Present

S. Ireland, Chair
J. Attwood (Thursday)
D. Barber
C. Beemer
D. Bishop
S. Burnell-Jones
K. Cook
F. Cole
D. Dietrich
R. Fife
R. Graham

E. Greenwood
L. Hall
G. Hayward
B. Hill
B. Hood
S. Keating
V. Kerr
M. Lambert
M. McGinn
M. A. Murray

B. Noble
K. Pederson
R. Rupert
S. Seguin
A. Spacek
M. Taylor
M. Ternovan
D. Trouten
S. Young
C. Zanchetta

Regrets

J. Atwood (Wednesday)
E. Howe

D. Norling
R. Rupert

B. Weichel

Staff

A. Coghlan
H. Campbell

On Invitation:
A. Bromstein,
Legal Counsel

J. Hofbauer, Recorder
P. Reinhart

G. Siskind
C. Stanford

RULES OF ORDER

S. Burnell-Jones served as the rules of order monitor for the Council meeting.

AGENDA

The agenda had been circulated. S. Ireland noted changes to order of items. Observers were informed that the Council meeting will recess at noon on September 22nd and reconvene at 9:00 a.m. on September 23rd.

MOTION 1

Moved by D. Barber, seconded by R. Graham,

That the agenda for the Council meeting of September 22 and 23, 2004 be accepted as circulated.

CARRIED

CLOSURE

The Executive had recommended closure of the Council meeting to receive an opinion from Legal Counsel.

MOTION 2

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

That the Council meeting be closed on or about 9:05 a.m. on Wednesday, September 22, 2004 to discuss personal or personnel matters and receive advice from legal counsel in accordance with clauses 7(2)(b),(d) and (e) of the Code.

CARRIED

CLOSED SESSION

Council moved into a closed session, which is recorded in a confidential appendix provided to those Council members in attendance at the session.

REGISTRATION REGULATION

A. Bromstein joined Council. In June 2004, Council approved in principle, for consultation, proposed amendments to the registration regulation to address transition provisions related to implementation of the new educational requirements in 2005.

Council received a report of the feedback to the regulation. The concerns of a number of other Canadian jurisdictions regarding the sunset clause in the Transitional Class were highlighted. Council was informed that a letter had been received from the Ministry of Health and Long-Term Care (MOHLTC) regarding the regulation. The letter identified that the Ministry consulted with the Ministry of Training, Colleges and Universities which has expressed concern about the Transitional Class, and requested that the sunset clause be removed because it may not be consistent with the Agreement on Internal Trade.

Council reviewed and discussed each of the provisions, and had a show of hands vote to indicate support.

Extension of examination deadline

Through a show of hands, Council identified support for this provision.

Grandparenting for Internationally Educated Nurses from other Canadian jurisdictions

This provision is being put into place to address applicants from other Canadian jurisdictions whose original nursing education is from outside of Canada. These applicants are being treated differently from IENs who have not established registration in Canada because they are subject to the Mutual Recognition Agreement and have written and passed the national registration examination.

The Registration Committee will monitor the impact of the new requirements on IENs and is exploring mechanisms that need to be in place to assist IENs. The College is working with educational stakeholders to develop different models of bridging programs to assist IENs to achieve Ontario's educational requirements.

By show of hands, Council identified its support for this provision.

Transition Class

Council discussed the Transitional Class provisions in relation to the stakeholder feedback, including that from the provincial government.

Council noted that the new entry requirements were identified as the result of extensive research and consultation into the requirements needed to meet the needs of the public in 2005. The Transitional Class provisions balance what the College's research shows is needed for public safety with the requirements for recognition of applicants from other Canadian provinces. Concern was also expressed that removal of the sunset provisions would be unfair to Ontario graduates who must meet the new educational requirements in 2005 to be eligible for registration.

Legal counsel noted that it is the College's obligation is to act in the public interest. He identified that it was not the intention of the Mutual Recognition Agreement that jurisdictions not be able to change educational requirements.

