophy, advanced clinical reasoning and a strong focus on whānau‑centred care, risk assessment and supported decision‑making to ADHD treatment. It also affirms NZNO’s long‑standing advocacy for nursing leadership and advanced practice roles that use the full extent of nurses’ education and experience.
Equity, access and a nursing lens
Nurse practitioners are often embedded in communities where ADHD is under‑recognised and under‑treated – Māori and Pasifika whānau, people in low‑income suburbs, and those navigating MSD, ACC, justice and Oranga Tamariki systems. In these settings, ADHD rarely arrives as a neat, standalone diagnosis; it sits alongside trauma, housing instability, substance use and chronic health conditions. Clinical principles for ADHD in Aotearoa emphasise cultural safety, te Tiriti obligations and attention to social context as core elements of quality care, not optional extras.
“When stimulants are carefully prescribed as part of a broader plan, the benefits can be profound.”
A nursing lens means seeing ADHD not just as a cluster of symptoms but as a pattern of life‑long barriers that can be shifted when systems adapt around the person. Nurse practitioners are well placed to integrate ADHD assessments into existing nursing relationships, reducing the need for multiple referrals and fragmented care pathways. They can provide psychoeducation that is accessible, culturally grounded and whānau‑inclusive, and advocate for reasonable adjustments in education and workplaces, linking people with peer support, ADHD networks and community resources beyond the clinic.
When stimulant prescribing sits within this broader, relational model of nursing care, the risk of ‘diagnose and dispense’ is reduced and the potential for genuine life change is increased.
Safety, training and stewardship
Any expansion of prescribing must be matched with robust training, clear standards and good systems. Medsafe and Pharmac have explicitly timed the implementation date to align with new clinical frameworks and to allow development of education programmes and guidance for practitioners initiating ADHD medicines. Nursing and nurse practitioner organisations now have an opportunity and responsibility to support consistent, evidence‑based practice – including nurse practitioner‑led education, peer supervision and clinical networks.
From a nurse practitioner perspective, safe stewardship of stimulants means comprehensive assessment that rules out alternative explanations for inattention, including sleep problems, mood and anxiety disorders, trauma, substance use, learning disability and medical or neurological conditions. It requires baseline cardiovascular and metabolic screening with ongoing monitoring, especially where there are comorbidities and polypharmacy, following recommended review intervals for weight, blood pressure and pulse. It also requires clear escalation pathways and shared‑care arrangements with psychiatrists, paediatricians and other specialists for complex presentations or safety concerns. Current methylphenidate shortages and supply changes add another layer, so nurse practitioners will need to stay familiar with new funded formulations, switching strategies and communication with whānau about supply.
Nurse practitioners are already accustomed to operating within prescribing frameworks for controlled drugs, including regular audit, peer review and adherence to local policies. Extending this to ADHD stimulants is a natural progression rather than a radical departure.
Challenges, risks and opportunities
There are real risks. Increased eligibility and more prescribers will drive demand into systems that are already under strain, particularly in regions with limited mental health services or high staff turnover. Without adequate investment in training, supervision and time for thorough assessments, there is a danger of narrow, medication‑only responses that fail to address trauma, learning needs and social determinants. There is also a risk that inequities simply shift rather than shrink: people with the resources to self‑advocate may access diagnosis and treatment more quickly than those facing language barriers, stigma or previous negative experiences with health services.
Nurse practitioners, with their grounding in advocacy, te Tiriti obligations and equity, have a key role in resisting this drift by actively prioritising under‑served communities and using their expanded authority to challenge, not reinforce, existing gaps. This includes speaking up about service design, staffing and funding, and ensuring that ADHD pathways work for those who most need them, not just for those who shout loudest.
This change arrives at a time when public understanding of ADHD is rapidly evolving, particularly among adults and women whose symptoms were missed in childhood. It invites nurse practitioners to step fully into ADHD care – not just as implementers of others’ decisions, but as clinicians who lead assessment pathways, design service models and contribute to research, policy and guideline development. For individual NPs, it will mean new responsibilities, but also new opportunities for advanced practice, mentorship and leadership within multidisciplinary teams and within NZNO.
On February 1, 2026, the legal wording changes; the real work is what happens next in our clinics, communities and services. As nurse practitioners, we are ready to do that mahi alongside our nursing colleagues, people with lived experience of ADHD, and their whānau.
- Sam Hargreaves is a mental health nurse practitioner working for Te Whatu Ora in South Auckland and in private practice, with a focus on ADHD assessment and treatment across the lifespan. He was a member of the Ministry of Health clinical reference group and a working group with Pharmac that helped develop the New Zealand Clinical Principles Framework for ADHD and the upcoming changes to ADHD prescribing and training requirements.