Minutes March 7 and 8, 2001
Present:
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M. MacLeod,
Chairperson |
E. Haugh |
S. Richardson |
Unable to Attend: D. Tysick
Staff:
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A. Coghlan |
G. Mackay |
G. Siskind |
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AGENDA |
The agenda had been circulated. |
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Motion 1 |
Moved by P. Howe, seconded by R. Kitson, That the agenda be approved. CARRIED |
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MINUTES |
Minutes of the Council meeting of December 13 and 14, 2000 had been circulated. A typographical error on page 186 was corrected. |
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Motion 2 |
Moved by L. Vanson, seconded by B. Rowley, That the minutes of the Council meeting of December 13 and 14, 2000 be accepted as corrected. CARRIED
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EVALUATION OF DECEMBER COUNCIL |
Council received the summary of the evaluation of the December meeting. While the rate of response to the evaluation has improved with the new tool, it was noted that the Executive remains concerned that all Council members need to participate.
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RPN EDUCATION |
M. MacLeod reviewed the history of this issue, noting the activities undertaken by the college as well as stakeholders. B. Rowley provided an overview of the perspective of the Registration Committee. She noted that Private Vocational Schools had expressed an interest in providing RPN programs. The Registration Committee had concerns because these schools have no standardized approval program and are skill focused. C. Vigar reviewed the process for gathering the data for the discussion. She noted that CNO is concerned that graduates are competent to practice and that the programs meet a standardized approval process. It was noted that Council has made the decision that it will not get into the business of approving programs. The responsibility for approving CAAT programs rests with the Ministry of Training, Colleges and Universities (MTCU). It is CNO’s responsibility to know that there is a satisfactory external review for programs and that the review process measures that graduates meet the entry to practice competencies. MTCU has expressed willingness to work with CNO on a program approval process. Council had a lengthy discussion about the proposed options. Some members identified the need to maximize access to the profession. Some felt that the national examination provided a sufficient test for the entry competencies. The following rationale were articulated for CAAT entry:
Council identified the need to make an investment in the future and to take a strong position regarding RPN entry to practice. |
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Motion 3 |
Moved by P. Howe, seconded by V. Floros-White, That practical nurse applicants for registration must graduate from a practical nurse community college program that incorporates CNO’s entry to practice competencies into its curriculum and that meets a standardized approval process. CARRIED (A. Cunningham and M. Nixon dissenting) |
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In making the decision, Council noted that the wide range of programs, accessibility of CAATs across the province, and availability of student funding provides ready access for individuals wishing to become RPNs. The next step in the process is the preparation of a draft regulation for consideration by Council in June. |
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INITIATION REGULATION |
S. Jenkinson and B. McCracken highlighted the discussion paper and findings in the consultation related to initiation of controlled acts by RPNs. They clarified what constitutes initiation. It was confirmed that there is a lack of understanding in the profession about initiation and there is a need to educate members and employers. The current initiation regulation is not presenting any barriers to clients receiving nursing care. It was noted that existing legislation governing care facilities (e.g. Public Hospitals Act) limits initiation by nurses. CNO continues to address the legislative barriers, however, a change is not anticipated in the near future. It was confirmed that initiation is not an entry competency for either RNs or RPNs, but rather pushes the boundaries of nursing. It was noted that the nurses consulted were more interested in other current practice issues, such as the need to clearly define the different roles of RPNs, RNs, and RN(EC)s, and did not see initiation as an issue. It was also pointed out that, with the exception of RN(EC)s, very few RNs are initiating. Some concern was expressed about potential for further blurring of roles if RPNs initiate. On the other hand, there was discussion about RPNs in the community having the authority to take independent action, as required. |
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Motion 4 |
Moved by E. Howe, seconded by D. Fox, That the current Initiation Regulation that permits initiation of controlled acts procedures to RNs (general and extended class) who meet the identified conditions in the regulation be maintained. DEFEATED |
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With the changes in health care, some members felt it important that RPNs be able to initiate. Discussion on this issue was deferred until after Council’s discussion about Conflict of Interest. |
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CONFLICT OF INTEREST |
A. Bromstein joined Council to highlight his legal opinion related to conflict of interest. He noted that, in law, people who are directors of corporations (Council members) are held to be in a "fiduciary" relationship with the organization. A fiduciary must have unequivocal alliance to the corporate mission of the organization. Therefore, a member cannot be a "fiduciary" of two organizations with related mandates (e.g., nursing professional associations and unions), since there is potential for conflict. It was noted that this is a "positional" conflict -- it is holding the position, not the member’s specific actions, that creates the conflict. Council was informed that more than half of the health regulatory Colleges have regulations prohibiting positional conflict and a number of others have policies which address the situation. Some colleges allow members who are in a potential positional conflict to run for election but require them to leave the conflicting duty if and when they are elected. Nursing organizations are not the only example of a potential conflict of fiduciary duty. Each circumstance needs to be reviewed individually within the context of what a reasonable person would believe. Participation on the boards of national and provincial nursing organizations, however, is an obvious positional conflict. It was confirmed that the fiduciary conflict relates only to Council members. Committee members do not have a fiduciary duty to the organization. In addition, staff members of an organization do not have a fiduciary duty. While there may be specific potential conflicts, there is not an over riding conflict when a staff member of a provincial or national nursing organization is on CNO Council. Council had a show of hands vote and supported including the limitation from serving on the provincial or national board of a nursing organization or union in the draft conflict of interest Bylaw. Legal counsel will prepare the Bylaw to address this issue as well as other aspects of conflict of interest. |
