Council Minutes

AGENDA

The agenda had been circulated. The Executive Committee meeting of September 23, 2002 was added to the agenda.

Council discussed meeting logistics and agreed to begin meetings at 9:00 a.m. on both days.

Motion 1

Moved by T. Clifford, seconded by R. Kitson,

That the agenda be accepted as revised.

CARRIED

MINUTES

Minutes of the Council meeting of June 5, 2002 had been circulated.

Motion 2

Moved by M. Ternovan, seconded by K. Wetherall,

That the minutes of the Council meeting of June 5, 2002 be approved as circulated.

CARRIED

Minutes of the Council meeting of June 6, 2002 had been circulated.

Motion 3

Moved by L. Lillie, seconded by D. Dietrich,

That the minutes of the Council meeting of June 6, 2002 be approved as circulated.

CARRIED

RULES OF ORDER

J. Lochrie joined Council for a discussion of rules of order. He noted that the rules are a tool to facilitate processes of Council. He reviewed the steps in formulating a motion. He noted that the purpose of parliamentary procedure is to facilitate the transaction of business and to promote cooperation and harmony.

He highlighted the following principles underlying parliamentary law:

• All members have equal rights, privileges and obligations.
• The majority vote decides.
• The rights of the minority must be protected.
• Full and free discussion of every proposition presented for decision is an established right of members.
• Every member has the right to know the meaning of the question before the assembly and what its effect will be.
• All meetings must be characterized by fairness and by good faith.

EVALUATION OF JUNE COUNCIL MEETING

Council received a summary of evaluations of the June Council meeting. The response to the new format for the June meeting was positive and it will continue to be used in the future.

SELF-EVALUATION

L. Haugh noted that self-evaluation is an important component of Council’s evaluation framework. She expressed appreciation to those Council members who undertook the process and noted that some members have included the additional level of peer feedback in the process.

MONITORING STRATEGIC OBJECTIVES

L. Haugh noted that monitoring the achievement of strategic objectives is a joint Council/staff responsibility. Council received a quarterly progress report which included:

• A report on performance indicators;
• An update on the action plan; and
• The Environmental Update.

Three reports related to the Action Plan were also provided to Council members, addressing:

• Developing and implementing a focused initiative to foster relationships with nurses;
• Developing and implementing a stakeholder collaboration strategy to influence the effectiveness of self-regulation; and
• Strengthening the corporate image of the College with stakeholders through the creation and implementation of a public relations plan.

A. Coghlan highlighted the report on the performance indicators. There has been an improvement in some key areas with respect to customer service. CNO has exceeded its target for growth of participation in REN sessions.

She noted that CNO’s data collection capacity places limitations on the indicators selected. As CNO increases its ability to collect, analyze and utilize data, the capacity to select and measure indicators will increase.

B. Campbell highlighted the action plan update. He noted that, on recognizing the need to integrate the deliverables related to Action 1 of Strategic Objective 2 [Establish systems (processes, structures and tools) to improve the collection, analysis, access, linking and sharing of data, information and knowledge across the organization and with stakeholders], the report has been rescheduled to December.

In highlighting the environmental update, B. Campbell noted that nursing continues to be a priority on the government agenda. Health human resource issues continue to dominate, primary care is being gradually implemented and there is a high level of activity across the country related to the nurse practitioner.

It was noted that communications is a thread that tracks through much of the work done in relation to the strategic objectives. CNO has a well-developed Communications Unit that is integrally involved in moving the strategic objectives and action plans forward.

BYLAW REVISIONS

V. Kerr highlighted revisions to the General Bylaw as recommended by the Elections Committee. The Elections Committee is recommending a revision to Article 25.04 to clarify that it would be the committee to make recommendations to Council on filling vacancies in elected positions.

Motion 4

Moved by P. Howe, seconded by B. Weichel,

That Article 25. 04 of the General Bylaw be amended as per attachment 1 to the Bylaw briefing package.

