Present

S. Ireland, Chair
J. Attwood
I. Bajnok (Wednesday)
D. Barber
C. Beemer
M. Bestwick
D. Bishop
S. Burnell-Jones
C. Charlton (Wednesday)
K. Cook
F. Cole

D. Dietrich
R. Fife
R. Graham
E. Greenwood
G. Hayward
B. Hill
E. Howe
S. Keating
V. Kerr (Wednesday)
R. Kitson (Wednesday)
M. McGinn

M. A. Murray
B. Noble
D. Norling
R. Rupert
A. Spacek
A. Taylor
M. Ternovan
D. Trouten
B. Weichel
S. Young

Absent

I. Bajnok (Thursday)
K. Campbell
M. Capobianco
C. Charlton (Thursday)

A. Cunningham
D. Fox
L. Hall
K. Kay

V. Kerr (Thursday)
R. Kitson (Thursday)
S. Richardson

Staff

A. Coghlan
C. Campbell

J. Hofbauer, Recorder
P. Reinhart

G. Siskind
C. Stanford

RULES OF ORDER

A. Taylor served as the rules of order monitor for the meeting.

AGENDA

The agenda had been circulated.

Motion 1

Moved by M. Ternovan, seconded by M. Bestwick,

That the agenda for the March 2004 Council meeting be approved.

CARRIED

MINUTES

Minutes of the Council meeting of December 10 and 11, 2003, including the confidential appendix, had been circulated to Council. The days identified in relation to member attendance were corrected.

Motion 2

Moved by D. Bishop, seconded by R. Fife,

That the minutes of the Council meeting of December 10 and 11, 2003, including the confidential appendix, be accepted as corrected.

CARRIED

EVALUATION

Summaries of the evaluations of the December Council meeting and the team building session had been distributed, for discussion. S. Ireland noted that as a result of the evaluation feedback, changes have been implemented in the process for preparation of draft motions.

TEAM BUILDING ACTION PLAN

Council received an action plan for implementing the priorities identified at the Council/staff teambuilding retreat. Two actions have already been implemented:

• Briefing notes all include the public interest rationale; and
• The Council meeting evaluation form prompts for identification of areas where the distinction between governance and operations is unclear (grey areas).

S. Ireland informed Council that at the end of the meeting, if time allows, there will be an opportunity to reflect on what went well and what could be improved in the future.

It was confirmed that the retreat was a collegial and productive session and that Council/staff relations have made significant progress. The survey conducted as background for the retreat will be repeated in June and annually thereafter.

RPN ENTRY TO PRACTICE

S. Ireland reviewed the background to this issue. In addition to publishing the proposed revised regulation approved by Council in October, for feedback, CNO actively sought the input from the current government regarding its position. Council was informed that CNO has received recent communication from the Ministers of Health and Long-Term Care and Training, Colleges and Universities identifying that both Ministers will support Council's decision.

S. Ireland noted that the proposed changes to the regulation had been approved in October 2003 for publication for consultation purposes. She pointed out that Council needs to make a new decision at this time, based on new information including the consultation feedback and the government's input.

Council noted that it has received clear feedback from all categories of members and from stakeholders that the proposed regulation amendment submitted to government in 2001 is in the public interest. In keeping with the College's strategic directions, CNO knowledge has been used to build a solid, cogent case for the College's position, including strong input from members and stakeholders. Council commended the President and Executive Director for their extensive efforts to ensure that the issue was well addressed with the government, resulting in government's understanding and support.

Motion 3

Moved by D. Dietrich, seconded by D. Barber,

That the Minister of Health and Long-Term Care be asked to approve and submit to Cabinet the RPN entry to practice regulation approved by Council in December 2001 (amending the College's Registration Regulation being Part II of Ontario Regulation 275/94 as amended to Ontario Regulation 212/00) and submitted to the Ministry by letter dated December 18, 2001.

CARRIED
(1 abstention)

Letters will be sent immediately to the Ministers of Health and Long-Term Care and Training Colleges and Universities, informing them of Council's decision.

RPN PROGRAM APPROVAL BY-LAW

Council reviewed a proposed draft By-Law to establish the RPN Program Approval Committee.

A number of concerns were raised about the proposal, largely related to the relationship between the Program Approval Committee and Council, and whether Council should have a direct role in program approval.

There was considerable discussion about the proposal that the Chair be a public member of Council, to provide a link with the committee. Some members identified their perspective that the committee should be arms length, and have no Council members.