Given that the College's new entry to practice requirements were based on extensive research and are designed to meet the needs of the public, Council members expressed support for the Transitional Class provisions to include the sunset clause.

By show of hands, Council members supported the provisions of the transitional class, as initially published.

Additional Amendments

Additional amendments were proposed to enhance the grand-parenting provisions for IENs and access to the Transitional Class. These changes were identified as minor enhancements, not requiring publication.

MOTION 3

Moved by S. Keating, seconded by R. Graham,

That Council approve the following additional revisions to paragraphs 8.1 (1) 1. and 8.2 (1) 1. of the proposed amendments to Ontario Regulation 275/94, amended to Ontario Regulation 472/01, as detailed in attachment 2 to the briefing note:

8.1 (1) 1. at the time of application The applicant must have been registered to practise nursing in another province or territory in Canada with a certificate or licence considered by the Registration Committee to be equivalent to a general certificate of registration as a registered nurse, prior to January 1, 2005.

8.2 (1) 1. at the time of application The applicant must have been registered to practise nursing in another province or territory in Canada with a certificate or licence considered by the Registration Committee to be equivalent to a general certificate of registration as a registered practical nurse, prior to January 1, 2005.

CARRIED

MOTION 4

Moved by V. Kerr, seconded by D. Bishop,

That Council approve the following additional revisions to paragraphs 11. (1) 5. and 11. (2) 5. of the proposed amendments to Ontario Regulation 275/94, amended to Ontario Regulation 472/01, as detailed in attachment 2 to the briefing note:

11.(1) 5. The applicant must have enrolled in a course(s) or nursing program, successful completion of which would result in the applicant meeting the requirements of paragraph 1 of subsection 6(1.1) or have signed an undertaking with the College, in a form acceptable to the Registration Committee, to enroll in the required course(s) or nursing program within a reasonable period of time.

11. (2) 5. The applicant must have enrolled in a course(s) or nursing program, successful completion of which would result in the applicant meeting the requirements of paragraph 1 of subsection 6(2.1) or have signed an undertaking with the College, in a form acceptable to the Registration Committee, to enroll in the required course(s) or nursing program within a reasonable period of time.

CARRIED

Due to a recent government decision, the provision regarding the Temporary Class requires revision.

MOTION 5

Moved by K. Pederson, seconded by C. Beemer,

That Council approve the following amendment to paragraph 9.(5)2 of the proposed amendments to Ontario Regulation 275/94, amended to Ontario Regulation 472/01, to read:

The member's practice must be monitored and directed by a member of the College holding a general or extended class certificate of registration.

CARRIED

S. Ireland noted that Council had approved the regulation in principle for publication in June and now needs to make a final decision regarding approval of the regulation for submission to government.

MOTION 6

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

That Council approve the amendments to Ontario Regulation 275/94, amended to Ontario Regulation 472/01, as detailed in attachment 2 to the briefing note, and as subsequently amended by Council at this meeting for submission to the Ministry of Health and Long-Term Care for passage, recognizing that changes may be necessary to the final language of the regulation due to passage of some or all of the outstanding amendments, and/or legal editing as required by government; and that Council confirm that subsequent changes to the regulation do not require Council approval unless they result in a change in intent from that approved by Council in accepting Attachment 2 and the subsequent amendments made by Council today.

CARRIED

The Executive Director and President normally sign a sealed regulation that is identical in intent to what is approved by Council. Given the concerns of the government regarding the provisions of the Transitional Class, the importance of the remaining components of the regulation, and the time sensitive nature of the provisions related to the examination extension, there was discussion about providing direction to sign off on a sealed regulation absent the Transitional Class provisions.