CARRIED

To facilitate administration, the Elections Committee is recommending a change to the date the voter’s list is prepared for administrative reasons.

Motion 5

Moved by K. Lawrence, seconded by D. Fox,

That Article 47.01 of the General Bylaw be amended as per attachment 1 to the Bylaw briefing package.

CARRIED

The Elections Committee is suggesting a revision to Article 51.02 to explicitly articulate the Executive Director’s role in relation to by-elections.

Motion 6

Moved by L. Hall, seconded by K. Cook,

That Article 51.02 of the General Bylaw be amended as per attachment 1 to the Bylaw briefing package.

CARRIED

The Elections Committee is recommending a new sub-article to require members currently serving in one elected capacity to resign prior to running in a by-election for another capacity.

Motion 7

Moved by M. Ternovan, seconded by J. Mac Eachern,

That sub-article 52.01.2 be added, as follows:

An elected councillor or an elected committee member shall not be eligible to run in a by-election unless he or she provides a written resignation from his or her position as an elected councillor or elected committee member which resignation must be received by the Executive Director and be effective on or before the deadline for receipt of nominations.

CARRIED

The Elections Committee is recommending a new article to limit the right of members who resign positions to run in the next election.

Motion 8

Moved by M. McGinn, seconded by K. Lawrence,

That sub-article 52.03.1 be added, as follows:

An elected councillor or elected committee member who resigns his or her seat is not eligible to run in a by-election which takes place as a result of that resignation or an election for the position which he or she resigned from which takes place within sixteen months of the day following the elected councillor’s or elected committee member’s resignation.

CARRIED

The Elections Committee is recommending a revision to Article 53.03 to clarify the deadline for receipt of nominations.

Motion 9

Moved by K. Lawrence, seconded by D. Fox,

That Article 53.03 of the General Bylaw be amended as per attachment 1 to the Bylaw briefing package.

CARRIED

The Executive Committee had asked that the Elections Committee consider whether the Executive should have discretion to make a decision about filling a vacancy in an elected position. The Elections Committee did not feel that it was appropriate for Council to delegate the function of filling vacancies. The Elections Committee noted that, since all members can participate in the Council and committee member elections, all Council members should participate in a decision to fill an elected vacancy.

In reviewing Article 55, however, the Elections Committee did identify the need for an amendment to allow the Executive Director to call an immediate by-election in the instance where there was 16 months or more remaining on the member’s term of office and no eligible runner-up.

Council had considerable concerns about the wording of the proposed new article. It was felt that the wording was not clear.

Motion 10

Moved by K. Lawrence, seconded by D. Fox,

That the proposed Article 55.03.1 be referred to Legal Counsel for clarification of the wording.

CARRIED

The revised article will be reviewed by Council in December.

BYlaw REGARDING THE NOMINATING COMMITTEE

In order to improve its processes, the Nominating Committee is recommending that it be appointed in December rather than March. This requires a Bylaw amendment. If the amendment is approved, the Nominating Committee will be appointed in December 2002 rather than March 2003.

Motion 11

Moved by K. Wetherall, seconded by K. Cook,

That the words "in the last quarter" be substituted for the words "in the first quarter" in Articles 24.03 and 24. 04 of the General Bylaw.

CARRIED

RESCINDING REGULATIONS

The Ministry of Health and Long-Term Care had informed CNO about the existence of Regulation 549 made under the Nursing Part of the Health Disciplines Act. The regulation establishes forms no longer relevant to CNO.