There was also some concern about the concept of the Approval Committee as a "standing" committee, and what that meant.

Council asked for information on options before making a decision regarding by-laws. Some possible options identified for exploration included the Program Approval Committee as the approval body; and the Program Committee as an advisory committee with Council as approval body.

Members asked that options be developed with input from legal counsel, for Council review in June.

REVISED STANDARD: INFECTION PREVENTION AND CONTROL

K. Ellis-Scharfenberg highlighted the major revisions of the Standard: Infection Prevention and Control. The revision addresses concerns of the membership as well as enhancing public interest.

Council members supported the clarity of the document, the incorporation of infection prevention, and the inclusion of references as evidence for the standards.

It was suggested that the concept of health promotion be strengthened by including the determinants of health and identifying communities at risk.

Motion 4

Moved by V. Kerr, seconded by J. Attwood,

That Council approve the practice standard — Infection Prevention and Control.

CARRIED

RN(EC) DRUG LIST

The Ministry of Health and Long-Term Care has identified that, due to stakeholder feedback, it will only pass the list of drugs that can be prescribed by RN(EC)s originally approved by Council in October 2002, if specific changes are approved.

It was confirmed that the proposed changes do not preclude future addition of deleted drugs. CNO is continuing to dialogue with the Ministry and stakeholders in an effort to gain consensus about specific drugs that are of concern.

The Executive is recommending approval of the changes, to expedite the regulation change and provide clients of members of the extended class with up-to-date treatment options.

Motion 5

Moved by B. Noble, seconded by J. Attwood,

That Council approve the following changes to the proposed revisions to Schedule 3 of Ontario Regulation 39/98, as approved by Council in October 2002, for forwarding to the Ministry of Health and Long-Term Care:

Deletions:

Bupropion HCL - for smoking cessation
Gatifloxacin oral - for adult pneumonia with comorbidity
Levofloxacin oral - for adult pneumonia with comorbidity
Norfloxacin oral
Ofloxacin
Atorvastatin calcium - for renewal
Fluvastatin - for renewal
Pravastatin sodium - for renewal
Simvastatin - for renewal
Salbutamol (Ventolin) - for Pulmonary Function Testing

Clarification:

Fluconazole (oral) Clarify that for renewal only
Gentamicin sulphate (Garamycin). Clarify that for otic, opthalamic, and topical routes.
Ketoconazole (Nizoral). Clarify that for topical route.

CARRIED

Council raised concern about the timeframe for government approval of this regulation and asked that all efforts be made to expedite its passage and meet the needs of clients of RN(EC)s.

EXPEDITING DRUG LIST

Recognizing the importance of client access to the best treatments, the Executive Committee is recommending strategies that CNO can implement to expedite the College's portion of the process of drug list revision. While implementing these changes, CNO will continue to work with the Ministry of Health and Long-Term Care on alternate approaches to allowing RN(EC)s to provide the best treatments to their clients.

Council supported the following strategies:

• Circulating the initial draft changes to the RN(EC) drug list without Council approval, and bringing the list and feedback to Council after circulation for final decision.
  • In supporting this strategy, Council suggested that the proposed changes be reviewed by the Executive prior to circulation.
• Focused consultation with members [e.g., RN(EC)s], rather than publishing in The Standard.
  • This strategy can only be implemented with the agreement of the Ministry of Health and Long-Term Care, and CNO will continue discussions with the Ministry on this matter. If this approach is implemented, it was suggested that The Standard flag for members of the General Class the ability to request the list and provide feedback.
• Identifying in the Council motion approving the list that each drug is a separate regulation change.
  • Adopting this approach would allow for government passage of drugs that are not contentious and continued dialogue on drugs where there is a concern.

COMMITTEE REPORTS

S. Ireland introduced the committee annual reports for 2003. She noted that they are an important accountability mechanism.

Executive Committee

S. Ireland noted that, for the first time, the number of reports from the long-term care sector is out of proportion with the number of members employed in that sector. The cause is not certain and the data is being closely monitored to see if there is a trend.

The Executive has also seen a significant increase in the number of incapacity matters. This may be the result of out-reach and heightened awareness of employers. The numbers are not out of proportion to what would be expected given the population.