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INITIATION REGULATION |
Discussion continued related to amending the initiation regulation to permit RPN initiation. There was considerable discussion about how the change in RPN entry to practice education might relate to this decision. It was confirmed again that initiation is not an entry competency, but is used in extraordinary circumstances by those with additional education and experience. It was clarified that initiating is making an independent decision to perform a procedure that has not been ordered or performed before for that client. It requires a high level of competency. There was some concern expressed that changing the initiation regulation was a "back door" approach to increasing the scope of practice of RPNs. It was recognized that initiation would be rarely used by RPNs, as other options exist, e.g., medical directives and consulting with an RN. It was noted, however that the RHPA allows for evolution of roles to meet client needs, and in the community there may be instances where a client would benefit from an RPN being able to initiate. |
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Motion 5 |
Moved by A. Cunningham, seconded by P. Howe, That the existing Initiation Regulation be revised to provide RPNs with authority to initiate a range of limited procedures and with specified conditions. CARRIED |
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It was identified that there will need to be education to help members to understand initiation. CNO will continue to educate members about the need to advocate in employment settings for appropriate policies and procedures so that initiation is not required. There was some concern expressed that the conditions lacked sufficient detail. It was suggested that the decision tree be revised to include determining whether there is a medical directive, policy, or protocol. It was suggested that there be further consultation about which acts might be initiated by RPNs. It was noted that the regulation will be approved for publication and further consultation can take place at that time.
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REINSTATEMENT |
The proposed revisions to the General Regulation and the fees bylaw related to reinstatement had been circulated to members. It was noted that there had not been significant feedback. |
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General Regulation: |
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Motion 6 |
Moved by S. Millar, seconded by V. Floros-White, That the amendments to the General Regulation related to reinstatement be approved for forwarding to the Ministry of Health and Long-Term Care. CARRIED
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Fees Bylaw: |
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Motion 7 |
Moved by R. Rupert, seconded by L. Lillie, That the proposed amendment to Bylaw 2 (Fees) re. reinstatement be approved. CARRIED
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BYlawS RE. REGISTER AND INFORMATION FROM MEMBERS |
Proposed bylaws related to the register and collection of information from members had been circulated to the membership. There had been limited feedback to the proposals. There was some discussion around requiring information from members for statistical purposes. It was identified that CNO’s data is critical for human resource planning nationally and provincially. CNO has an obligation as the regulatory body to have the authority to collect the information to permit accurate human resource planning. The need to educate members about the rationale was confirmed. |
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Motion 8 |
Moved by S. Millar, seconded by A. Cunningham, That the proposed Bylaws related to the Register and Information from Members be approved. CARRIED
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ANNUAL COMMITTEE REPORTS |
It was noted that presentation of annual committee reports serves as an accountability mechanism between committees and the Council. Chairs will briefly highlight the report and there will be an opportunity to ask questions. |
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Executive Committee |
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M. MacLeod noted a 23% increase in statutory activities due to an increase in mandatory reports. The number of mandatory reports for sexual abuse remained fairly constant. The Executive has seen a significant increase in the number of reports of substandard practice in 2000, with the bulk relating to lack of assessment skills and medication errors. CNO is starting to track the number of new graduates reported for termination. This report shows that the proportion of new graduates reported to the College is slightly higher than the proportion of new graduates in the general membership. |
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Client Relations Committee |
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E. Howe highlighted the report of the Client Relations Committee. Its focus in 2000 was re-evaluating its role, evaluating the abuse prevention program, and abuse prevention orientation of Council and committee members. |
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Complaints Committee |
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P. Howe noted that there has been an increase in the number of complaints addressed through participative resolution. He pointed out that some PRPs have an educational impact on the facility. The process for addressing frivolous and vexatious complaints was highlighted. It was noted that a few have been appealed to HPARB and CNO is awaiting the decisions. |
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Discipline Committee |
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M. Taylor noted a significant increase in the number of cases considered by the Discipline Committee in 2000. 35 out of 45 cases proceeded by an agreed statement of fact and/or joint submission on penalty. Efforts have been focused at the pre-hearing conferences to seek resolution of undisputed facts.