MOTION 7

Moved by M.A. Murray, seconded by M. Taylor,

That Council directs the President and Executive Director to sign any sealed regulation related to the amendments approved to Ontario Regulation 275/94 amended to Ontario Regulation 472/01as detailed in attachment 2 of the briefing note, and amended by Council today, provided that the intent of Council has been satisfied and even if one or more of the accommodation mechanisms is(are) not included, if received prior to the next regular Council meeting.

CARRIED

MINUTES

Minutes of the Council meeting of June 9, 2004 had been circulated.

MOTION 8

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

That the minutes of the Council meeting of June 9, 2004 be approved.

CARRIED

Minutes of the Council meeting of June 10, 2004 had been circulated.

MOTION 9

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

That the minutes of the Council meeting of June 10, 2004 be approved.

CARRIED

EVALUATION OF THE JUNE COUNCIL MEETING

Council members had received the summary of the evaluation of the June Council meeting.

COUNCIL/STAFF EFFECTIVENESS SURVEY

Council members received a report on the second Council/staff effectiveness survey. The survey reflected improvements in all areas. The survey will be revised and repeated annually in June.

S. Ireland noted that, while there has been an improvement, there are still opportunities to continue to build the effectiveness of the Council/staff relationship.

PRACTICAL NURSE PROGRAM APPROVAL COMMITTEE

S. Ireland reviewed the background to the development of the By-Law revision related to the Practical Nurse Program Approval Committee. She highlighted where the By-Law reflects the decisions about the committee's structure and role made by Council in June, 2004.

MOTION 10

Moved by R. Fife, seconded by R. Graham,

That Council amend By-Law No 1 by adding those words, Articles, Sub-Articles and headings that are highlighted in Attachment 1 to the minutes, by deleting those words, Articles, Sub-Articles and headings that are over struck in Attachment 1 to the minutes, thereby establishing a new standing committee of the College known as the Practical Nurse Program Approval Committee, as well as dealing with matters related or incidental thereto.

CARRIED

S. Ireland updated Council on the activities of the Practical Nurse Program Approval Committee.

PRACTICE STANDARD: PRIVACY AND CONFIDENTIALITY

L. Bildfell reviewed the impetus for development of the new Practice Standard. Council members made a number of editorial suggestions and also suggestions for clarification. Through a show of hands, Council supported the editorial changes and clarifications for integration into the Practice Standard.

Education plans for the Practice Standard will include articles in The Standard and QP. It was suggested that, in the light of some of the cases coming forward to committees, scenarios be included in The Standard to help members to understand expectations regarding confidentiality, for example that it is important to limit the sharing of information about clients to other nurses providing care for the client. The Documentation REN session will be updated in the new year to address the Practice Standard.

In addition, the Federation of Health Regulatory Colleges is sponsoring a number of workshops around the province on the new provincial privacy legislation. A listing of the workshops is included in the recent issue of The Standard and posted on the web site.

MOTION 11

Moved by R. Graham, seconded by D. Dietrich,

That Council approve the draft document entitled Practice Standard: Confidentiality and Privacy - Personal Health Information for publication.

CARRIED

Thursday, September 23, 2004

STATUTORY COMMITTEE SEMI-ANNUAL REPORTS

S. Ireland congratulated the statutory committee chairs elected over the summer. She noted that the reports are a mechanism for committee accountability to Council.

Executive Committee

S. Ireland highlighted the semi-annual report of the Executive Committee. The Executive and Complaints committees have experienced significant increases in matters being referred. An update on the operational trends in Investigations and Hearings will be presented as a part of the Executive Director update.

A disproportionately high number of reports continue from the Long-Term Care sector and this will be closely watched. It was also noted that while incapacity matters increased in 2003, the 2004 numbers remain consistent with 2003 and remain low when compared with the nursing population.

Client Relations

D. Trouten reviewed the role of the Client Relations Committee and highlighted the plans to revise the One is One Too Many program. She noted that the program continues to be actively marketed and has recently been "re-branded" to reflect CNO's new corporate identity, which has resulted in significant sales. She reported that the Committee is awaiting a letter of indemnity from the Provincial government regarding the by-law for funding for therapy for sexually abused patients.

