College of Nurses of Ontario Council Minutes
June 5, 2001

Present:

AGENDA

The agenda had been circulated.

Motion 1

MINUTES

The minutes of the Council meeting of March 7 and 8, 2001 had been circulated. The minutes were corrected to include further information related to the issue of RPN initiation and to clarify a trend noted in the Executive Committee report.

There was some question about approving the minutes given that the rationale for the decision to allow RPN initiation had not been captured. M. MacLeod clarified that the rational had not been included in the minutes because it had not been summarized for Council's input and support.

Motion 2

EVALUATION OF MARCH COUNCIL

Council received a summary of the evaluation of the March Council meeting. Observer Guidelines had been prepared as a result of the evaluation input, and an addition was suggested.

PUBLIC MEMBERS

In March, Council approved a motion directing the President to send a letter to the Ministry of Health and Long-Term Care about the disparities between the expense policies of elected and public members. M. MacLeod highlighted the recommendation of the Executive that the motion be rescinded, and its rationale.

There was some discussion about the Executive's decision to bring the issue back to Council. The Executive's rationale was reviewed. It was noted that this issues speaks to the need to have the appropriate information prior to decision-making.

In making the decision to rescind the previous motion, the following rationale was identified: ·

• The issue of remuneration for public member participation at Council falls outside mandate of Council;·
• The Ministry of Health and Long-Term Care is aware of the disparity;·
• CNO is only one of 21 colleges, and any change would have broad impact; and
• The process for making the previous decision was faulty.

It was suggested that, in future, items not be added to the agenda without due notice and appropriate background information.

COUNCIL EFFECTIVENESS

In March, Council discussed the summary of the evaluation of Council effectiveness. While it was found that Council is functioning effectively, some areas for potential improvement were identified and the Executive was asked to develop an action plan.

The Executive proposed an action plan for the coming year that recognizes and builds on the work of the Ad Hoc Committee on Governance and includes discussions of governance at each Council meeting until March of 2002. At that time, the next evaluation of Council effectiveness will take place.

Council supported the content of the plan, noting that it is broad and allows for evolution. It was suggested that a review of the process for decision-making and how issues are added to the agenda be included and that the review of the role of Council members be moved forward.

Council identified its belief that the plan will enhance the understanding of Council and operational responsibilities, and hopefully by the end of the year, there will be a much better understanding of roles and responsibilities. At that time, Council can assess what further work, if any, is required.

It was agreed to bring forward the plan, together with a status update, at each Council meeting.

M. MacLeod introduced the draft governance model. Built on the governance framework, the model delineates the distinct areas of governance and operations and the circumscribed areas of shared accountability.

It was pointed out that statutory committees are not included in the model because, while they have statutory roles essential to CNO meeting its mandate, governance is a Council role.

It was noted that the model includes key areas and is not meant to be comprehensive. It was suggested that the model be revised to include the reporting link between statutory committees and Council. It was also suggested that the governance plan be amended to address the roles of statutory committees, their interrelationship with Council, and the mechanism for committee accountability and communication of Council decisions to committees.

The model was identified as a good beginning but it was suggested that as the year progresses and there is continuing discussion, there may be further clarification.

STRATEGIC PLANNING UPDATE

B. Campbell presented an update on the strategic planning process and identified and how Council members can assist with the consultation process. It was clarified that, at this stage in the process, themes and sub-themes have been identified for consultation, but the strategic issues will be identified as a result of the data from the consultation and the previous research. The four themes that will form the basis for consultation were reviewed and the consultation plan highlighted.

Concern was expressed about the process for consultation with the public, in particular the limited numbers. It was identified that the College’s communications plan includes a public survey, and that information will also inform the strategic planning process.

ROLES OF RNs and RPNs

M. MacLeod updated Council on the development of a document describing the roles of RNs and RPNs. Because of the work done on entry to practice competencies, it is relatively simple to differentiate the practice of beginning practitioners. However, describing and differentiating the practice of experienced practitioners is more complex and requires further work. Council supported the need to do the necessary work for a quality product.

RPN ENTRY TO PRACTICE

In March, Council passed a motion identifying that, beginning in 2005, the entry to practice for RPNs will be a diploma from a College of Applied Arts and Technology. Draft revisions to the registration regulation to implement Council’s decision were reviewed, for approval for circulation to members (Appendix A). It was noted that, due to previously approved regulation amendments that have yet to be passed by government, additional amendments are required.