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Fitness to Practise |
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D. Barber noted that informal resolution of incapacity issues has been a very effective use of resources for both CNO and members. She pointed out the rigour of the compliance monitoring processes. |
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Quality Assurance |
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I. Bajnok reported that the committee is continuing with the conceptual and development work around QA program. The committee’s role in the statutory area will be implemented in the near future. A target group identified for Practice Review is those members referred from other committees. Council received an update on work in Practice Review and Reflective Practice. It was reported that the Practice Setting Consultation Program® (PSCP®) continues to move forward. Council was informed that CNO is on target in terms of development of the program.
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Registration Committee |
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B. Rowley reported the progress made in relation to major issues such as exam review. She noted that there has been an increase in requests for review of decisions by HPARB, usually from applicants whose timeframe or number of opportunities to write has expired. All of HPARB’s decisions to date have been in CNO’s favour. A major decision for the Registration Committee was to accept the Quebec examination as an equivalent to the national examination. The Registration Committee is concerned that all applicable members are not self-reporting criminal convictions. The committee will be exploring including a declaration on the Annual Payment Form for 2002. It was noted that the scores that Ontario accepted for language fluency tests were lower than other provinces and have now been brought into line with the rest of the country. M. MacLeod expressed appreciation to the chairs, committees and staff. She noted that the reports confirm the importance of the work of the statutory committees to CNO meeting its mission/vision. |
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EVALUATION OF COUNCIL EFFECTIVENESS |
Council members received a summary of the responses to the evaluation of Council effectiveness. It was noted that a new tool was used for this year, focusing on the governance philosophy. In order to facilitate discussion in an open forum, members were asked to complete the tool in advance. The Governance Committee had identified the process of evaluation of Council as an important part of Council's governance role. The evaluation has three components: process evaluation of each Council meeting, the annual evaluation of effectiveness in March, and the evaluation of individual Council members. In reviewing the responses to the evaluation of Council effectiveness, the Executive expressed concern that not every Council member participated. It was noted that the response to the tool confirms that Council is functioning effectively. Areas of particular strength, and those that need to be strengthened further can be identified. Some of the areas that need to be strengthened may be addressed through ongoing activities (e.g., clarity of annual goals through the new strategic planning process, conflict of interest by the new Conflict of Interest Bylaw). Focused and concise discussion continues to be identified as an area for improvement. This is an area that Council is trying to improve with each meeting and is also monitored through the process evaluation of meetings. There was some discussion about whether there needed to be changes to the tool to facilitate improved response. It was suggested that the tool be maintained for another year, to facilitate comparison and gather more input on what might be improved for the future. The following areas were identified for potential exploration:
There was some discussion about whether to establish a new Governance Committee to review the feedback. After the Governance Committee completed its work, ongoing monitoring of governance became part of the Council role. The Executive was asked to review Council’s feedback and bring forward a plan for addressing the key issues to Council in June. It was confirmed that there has been an increase in focus and the quality of discussion at Council. There needs to be more focus on strategic visioning and regulation for the future. It was suggested that helping Council understand what is a strategic be a continuing focus. It was noted that, with the new approach to strategic planning, CNO will see a real change in how issues and priorities are identified and addressed. The Executive’s concern about the response rate was discussed. It was noted that it is difficult to really analyze the results because the views of non-respondents are not known. Council was asked to articulate a goal for 2002 and identified 100% completion as the target. It was suggested that participation in the evaluation processes be included in the Council members’ responsibilities. It was also suggested that the forms be included in the orientation materials so that new members know they will be asked to complete the evaluation at year-end. |
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EXECUTIVE DIRECTOR |
A. Coghlan highlighted internal and external activities from December through March. She updated Council on some of the internal changes related to implementation of the Leadership Vision and the organizational realignment. |
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EXECUTIVE COMMITTEE |
Minutes of the Executive Committee meetings of January 17, 2001 and February 14, 2001 had distributed. |
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Motion 9 |
Moved by S. Millar, seconded by V. Kerr, That the minutes of the Executive Committee meetings of January 17, 2001 and February 14, 2001 be accepted. CARRIED |
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RNAO LIAISON |
M. MacLeod highlighted the issues discussed at the RNAO liaison. There was some discussion about the current employment statistics and whether they are indicative of an increase in full-time positions in the province. Given the way statistics are currently collected, this is difficult to determine. There was some discussion about the need to address orientation in the workplace. JPNC is preparing submissions for the MOHLTC budget, one of which addresses orientation and mentoring in the workplace. |