Complaints Committee

M. A. Murray reported on the increase in complaints addressed by the Complaints Committee. She noted that the majority of complaints are from the public and that the increase may reflect confidence that the College will address the issues.

There appears to be a decline in complaints from the mental health sector. This may be a reflection of enhanced professionalism and/or of reorganization of the health care system where mental health settings are now part of larger acute care settings. This is an example of the challenge of interpreting the meaning of the data collected in committee reports.

Discipline Committee

M. Ternovan presented the report of the Discipline Committee. It was noted that 75% of cases were addressed through agreed statements of fact.

Fitness to Practise Committee

R. Graham presented the report of the Fitness to Practise Committee. The committee has changed the process for consent orders, the first panel to review consent orders will meet in October.

Quality Assurance Committee

S. Keating reported that there was a 94% success rate for direct care nurses who completed the Practice Review Written Assessment. Over 80 nurses have been granted deferral from Practice Review in 2004 due to extenuating circumstances. Eight nurses are refusing to participate in Practice Review and the Quality Assurance Committee will be developing a process to address these situations.

It was noted that many RN(EC)s are waiting to participate in their first Practice Review which is required after 1800 hours of practice or 3 years. J. Anderson provided an update on development of the changes in the process.

Registration Committee

C. Beemer presented the report of the Registration Committee. The committee has experienced a considerable increase in volume, perhaps due to the impending change in entry to practice requirements on January 1, 2005.

C. Beemer noted that 20% of all applicants are internationally educated. Programs are being put into place to assist internationally educated applicants to meet the new requirements.

EXECUTIVE DIRECTOR UPDATE

A. Coghlan noted that the Executive Director Update will focus on current "hot" issues in the organization. G. Siskind presented a brief report on Investigations and Hearing activities from an operational perspective.

She highlighted the pressures on the system created by the increase in complaints and reports and the approaches being used to address the increase.

Council was updated on the new College information system. The operational activity related to implementation of the new entry to practice requirements was outlined. Council was informed that a video about the College targeted at nursing students is in preparation with a target launch of December Council. An update on regulations was provided.

It was noted that extensive collaboration with the Ministry of Health and Long-Term Care has resulted in passage of the drug list for members of the Extended Class. An update was also provided on public appointments.

STATISTICS REPORT

Highlights of the 2004 statistics were presented to Council. It was noted that the new format statistics reflect the membership at a specific point in time.

EXECUTIVE COMMITTEE

Council had received minutes of the five Executive Committee meetings since the June Council meeting: June 10, 2004; June 28, 2004; July 8, 2004; August 17 and 18, 2004; and September 8 and 9, 2004. S. Ireland briefly highlighted the minutes.

In September, the Executive filled a committee vacancy.

MOTION 12

Moved by D. Trouten, seconded by R. Graham,

That the appointment of Mike Ternovan to the Client Relations Committee until June 2005 be ratified.

CARRIED

FINANCE COMMITTEE

K. Cook and S. Burnell-Jones presented the report of the Finance Committee meeting of September 8, 2004. The Financial Statements for the nine months ended September 30, 2004 were highlighted.

Examination Fees

The cost for the College to purchase the examination for registration as an RN is increasing significantly. K. Cook reported that the Finance Committee considered a variety of options for addressing the increase in the cost of purchasing the examination, including short-term subsidization of the fees.

It was noted that the increase in cost is driven by the new format of the examination which is more expensive to develop, maintain and mark.

The Finance Committee recommended a short-term subsidization, the cost of which would be partially offset by a net surplus in examination revenue generated due to the high volume of examinations in 2002 and 2003. The Finance Committee felt that it was important to support the students in 2005 who will be the first that were required to complete the BScN, which is a more expensive and lengthier educational program.