Client Relations Committee

V. Kerr noted that the committee has completed its role in relation to abuse prevention.

The importance of clear communication with the public was noted. It was identified that the College participates in the Federation of Health Regulatory College's advertisements for open Council meetings. Information about attending Council meetings is also included in Here for You, which will be distributed to 500,000 Ontario households in 2004.

Given concerns about long-term care settings and abuse, there was a suggestion that CNO consider strategies to address abuse in long-term care. It was identified that the College needs to understand the nature of the types of complaints and reports that are coming from the long-term care sector before CNO attempts to identify solutions. V. Kerr agreed to take this matter to the Client Relations Committee.

Complaints Committee

M. A. Murray highlighted the report of the Complaints Committee. She noted that the high rate of confirmation of committee decisions by the Health Professions Appeal and Review Board is indicative of the robust procedures and sound decision-making of the committee.

It was identified that matters resolved the Participative Resolution have increased, as have referrals to the Quality Assurance Committee.

Discipline Committee

M. Ternovan noted that there has been an increase in hearing days, and the number of witnesses, despite a decrease in the number of hearings. This is reflective of increased complexity of cases. Another trend is contested hearings that are booked and then an agreement is reached at the last minute.

It was identified that the Disciplinary process can also be rehabilitative, with the use of terms, limitations and conditions assisting a member to continue in practice as a competent professional.

Fitness to Practise Committee

S. Young noted that the Fitness to Practise Committee is reviewing its process for consent orders, but that no decisions have been finalized at this time.

Quality Assurance Committee

K. Cook noted that Practice Review provides evidence that CNO members are practicing in accordance with standards. The committee is continuing its work to extend practice review to include nurses in the administrator role.

Members have identified that supports provided at the work setting, such as a place to write or providing interface with people who have written the Practice Review Written Assessment before, are helpful. It was suggested that there be an article in a future edition of Quality Practice identifying how employers can support nurses in self-regulation.

Registration Committee

D. Dietrich reported that the Registration Committee has started to meet in panels in order to provide more timely responses to applicants. This approach has been positively received by applicants and employers and contributes to building confidence in nursing self-regulation. The new process is a good example of a committee and staff working together effectively.

RESULTS REPORT

The CNO Results Report was presented by A. Coghlan and D. Franchi. These indicators are for 2004 and they will need to be integrated into indicators that arise out of the strategic planning process. It was also suggested that the Finance Committee explore financial indicators.

There was some discussion about the overall process of performance measurement. It was noted that the International Standards Organization has measurement for companies and organizations. The Federation of Health Regulatory Colleges has begun reviewing the applicability of the ISO standards for regulatory bodies.

MEMBERSHIP STATISTICS

A. Coghlan presented new initiatives related to the College's membership statistics. CNO is moving towards timelier reporting of statistics, releasing the current statistics mid-year. In addition, the depth and breadth of statistics reported will be enhanced. With the new approach, interpretation and context will be provided with every statistical table.

STRATEGIC PLANNING

S. Ireland noted that the strategic planning process began with the joint Council/staff workshop. The next step in the process is to establish Ad Hoc Committee on Strategic Planning to steer the process.

A proposed process was highlighted and supported by Council. It was identified that the Ad Hoc Committee might fine tune the process as it is implemented, but that it would continue to be a focused process, allowing for input from Council, committees and staff.

AD HOC COMMITTEE ON STRATEGIC PLANNING

Three options were presented for the structure of the committee. There was some discussion about whether the proposed size was too large, and a number of alternative structures were discussed. There was also discussion about whether the numbers of Council and staff should be equal. While some members felt that a smaller committee would be preferable and that Council members should take precedence over staff, others felt that reducing staff was not consistent with the principles of Council and staff working together and the work done in team building.

It was identified that the Strategic Planning Committee will report to Council and there will be ample opportunity for Council to exercise its role in strategic planning.

Motion 6

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

That the Ad Hoc Committee on Strategic Planning be the President, two RNs, two RPNs, three public members and six members of staff.

Defeated

It was identified that all Council members around the table are equal and Council's usual approach in structuring ad hoc committees is for equal numbers of each category of member.

Motion 7

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

That the Ad Hoc Committee on Strategic Planning be the President, two RNs, two RPNs, two public members and an equal number of staff.

Amendment to Motion 7

Moved by E. Howe, seconded by A. Spacek,

That motion 7 be amended to increase the public members to three and the staff members to eight.

Defeated

The amendment was not supported because the norm in committee structure is equal numbers of RNs, RPNs and public members.