B. Rowley noted that the regulation amendments have been reviewed by the Registration Committee.

Motion 4

CARRIED

INITIATION

At the last Council meeting, a motion was passed providing direction to prepare an amendment to the regulation related to initiation of controlled acts.

It was identified as necessary to confirm the rationale for the revision to the initiation regulation, for inclusion when publishing the regulation and to present a solid rationale for the Ministry of Health and Long-Term Care.

It was noted that there is a lack of clear understanding about initiation, and indeed that initiation is currently limited to RNs with expert knowledge. It was identified that there are also RPNs with expert knowledge in specific areas (e.g., wound care), and that the important criteria is not the category of membership but the expert skill and advanced knowledge required for safe initiation.

The following rationale was identified:

• With increased utilization of nursing services in the home and increasing acuity of clients, RPNs need to have the ability to initiate in instances where normal back-up resources are not available to provide for care in a timely fashion;
• The ability to initiate provides for continuity of care in remote practice settings, and other settings where there may not be the normal back-up resources;
• The proposed revision recognizes that there are some RPNs that have the knowledge and skills necessary for initiation, as just there are some RNs with the knowledge and skills required;
• The proposed revision acknowledges the evolution client needs, practice environments, and of RPN roles now and into the future;
• The proposed revision sets out the procedures and conditions required for initiation, facilitating access to care and providing for protection of clients; and
• The proposed revision provides guidelines and limits for practitioners and employers regarding initiation of controlled acts.

Council reviewed the proposed revisions to the initiation regulation (Appendix B).

Motion 5

FUNDING FOR THERAPY AND COUNSELLING

E. Howe, Chair of the Client Relations Committee highlighted the committee’s recommendations and rationale regarding the proposed regulation related to funding for therapy for clients who have been sexually abused by nurses (Appendix C). The proposed regulation sets out criteria for funding, in addition to those identified in the Regulated Health Professions Act. It was identified that the regulation provides some discretion to the Client Relations Committee because it is impossible to determine all of the criteria in advance.

Motion 6

MUTUAL RECOGNITION AGREEMENT

B. Rowley highlighted the Registration Committee’s recommendations and rationale related to the RN and RPN Mutual Recognition Agreements (MRAs).

It was noted that there is nothing inconsistent with current CNO practice in the RPN MRA and legal counsel has no concerns about CNO signing the agreement.

All provinces except Quebec and Ontario have signed the RN MRA. After considerable review, CNO’s Registration Committee has accepted the new Quebec registration examination for RNs as equivalent to the national examination. The RN MRA requires that signatories not accept that the Quebec examination. CNO has implemented all of the other provisions of the MRA, which enhance mobility, but due to the issue around the Quebec examination, the Registration Committee recommends that CNO not sign the RN MRA.

It was noted that CNO’s current registration practices are in line with the mobility provisions of the agreements. While the Registration Committee supports amending the registration regulation to reflect the intent of the Agreement on Internal Trade, it is recommending the revision be deferred to facilitate a total review of the regulation and also take into account the recommendations for legislative change that arise from the RHPA Review.

Motion 7

CARRIED

Motion 8

CARRIED

Motion 9

EXECUTIVE DIRECTOR UPDATE

A. Coghlan provided an update on external and internal activities.

EXECUTIVE COMMITTEE

Council received minutes of the Executive Committee meetings of March 14, 2001, March 30, 2001, April 11, 2001, April 18, 2001, May 8, 2001 and May 29, 2001. M. MacLeod highlighted key issues discussed at those meetings.

LIAISONS

Notes of liaisons with ONA and RPNAO were highlighted. Terms of reference for liaisons and recent Council decisions were discussed.

JPNC

M. MacLeod highlighted the structure and role of JPNC. She noted that there are positive indications of progress with funding for nursing issues. JPNC is planning a retreat to identify priorities for the next year.

COUNCIL MINUTES

The Executive Committee recommended a process for approval and early availability of draft Council minutes on the website and FastFax.

There was some concern about making the minutes available prior to Council approval, particularly given the possibility of amendment. Instead, it was suggested that the process be revised to make Council motions available on the website and Fast Fax.

It was identified that this approach will provide a clear and succinct synopsis of Council decisions, without the detail of the minutes and potential for further amendment.

Motion 10

CARRIED

DEFERRALS

Given the time, Council discussed deferral of two issues.

Motion 11

CARRIED

CONCLUSION OF MEETING

At 4p.m. it was,

Motion 12