Motion 12

Moved by E. Howe, seconded by J. Mac Eachern,

That the Ministry of Health and Long-Term Care be asked to rescind regulations made under the Nursing Part of the Health Disciplines Act, specifying the following forms:

• Form 1 – Certificate of Competence – Registered Nurse
• Form 2 – Certificate of Initial Registration – Registered Nurse
• Form 3 – Certificate of Competence – Registered Nursing Assistant
• Form 4 – Certificate of Initial Registration – Registered Nursing Assistant

CARRIED

STANDARDS OF
PRACTICE FOR RN(EC)

Council had received a proposed draft revision of the Standards of Practice for Registered Nurses in the Extended Class. The Standards have been updated to reflect changes in legislation (i.e., revised drug and laboratory test lists), and edited for clarity. There are no substantive changes other than those already approved as part of legislative change.

Council suggested some revisions for clarification and the addition of a decision-tree or algorithm addressing consultation.

Motion 13

Moved by L. Lillie, seconded by K. Lawrence,

That Council approve the revised Standards of Practice for Registered Nurses in the Extended Class.

In considering the motion, Council noted that the document is an updating and editing of the standards, rather than a revision. It was suggested that the motion be clarified.

Amendment to Motion 13

Moved by L. Lillie, seconded by D. Fox,

That Motion 13 be amended by addition of the words "document entitled" following the word "revised".

CARRIED

Amended Motion 13

The following motion had been duly moved and seconded,

That Council approve the revised document entitled Standards of Practice for Registered Nurses in the Extended Class.

CARRIED

RN(EC) DRUG &
LABORATORY TEST LIST

In March, Council approved the draft revisions to the lists of drugs, laboratory and diagnostic tests that can be ordered by registered nurses in the extended class. The proposed changes were published and Council received a report of the feedback. It was noted that there had been considerable stakeholder participation in development of the proposed list.

Motion 14

Moved by R. Kitson, seconded by K. Campbell,

That the proposed changes to the RN(EC) Drug and Laboratory/Diagnostic Tests schedules as published in the June 2002 Communiqué be approved for forwarding to the Ministry of Health and Long-Term Care.

CARRIED

STATUTORY COMMITTEE REPORTS

L. Haugh noted that the semi-annual reports of the statutory committees are an important component of committee accountability to Council. The reports cover the period from January to June 2002.

Executive Committee

L. Haugh highlighted the Executive Committee semi-annual report. She noted that, while this report focuses on its statutory role, the Executive has an important function in relation to the effective functioning of Council.

L. Haugh noted that employers continue to have a high level of awareness of the obligation to report members who are terminated. Incidents related to documentation and medication administration were the most frequently reported nursing practice concerns. Incapacity cases have reduced from 2001.

Client Relations Committee

V. Kerr noted that the committee is focusing on the administration of fund for victims of sexual abuse and CNO’s abuse prevention program. A survey is underway to determine how the abuse prevention program "One is One too Many" is being used by purchasers and its effectiveness. The committee will report the results to Council in December.

Council noted that the statutory reports from the Executive, Complaints and Discipline indicate that abuse remains a significant problem. If One is One Too Many proves effective, it will be important to continue to market the program.

Complaints Committee:

P. Howe highlighted the report of the Complaints Committee. There has been an increase in the number of complaints reviewed, while there has not been a concurrent increase in complaints deemed frivolous and vexatious. This indicates an increase in the number of complaints investigated and in the efficiency of investigations.

There was a 30% increase in complaints about abuse during this timeframe.

Requests for Health Professions Appeal and Review Board (HPARB) reviews of decisions of the committee have reduced, perhaps due to the use of the Participative Resolution Program.

Discipline Committee

M. Taylor highlighted the report of the Discipline Committee. She noted that the committee has worked hard to meet its timelines for decision-making.

This period saw an increase in agreed statements of fact and joint submissions on penalty, but there was also an increase in hearing days for complex contested cases.

Fitness to Practise Committee

S. Young highlighted the report of the Fitness to Practise Committee. She noted that the committee continues to have success in addressing most matters informally through agreements, and very few hearings prove necessary.

Quality Assurance Committee

K. Lawrence noted that the primary focus of the Quality Assurance Committee in the first half of 2002 was development and implementation of practice review. An evaluation of reflective practice has also been undertaken.

