Wednesday June 8, 2005

S. Ireland , Chair
J. Attwood
D. Barber
F. Bari
C. Beemer
D. Bishop
S. Burnell-Jones
K. Cook
F. Cole
B. Dowson
R. Fife

C. Genereux
R. Graham
A. Grant
E. Greenwood
G. Hayward
B. Hood
E. Howe
S. Islam
S. Keating
M. Lambert
M. McGinn

M. A. Murray
D. Norling
K. Pederson
R. Rupert
S. Seguin
M.L. Sivilia
A. Spacek
B. Taa
M. Ternovan
B. Weichel
C. Zanchetta

D. Dietrich
B. Hill

A. Mahdavian

M. Taylor

A. Coghlan
C. Campbell

J. Hofbauer, Recorder
P. Reinhart

G. Siskind
C. Stanford

WELCOME

S. Ireland welcomed new Council members attending the meeting.

RULES MONITOR

A. Spacek served as the rules of order monitor.

AGENDA

Council members had received the agenda for the meeting.

MOTION 1

Moved by B. Weichel, seconded by R. Graham,

That the agenda be approved.

CARRIED

Minutes

Minutes of the meeting of March 9, 2005 had been distributed. Page 353 of the minutes was amended to clarify that the Fitness to Practise panels only meet at the College if there are three or more consent orders for review.

Motion 2

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

That the minutes of the Council meeting of March 9, 2005 be accepted as amended.

CARRIED

Evaluation

Council members received a summary of the responses to the evaluation of the March Council meeting. S. Ireland expressed appreciation to members for the high level of response.

Three Streams of RN(EC) Practice

S. Galloway presented a document describing three streams of practice for the future Extended Class: Primary Health Care Nurse Practitioners (currently members of the extended class), Acute Care – Child and Acute Care – Adult.

Council provided some suggestions for clarifying the document. There was suggestion to clarify the language, and particularly to be explicit that an autonomous role includes the need to consult.

The legislative changes that need to take place have in order to incorporate Acute Care Nurse Practitioners into the Extended Class have been identified, including necessary amendments to the Nursing Act and the Public Hospitals Act. CNO has started working with the Ministry of Health and Long-Term Care and legal counsel on the necessary changes.

It was noted that, following consultation, the description of the three streams of practice will serve as a foundational document to support the development of standards and an assessment process.

Telepractice

L. Bildfell and M. Budwal highlighted the proposed Practice Guideline: Telepractice, replacing the current Telephone Practice. The process for revising the document, including the consultation, was reviewed. A number of suggestions were made for clarification.

Council identified that the document needs to be clearer regarding the RPN scope of practice and role in telepractice. It was noted that new RPNs have enhanced assessment skills and that the expectations around assessment for each category need to be clearly articulated.

Staff were asked to revise the document, given Council’s feedback, and to bring the revision to Council in September for decision.

HPRAC Update

A. F. Allen presented an update on the legislation review being undertaken by the Health Professions Regulatory Advisory Council (HPRAC) and presented an overview of the underpinnings of the current legislation. It was noted that regulatory colleges are being asked to identify mechanisms to remove barriers and allow for more effective and efficient self-regulation.

The College is anticipating detailed information from HPRAC regarding its priorities and timeframes, although HPRAC has made it clear that the consultations need to be complete near the end of 2005.

The Federation of Health Regulatory Colleges is developing a submission. Depending on timing, it will be reviewed by Council or the Executive to determine whether CNO will support the submission in whole or in part.

Given the tight timeframes that are anticipated, while Council may be able to approve some submissions, others will need to be approved by the Executive. If, due to time constraints, the Executive makes a submission on behalf of Council, the submission will clearly indicate that Council will be reviewing it in the future and may add an addendum. It was also noted that the review process is iterative and there will be further opportunities to respond.

It was identified that one of the issues in the original referral by the Minister was the regulation of Personal Support Workers (PSWs). Council members expressed concern about the growing use of PSWs and the inappropriate use of those practitioners by some facilities. CNO and HPRAC have both started consulting with employers on the use of PSWs.

