Council Minutes

G. Mackay
P. Reinhart

G. Siskind
C. Stanford

AGENDA

The agenda was circulated. The Finance Committee report and the Strategic Plan will be addressed on Thursday morning. Questions or discussion about the materials sent to Council for information will be dealt with under "Other Business".

Motion 1

CLOSURE

The Executive recommended closure of the Council meeting to review the recommendations of the Finance Committee related to staff compensation and Council and committee stipends.

Motion 2

MINUTES

Minutes of the Council meeting of October 3 and 4, 2001 were distributed. It was suggested that a heading on page 218 be clarified and that the section on page 221 about the Client Relations Committee identify that the regulation was addressing funding for therapy for victims of sexual abuse.

Motion 3

EVALUATION

L. Haugh noted that there was a significantly improved response rate to the evaluation and thanked Council members for their input. She noted that the evaluation is an important part of the governance process and changes have resulted from the input.

GOVERNANCE

As a result of the evaluation of Council effectiveness in March of 2001, Council made a commitment to review the governance process over the year. The evaluation of Council effectiveness will be taking place in March of 2002. L. Haugh reminded Council that last year a goal of 100% participation was established.

L. Haugh reviewed the decision-making process. She noted the distinct, yet interdependent, roles of Council and staff in decision-making. The Governance Model and Governance Philosophy were both reviewed in relation to how they reflect the Council/staff roles in decision-making. Two examples of the decision-making process were highlighted.

Council members had been asked to review the Council values in advance and identify how the values are reflected in Council decision-making.

There was considerable discussion about accountability. The review of governance processes is an important accountability mechanism for Council. Accountability was the major theme throughout the discussion of the proposed response to the RHPA Review in October.

For public accountability, the public needs to know about regulatory bodies and their role. The Federation of Health Regulatory Colleges is developing a plan for education of the public, including consultation with the provincial government about its role in the education process.

Council identified that other examples of accountability include the new standards to facilitate the provision of safe, effective and ethical nursing services, and Council’s decision to seek the input of members, the public and stakeholders in developing the Strategic Plan.

It was noted that integrity is woven into all of Council processes. It is not as concrete or visible as other values as it is not linked to specific issues.

In relation to openness and transparency it is noted that CNO is more accessible to members. More members are seeing CNO as a resource due to the Regional Education Network, practice advice and the website.

The strategic planning process, which involved staff and Council in partnership, was a strong reflection of the value of mutual respect and collaboration. The success of the process is evidence of how the distinct roles of Council and staff work well together.

The values are essential to effective governance. Council will review the values again in March in the light of the evaluation of Council effectiveness for 2001.

PROFILE OF PRACTICE EXPECTATIONS FOR RNs and RPNs

Council reviewed the Profile of Practice Expectations for RNs and RPNs, prepared to describe current nursing practice. This document is different from anything CNO has prepared before – it is solidly evidence based and provides a brief outline of current practice. It was developed in response to repeated requests for a clear and concise description of the roles of RNs and RPNs and the differences between the categories. The Profile has been prepared to be easy to update. A more detailed companion document is being prepared for Council review in March.

Motion 4

There was discussion about the member consultation undertaken in development of the Profile. Council was reminded that an alternative approach had been approved for development of this document.

It was recognized that the Profile is brief and meant to highlight key aspects of practice and key differences between RNs and RPNs. A fuller description of practice will be provided in the companion document.

There was discussion about holding publication of the Profile pending completion of the companion document. One of the challenges for CNO is responding to needs in a timely fashion, and there is considerable demand for the Profile. Releasing it at this time will allow for education in the Spring and for evaluation of the brochure.

PROFESSIONAL STANDARDS

S. Rodgers highlighted the proposed revisions to the Professional Standards. She noted that the research and consultation to develop the Role Profile informed the revision. Changes include expansion and enhancement of the content, particularly in relation to the other dimensions of practice. The Standards now include an explicit requirement for participation in the Quality Assurance program.

The plan is to consult on the draft early in the new year and present a final document for Council’s review in March.

Motion 5

It was confirmed that the Professional Standards are broad enough that they encompass the RN(EC) role.

RPN ENTRY TO PRACTICE

L. Haugh presented an overview on how regulations are approved.

In June, Council had approved proposed revisions to the Registration regulation to change the requirement for RPN entry to practice to a diploma from a College of Applied Arts and Technology, effective January 1, 2005. These changes are the result of extensive collaboration and research. The regulation was published and Council received a report of the feedback.

Motion 6

Council was informed that discussions are ongoing with the Ministry around an approval mechanism for RPN programs.

INITIATION OF CONTROLLED ACTS

L. Haugh reviewed the background to the proposed regulation to allow RPNs to initiate controlled acts. S. Rodgers noted that initiation is different from "performing" and requires different competencies. Most nurses provide care in situations where protocols exist and, therefore, do not need to initiate.

L. Haugh noted that there has been significant response to the regulation, and much of it does not support the proposal. She reminded Council that it needs to make its decision in the public interest. If Council approves the regulation, it will be important to clearly articulate a rationale for forwarding to government, and to respond specifically to concerns identified in the responses.

There was considerable discussion about the proposed regulation change. A number of Council members expressed concern about moving forward with the regulation given the feedback from members. It was identified by some Council members that responses did not support that RPN initiation was necessary for client care. In the responses, members also identified concerns that RPN initiation would further blur roles. Some Council members noted that the research presented to Council in March did not support the need for RPN initiation and did not provide evidence that the current regulation is a barrier to care.