The Practice Setting Consultation Program is celebrating success, with significant interest in the program across the country, including licensing agreements in a number of provinces.

Registration Committee

S. Young presented the report of the Registration Committee on behalf of R. Rupert. She noted that CNO assessed approximately 1600 applicants, of which 217 were referred to the committee.

Policy issues considered by the Registration Committee included mobility, education, and classes of registration (disabled).

A question was raised as to whether the Registration Committee is considering requiring criminal background checks for initial registration. This has been flagged as a policy issue for review in the future.

EXECUTIVE DIRECTOR
UPDATE

A. Coghlan updated Council on the employer sessions. She highlighted the evolution of the sessions and their purpose.

There was some discussion about widening the availability of the sessions through alternative formats such as video. The question and answer session is an important component of the workshop. Interactive alternatives on the internet may be explored for the future.

ELECTIONS

COMMITTEE MEMBERS

The Executive Committee recommends members of the Elections Committee. In making the recommendations, the Executive tried to balance the mix of new and experienced members on the committee.

Motion 15

Moved by D. Trouten, seconded by M. Ternovan,

That Council ratify the following 2003 Elections Committee: Kathy Cook, RPN; Veronica Kerr, Public Member; Lory Lillie, Public Member; Mary Ann Murray RN; Jayne Sanger, Public Member; and Sophie Young, Public Member.

CARRIED

PUBLIC MEMBER

COMMITTEE APPOINTMENTS

T. Clifford’s term of office on Council will end on October 27. Vacancies will result on the Complaints and Quality Assurance Committees. R. Graham has been appointed as a public member effective October 27^th.

Motion 16

Moved by A. Taylor, seconded by K. Campbell,

That Ruth Graham, Public Member, be appointed to the Complaints Committee from October 27 , 2002 to June, 2003; and Bill Weichel, Public Member, be appointed to the Quality Assurance Committee from October 27 , 2002 to June, 2003.

CARRIED

COMMITTEE APPOINTMENTS

The Executive discussed the committee appointment of a member who identified that he would not be able to meet his commitment to the Discipline Committee for six months. The Executive recommended alternative appointments.

Motion 17

Moved by B. Hill, seconded by V. Kerr,

That Ruth Kitson be appointed to the Discipline Committee, replacing David Fox, to June 2003; and that David Fox be appointed to the Client Relations Committee, replacing Ruth Kitson, to June 2003.

CARRIED

EXECUTIVE COMMITTEE

Council received minutes of Executive Committee meetings of: June 6, July 11, August 14, September 18 and September 23. L. Haugh highlighted the meetings. She noted that the Ministry of Health and Long-Term Care has invited CNO to a meeting with nursing stakeholders later this month to discuss RPN initiation.

FINANCE COMMITTEE

D. Barber highlighted the report of the Finance Committee conference call meeting of September 23^rd.

The Finance Committee reviewed the financial statements as at August 31, 2002. It was noted that, while there is still a significant positive variance between budget and actual, over 75% of the variance relates to revenue and the expense variance is significantly reduced.

A number of members identified that they had received incomplete financial statements and further discussion was deferred until copies were distributed.

ELECTIONS COMMITTEE

V. Kerr highlighted the final report of the 2002 Elections Committee. The committee had presented a report of the election results in June, and noted an increase in the percentage of members voting.

The Elections Committee has given considerable attention to reviewing the Bylaw related to elections, and recommendations were reviewed by Council on October 2^nd.

A major focus of the committee this year related to strategies to enhance participation in the election, both in terms of attracting potential candidates and increasing voting. The committee expressed appreciation to the Communications Unit for its collaboration in reshaping the election materials. The committee had found the link with the Communications Unit so valuable that it is recommending a revision to its terms of reference to ensure an ongoing relationship.