Delegation and Medical Directives

M. Cyr and S. Avey-Morrison presented an educational session on delegation and medical directives. The historical perspective was reviewed and the practice realities and legal issues related to delegation were outlined. It was noted that CNO had prepared regulations related to delegation; these regulations have not been passed by government. CNO has incorporated the conditions for delegation that had been included in the draft regulation into the Guide to Decide.

Council identified that terminology needs clarification – for example the difference between standing orders and medical directives. It was confirmed that a decision framework that includes factors related to clients, the nurse and the environment is helpful to decision making and might be applied to help nurses make decisions regarding medical directives. Council identified that CNO guidelines should support the effective use of nursing staff in facilities.

It was suggested that the document being prepared include examples to assist members in working through issues. It was noted that the new educational requirements and College standards and guidelines have prepared the nursing profession to take on this type of decision making.

ED update

P. Reinhart provided a brief update on key activities in the Corporate Services Department. He reported on implementation of the College’s new information system, noting that the functional specifications have been completed, the system is being built and development of an integration plan is underway.

A. Coghlan outlined examples of CNO influence on provincial policy, including participation on the Nurse Practitioner Implementation Team and Provincial Pandemic Flu plan.

The Federation of Health Regulatory College’s public information campaign was launched in April with radio ad linked to a new web-site. This outreach initiative is aimed at raising consumer awareness regarding the health regulatory colleges and the difference between regulated and unregulated professionals.

A. Coghlan highlighted recent international conferences. She outlined the “Tuning Initiative” being undertaken -- Universities in Europe are collaborating in identifying common competencies.

There was some discussion about the 2005 annual renewal process and complaints from members who had sent materials in on time, but due to the return of incomplete forms, had been charged late fees. Council was informed that the vast majority of forms were completed correctly. The importance of applying the requirements in a fair and consistent manner was identified. CNO plans to implement on-line renewal in 2007 which is anticipated to reduce issues regarding incomplete forms.

Executive Committee

S. Ireland highlighted the notes of the Executive Committee meetings of March 29 and 30, 2005; April 20 and 21, 2005; May 9 and 10, 2005; May 31, 2005 and June 2, 2005

Elections Committee

Council had received the report of the Elections Committee. It was noted that the committee will be exploring mechanisms to enhance participation and employer support at its meeting over the summer.

Finance Committee

K. Cook presented the report of the Finance Committee meeting of May 17, 2005. The unaudited financial statements for the four month period ending April 30, 2005 had been circulated. The reasons for major variances were highlighted.

Motion 3

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

That the unaudited financial statements for the four month period ended April 30, 2005 be accepted.

CARRIED

Code of Ethical Conduct

When Council first approved the Code of Ethical Conduct for Council and Committee Members, a commitment was made to evaluate the effectiveness of the Code. Council received a summary of the evaluation. It was clear from the evaluation that all members have taken responsibility and accountability for the effectiveness of the Code.

By-Law

The Executive is recommending changes to the General Bylaw related to committee structure, on request of the Nominating Committee. By adding one member to each of the Discipline and Fitness to Practise committees, additional support will be provided to address the committee workload and those elected committee members serving on Client Relations will have a second committee and be more engaged with the College.

Motion 4

Moved by S. Keating, seconded by B. Weichel,

That article 19.01 of the College’s By-law No. 1 General be amended by revoking clause iii and substituting the following:

iii) twelve thirteen elected committee members, eight of whom were elected as RNs and four five of whom were elected as RPNs.

CARRIED

Motion 5

Moved by J. Attwood, seconded by D. Bishop,

That article 20.01 of the College’s By-law No. 1 General be amended by revoking clause iii and substituting the following:

iii) five six elected committee members, three four of whom were elected as RNs and two of whom were elected as RPNs.

CARRIED

Conclusion

The Council meeting concluded at 4:15 p.m.