On the other hand, some Council members identified the increasing use of RPNs in the community and the need for continuity of care as supporting the need for RPN initiation. It was noted that RPNs are accountable practitioners and will only initiate if competent to do so. Just as initiation is rarely used by RNs, it is not anticipated to be used frequently by RPNs. Rather, it will be used by highly experienced practitioners. It was also identified that the range of procedures that can be initiated by RPNs is safe and appropriate.

Motion 7

CARRIED

Rationale:

The following were identified as the rationale for forwarding to the Ministry of Health and Long-Term Care:

• RPN initiation acknowledges that a limited number of RPNs as well as RNs, have the knowledge, skill, and judgment to initiate;
• Procedures which RPNs will be able to initiate are more limited than those RNs can initiate, are safe for RPN initiation, and meet client needs;
• All nurses are accountable for knowing the personal limits of their competence, including determining whether to initiate;

• The change provides the ability to initiate for continuity of client care in the community and long-term care when there is no physician available and no protocol;
• The proposal acknowledges highly experienced RPNs in long-term care and the community who possess the knowledge, skill and judgment to initiate; and
• The knowledge, skill and judgement to initiate, rather than membership category, should be the determination for the right to initiate.

FUNDING FOR THERAPY FOR VICTIMS OF SEXUAL ABUSE

In June, Council had proposed a regulation extending the criteria for funding for therapy for victims of sexual abuse by nurses. The regulation had been published in the Communiqué in September. One positive response had been received.

Motion 8

Council was informed that a contingency fund included in the budget will provide funding for victims of sexual abuse, if needed.

CONDUCT BYlaw

In September, Council had approved Bylaw 3 re. Conduct of Councillors and Committee Members (Conduct Bylaw). Council asked that including the requirement for confidentiality in the Bylaw and extending the fiduciary conflict be explored.

The Executive felt that inclusion of the concept of confidentiality in the Conduct Bylaw would be redundant since there are explicit confidentiality requirements in the Regulated Health Professions Act. The need for committee education on confidentiality will be discussed with the committee Chairs.

The Executive also reviewed the possibility of expanding the fiduciary conflict to include associations representing health service providers and major employers. The Executive thought that, while there may be conflicts in relation to specific issues, there was not an overlap or conflict at the mandate level and therefore, the conflict did not out-weigh the right of free association.

In reviewing the Bylaw, the Executive decided to recommend that the wording of Articles 4.01 of the Conduct Bylaw and 52.07 of the Election Part of the General Bylaw be amended to remove the names of the nursing organizations. The more general wording provides guidance without appearing overly limiting.

Motion 9

ELECTION BYlaw

In reviewing the Election Part of the General Bylaw, it became apparent that Article 25.04 needed to be revised to reflect the changes in the role of the Elections Committee approved by Council in December.

Motion 10

CARRIED

EXECUTIVE DIRECTOR UPDATE

A. Coghlan provided an annual summary of the activities of the departments and teams.

EXECUTIVE COMMITTEE

L. Haugh highlighted the minutes of the Executive Committee meetings of October 30^th and November 21st.

In October, the Executive discussed the process for adding items to the agenda. While the Bylaw requires prior notice for motions, matters deemed urgent by the Council can be added to the agenda at the meeting as other business. This approach facilitates informed decision-making and allows for Council discussion of urgent matters.

In November, the Executive discussed changing support for Council and committee members.

Motion 11

CARRIED

STRATEGIC PLAN

Council received the proposed Strategic Plan for 2002-2005. Since the budget includes the financial provisions for the plan, L. Haugh identified that Council will discuss the plan to see if it is supported in principle. Formal approval will occur after the budget is approved. She noted that the Plan is proposed by the Ad Hoc Committee on Strategic Planning, a joint Council/staff committee.

B. Campbell highlighted the plan. He noted that the two objectives in the plan are intertwined.

Council identified that the plan is visionary and a significant leap forward for the College in strategic planning.

FINANCE REPORT

J. Badgerow reported on the Finance Committee meeting of November 28th. The Financial Statements as at October 31^st were highlighted by P. Reinhart. He noted that the increase in the cash position related to the increase in fees and highlighted the expense variances.

Salaries, Benefits, and Stipends

Council held a closed session to discuss staff salaries, benefits, and Council stipends. The session is recorded in the confidential appendix.

2002 Budget

P. Reinhart highlighted the operating and capital budget. He noted that the budget falls within the budget guidelines approved by Council in October. Based on the proposed budget, it is not anticipated that CNO will require an increase in registration fees until 2005. Council was informed that other fees, such as service fees, are being reviewed.

Motion 12

CARRIED

STRATEGIC PLAN

After approval of the budget, Council discussed the Strategic Plan.

Motion 13

JPNC

Council received a verbal report on the last meeting of the Joint Provincial Nursing Committee (JPNC). L. Haugh noted that JPNC received reports of the sub-committees. She reported that Kathleen MacMillan has resigned as Chief Nursing Officer.

It was identified at JPNC that an initiative to enhance clinical opportunities for nursing students will be included in the Ministry’s budget submission.

ANNUAL MEETING

Based on the Council’s input, the Executive presented a proposal in which the Annual Meeting would be integrated into the June Council meeting. This approach can be evaluated at the end of the year.

Motion 14

CARRIED

The Executive will explore a new approach to the June Council meeting to address Council’s decision and also prior concerns about the imbalance of activities over the two days of the meeting.

COMMITTEE MEMBERSHIP

The Executive recommended the appointment of Marilyn Bestwick to the Discipline Committee.

Motion 15

OTHER BUSINESS

An opportunity was provided to discuss "for information" materials. The Federation response to the HPRAC report was discussed. It was noted that CNO was part of the Federation submission.

NEXT MEETING

Council will meet again on Tuesday and Wednesday, March 26 and 27, 2002.

CONCLUDE

The Council meeting concluded at noon.