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JPNC |
M. MacLeod highlighted the updated Council on JPNC meetings. In discussing JPNC activity in relation to legislation, Council commented on the quality of CNO’s responses to legislation with such short time for consultation. It was noted that while JPNC is not addressing this, the policy group at CNO is developing internal strategies to deal with short-term requests. At the last Council, there was a request for key points in anticipation of a request for response. In addition, some excellent collaborative work with the Federation is facilitating quick responses. |
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EXPENSE POLICIES |
The Executive Committee reviews and recommends changes to expense policies. Some proposals were brought forward for clarity and to provide direction for staff in applying the policy consistently and fairly. |
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Hotel Accommodation |
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The Executive recommended a revision to the policy regarding hotels, to give increased guidance to members. |
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Motion 10 |
Moved by R. Rupert, seconded by D. Barber, That the policy re. overnight accommodation [Section 1(a)] be revised effective June 2001 to include: Hotel accommodation is not generally provided to members who reside within a radius of 40 km of the meeting site. CARRIED
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Incidentals |
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The Executive is recommending that the policies be simplified, reflecting those of other organizations and removing ambiguity about what is a reasonable expense. |
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Motion 11 |
Moved by L. Baker, seconded by M. Nixon, That the expense policies be revised effective June 2001 to remove Section 5 re. Telephone expenses, delete the second sentence of Section 6, and replace Section 5 with: 5. Incidentals A daily incidental allowance of $8.00 may be claimed, without supporting receipts, for telephone calls and other incidentals such as porters. CARRIED |
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Car Allowance |
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CNO has based its car allowance on the government rate, which has been increased. |
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Motion 12 |
Moved by B. Weichel, seconded by S. Keating, That Sections 2 (a) and (b) of the Expense Policies be revised to change the car allowance to 41 cents/kilometre, effective immediately. CARRIED, 1 abstention |
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The change was effective immediately to address rising fuel costs. A public member requested that the College advocate on behalf of public members re. cost of car allowance and government policies which provide no reimbursement for public members living within a specific radius of the meeting. |
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Meal Allowance |
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Council discussed whether the current policy providing for a maximum daily meal allowance of $45, irrespective of the length of the meeting, was equitable. It was noted that this is not a financial issue but rather one of equity. Council supported the current policy, noting that abuse is not a concern. Again, it was suggested that CNO consider addressing the inequity of expenses for public members. |
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NOMINATING COMMITTEE |
The Executive appoints the Nominating Committee from among volunteers, for ratification by Council. |
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Motion 13 |
Moved by V. Floros-White, seconded by S., Richardson, That the appointment of Mary MacLeod, Marg Nixon, Jayne Sanger, Marsha Taylor, Lois Vanson and Kay Wetherall to the Nominating Committee be ratified. CARRIED |
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SCRUTINEERS |
The Executive appoints scrutineers for the election of Council officers, for ratification by Council. |
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Motion 14 |
Moved by S. Keating, seconded by R. Rupert, That the appointment of Marg Axelson, Laird Ross, and Sophie Young as scrutineers for the June 2001 election of officers be ratified. CARRIED |
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AD HOC COMMITTEE ON STRATEGIC PLANNING |
The Ad Hoc Committee is a joint Council/staff committee. The Executive appointed the Council members of the Ad Hoc Committee, for ratification by Council. The Executive Director will appoint the staff members of the committee. |
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Motion 15 |
Moved by S. Millar, seconded by L. Vanson, That the appointment of the current Executive Committee and Irmajean Bajnok, Deanne Barber, Veronica Kerr, Betty Rowley, Marsha Taylor and Bill Weichel as the Council members on the Ad Hoc Committee on Strategic Planning be ratified. CARRIED
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PUBLIC MEMBER EXPENSE POLICIES |
At several points during the meeting, concern had been expressed about the inequity of the expense policies for the public members as compared with CNO’s policies for elected members. |
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Motion 16 |
Moved by P. Howe, seconded by E Howe, That Council send a letter through the President to the appropriate MOHLTC contact to address concern regarding the disparity in the expense policies between public and elected members CARRIED
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While some members expressed concern that it was not appropriate for CNO to intervene in relation to public member expenses and that it could be perceived to be a conflict of interest, a majority of members were concerned about the inequity and supported the motion. |
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NEXT MEETING |
The next meeting of Council will be June 5 and 6, 2001. The Annual Meeting will be at 4p.m. on June 4th. |
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ADJOURNMENT |
At 12:30 p.m., it was |
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Motion 17 |
Moved by V. Floros-White, seconded by S. Young, That Council adjourn. |
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Approved by Council, June 5, 2001