The committee also discussed cost-effectiveness of elections process and options for voting. One option discussed was telephone voting. The committee supported staff exploring the business case for telephone voting. If there is a financial advantage, then the committee will explore this option further.

Motion 18

Moved by A. Taylor, seconded by E. Greenwood,

That Council approve the revised Elections Committee terms of reference, as attached to the committee report.

CARRIED

NOMINATING COMMITTEE

P. Howe presented the report of the 2002 Nominating Committee. He noted that the committee implemented significant changes to the process for assigning members to committees. The new process was highlighted in June, and the committee met since then and further refined the process.

In addition to committee effectiveness, goals for the process include objectivity, transparency, and maximizing opportunities to participate. The criteria and process for developing the slate of committee members was highlighted. Council members noted that the new process seems to be fair, objective, and transparent.

The Nominating Committee recommended some changes to its terms of reference.

Motion 19

Moved by P. Howe, seconded by M. Taylor,

That Council approve the revised Nominating Committee terms of reference (attachment 3 to the committee report).

CARRIED

It was noted that the process identified by the Nominating Committee is new and evolving, but a substantial base and framework has been built for continued objectivity in decision-making. The process will be evaluated in the future.

FINANCE COMMITTEE

Council continued with a review of the Financial Statements as at August 31, 2002. It was noted that the increased revenues reflect an increase in activity. While the additional revenue is expected to carry over into 2003, it is also related to increased volumes, which may result in increased costs.

Budget Increase Guidelines

The Finance Committee is recommending a budget increase guideline to provide guidance to staff in developing the 2003 budget. The recommended guideline will address increases in costs and staffing changes to meet workload demands. There are, however, a number of unknowns that are not included in the guideline.

There was considerable discussion about the recommendation. There was some discomfort about the unknowns and it was confirmed that they will be addressed in the budget presented in December. The process for budgeting was reviewed. It was confirmed that efficiencies are explored as part of the budget process.

Motion 20

Moved by D. Barber, seconded by E. Howe,

That Council approve a maximum operating budget expense increase guideline of 3% for 2003 over 2002, excluding unknowns related to the strategic initiatives, changes to the RHPA, changes to base salary levels, depreciation on capital expenditures and operational changes in the air travel industry.

CARRIED

The Finance Committee had noted that major capital expenditures were devoted to renovating the building in 2002. For that reason, CNO can return to capital budgeting for building maintenance based on the depreciation budget. It is necessary, however, to focus resources on systems development, particularly the database.

Motion 21

Moved by D. Barber, seconded by A. Taylor,

That Council approve a capital budget for 2003 of a maximum of $1.5 million.

CARRIED

PRACTICE REVIEW

L. Haugh noted that the launch of Practice Review created interest in the nursing community. S. Rodgers highlighted the program, the process, the results for the first group of nurses to participate in Practice Review and plans for the future. Beginning in 2003, a representative sample of 400 nurses will participate in Practice Review. In addition, a focus of activity will be to expand Practice Review to address the other dimensions of practice, including administration.

OTHER BUSINESS

Council had the opportunity to raise questions about the background materials circulated "For Information".

In relation to the consultation plan for the revision of the Medication Administration Standards, it was suggested that the broader issues regarding ethics, use of medications as chemical restraints, palliative care, and terminal sedation be addressed.

There was a request to clarify the intention regarding the involvement of the Complaints and Quality Assurance committees in the process to determine how to address referrals from Quality Assurance to Complaints. It was noted that the background policy work up is being prepared by staff to support the committees in the development and implementation of the policy.

Concern was raised about whether continued delay in passage of the regulations related to RPN education will impact on the reforms in the education sector. Council was assured that educators have moved forward with implementing the new program standards.

NEXT MEETING

The next Council meeting will be Wednesday and Thursday, December 11 and 12, 2002.

CONCLUSION

At 12:30 hours, it was

Moved by D. Trouten, seconded by K. Campbell,

That Council conclude.