Motion 7

The following motion was duly moved and seconded,

That the Ad Hoc Committee on Strategic Planning be the President, two RNs, two RPNs, two public members and an equal number of staff.

CARRIED

Motion 8

Moved by R. Graham, seconded by A. Spacek,

That Council authorize the Executive Committee to appoint the necessary additional Council members of the Ad Hoc Committee on Strategic Planning from among Council volunteers.

CARRIED

The Executive will present draft criteria for committee membership to Council on Thursday, for input

TERMS OF REFERENCE

Draft terms of reference for the Ad Hoc Committee on Strategic Planning were presented to Council. Changes were made to the terms of reference to leave the committee the discretion to review the strategic objectives and determine if they are appropriate or additional objectives are required, and to require an interim report to Council in June.

Motion 9

Moved by B. Weichel, seconded by D. Bishop,

That the terms of reference of the Ad Hoc Committee on Strategic Planning (attached to the minutes) be approved as amended.

CARRIED

RECESS

At 4:30 p.m., Council recessed until 9:00 a.m. on Thursday, March 11, 2004.

AD HOC COMMITTEE ON STRATEGIC PLANNING

Council identified that the following criteria for membership on Ad Hoc Committee on Strategic Planning:

• Leadership abilities and experience;
• Participation in Council activities;
• Balance in committee assignments;
• Experience on a variety of committees;
• Ability to analyze issues from multiple perspectives; and
• Expressed willingness to dedicate the required time and energy.

The following criteria were also identified with respect to the balance of committee membership:

• Willingness to dedicate the time to learn new skills and approaches;
  
• Experience in strategic planning;
  
• A mix of experienced and novice Council members; and
  
• Geographical diversity.

EXECUTIVE DIRECTOR UPDATE

A. Coghlan outlined the College's relationship with the Coroner's Office and how it relates to the College's public protection role.

EXECUTIVE

Notes of the Executive Committee meetings of December 16, 2003, January 13, 2004, January 21 and 22, 2004, January 28, 2004 and February 18 and 19, 2004 had been distributed. S. Ireland briefly highlighted each meeting.

FINANCE COMMITTEE

D. Norling highlighted the meeting with the auditors. She noted that they were very pleased with the financial controls in place at the College.

She reported that the Finance Committee will be reviewing the surplus and discussing how much surplus is appropriate for the College. The committee will also be looking at investments at its next meeting.

In discussing the surplus, there was a suggestion that consideration be given to mechanisms to enhance the engagement of elected committee members with the College. The Executive will follow up on this issue.

NOMINATING COMMITTEE

D. Barber highlighted the process used by the Nominating Committee in making committee assignments.

LIAISON MEETINGS

Council received notes of the ONA/CNO liaison of January 22, 2004 and the RPNAO/CNO liaison of February 18, 2004.

It was identified that ONA is collecting information on racism in nursing and the issue will be discussed at the next liaison. Council requested an update after the meeting.

In relation to the liaison with RPNAO, CNO identified that it has confirmed that trade marking of the title "nurse" by CNA has no impact on nurses in Ontario. CNO will monitor RPNAO's efforts to trade mark the title RPN and will respond to ensure that the appropriate officials understand the role of the regulatory body and the title protection provisions under the RHPA.

JOINT PROVINCIAL NURSING COMMITTEE

S. Ireland updated Council on the January 26, 2004 meeting of the Joint Provincial Nursing Committee.

OUTSTANDING REGULATIONS

Council received updates on the outstanding regulation amendments.

MEETING WITH THE MINISTER OF HEALTH & LONG TERM CARE

S. Ireland reported on the meeting with the Minister of Health and Long-Term Care. She noted that the College now has a direct link to Senior Policy Analyst in the Minister's office.

SCRUTINEERS

Council ratifies the scrutineers for the election of Council officers. The Executive had selected the scrutineers from among outgoing Council members.

Motion 10

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

That the appointment of Kien Campbell, Ruth Kitson and Sheila Richardson as scrutineers for the June 2004 election of officers be ratified.

CARRIED

REFLECTION ON THE MEETING

Council identified that the meeting was very professionally conducted, providing ample opportunity to speak. Members identified that they feel better able to participate because of the way the meeting is managed.

CONCLUSION

At noon, it was,

Motion 11

Moved by D. Bishop, seconded by M. Bestwick,

That Council conclude