There was considerable discussion about the proposal to subsidize students. Some members felt that the principle that member fees are not used for applicant processes should be maintained. Others expressed the view that, for this one time given the size of the increase and the change in entry requirements, that CNO should subsidize the fee in the short term.

It was confirmed that Council is making a decision in principle at this time and members will have an opportunity for input with circulation of the proposed fees by-law.

MOTION 13

Moved by M. Ternovan, seconded by J. Attwood,

That the fee for writing the examination for registration as a nurse be increased to $315.00 effective June 2005, $373.83 effective January 2006, with an annual increase of $9.35 thereafter (excluding GST).

CARRIED

MOTION 14

Moved by M. Ternovan, seconded by S. Young,

That, effective the examination taken in June 2005, the fee for rescoring the nurse examination be $46.73 (excluding GST).

CARRIED

BY-LAW

The examination fee is established in the Fees By-Law. Any changes to the fees by-law need to be circulated to members for 60 days for feedback. Council will receive a report of the feedback in March and will make a final decision about the By-Law.

MOTION 15

Moved by M. McGinn, seconded by M. Taylor,

That Council approve in principle, for consultation, the amendment of the College's By-law No. 2 Fees by:

1. revoking clause i and ii of Article 9.01 and substituting the following:
   1. $200.93 if the examination is to be taken prior to June 1, 2005;
   2. $315.00 if the examination is to be taken on or after June 1, 2005 but prior to January 1, 2006;
   3. $373.83 if the examination is to be taken on or after January 1, 2006 but prior to January 1, 2007;
   4. 383.18 if the examination is to be taken on or after January 1, 2007 but prior to January 1, 2008;
   5. 392.53 if the examination is to be taken on or after January 1, 2008 but prior to January 1, 2009;
   6. 401.88 if the examination is to be taken on or after January 1, 2009 but prior to January 1, 2010; and
   7. 411.23 if the examination is to be taken on or after January 1, 2010.
   
   
2. revoking the whole of Article 9.03 and substituting the following:
   9.03 A person who applies to have the results of an examination referred to in Article 9.01 re-scored shall pay a fee of:
   
   1. $35.00, if the examination to be rescored was taken prior to June 1, 2005; and
      
   2. $46.73, if the examination to be rescored was taken on or after June 1, 2005.
      

CARRIED

ELECTIONS COMMITTEE

M. A. Murray briefly highlighted the report of the Elections Committee meetings. She noted that the committee continues to work to ensure that candidates are clear about the regulatory role in their literature to members. The Elections Committee proposed changes to its terms of reference.

MOTION 16

Moved by J. Attwood, seconded by G. Hayward,

That Council approve the revised Elections Committee terms of reference (appended to the minutes).

CARRIED

ELECTIONS COMMITTEE

The Executive appoints the Elections Committee, for ratification by Council.

MOTION 17

Moved by S. Keating, seconded by J. Attwood,

That Council ratify the following 2005 Elections Committee: Cheryl Beemer, RN; David Bishop, public member; Denise Dietrich, RPN; Ruth Graham, public member; Brenda Noble, public member; and Bill Weichel, public member.

CARRIED

OTHER BUSINESS

Council discussed the growing use of Personal Support Workers (PSWs) in the health care system. It was noted that many PSWs work in long-term care and some are seeking regulation. This is a complex issue that needs to be addressed strategically by a variety of stakeholders in the health care system. Previously, CNO has had influence in relation to the education of PSWs.

DEBRIEF

Council had a brief discussion about the meeting process -- what worked well and what can be improved. Council members identified that the background information presented for the meeting allowed members to be prepared. The new approach to the Executive Director's update was supported. S. Ireland expressed appreciation to Council members for their preparation and input.

CONCLUSION

At 2:45 p.m., it was

MOTION 18

Moved by A. Spacek, seconded by S. Young,

That Council conclude.

CARRIED