COUNCIL

Present

S. Keating, Chair
F. Bari
C. Beemer
D. Bishop
L. Bracken
K. Cook
F. Cole
D. Dietrich
B. Dowson
R. Fife

C. Genereux
R. Graham
A. Grant
G. Hayward
B. Hill
B. Hood
S. Ireland
S. Islam
M. Lambert
M. McGinn
A. Mahdavian

N. Mohabir (Wednesday)
M. A. Murray
D. Norling
L. O’Hearn-Grant
C. Ritchie
M.L. Sivilia
A. Spacek
B. Stewart
M. Taylor
B. Weichel

Regrets

J. Attwood
G. Fieber
N. Mohabir (Thursday)

S. Padda
K. Pederson
S. Seguin

B. Taa
C. Zanchetta

Staff

H. Campbell
A. Coghlan

J. Hofbauer, Recorder
P. Reinhart

G. Siskind
C. Stanford

WELCOME

S. Keating welcomed new public members to Council: Linda Bracken, Nalini Mohabir, and Brian Stewart.

AGENDA

It was noted that the Council meeting will recess at 12:30 p.m. on Wednesday, September 28th and reconvene at 9 a.m. on Thursday, September 29th.

MOTION 1

Moved by R. Graham, seconded by L. Bracken,

That the agenda for the Council meeting of September 28 and 29, 2005 be accepted as presented.

CARRIED

MINUTES

Minutes of the Council meeting of June 8, 2005 had been circulated.

MOTION 2

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

That the minutes of the Council meeting of June 8, 2005 be accepted as presented.

CARRIED

Minutes of the Council meeting of June 9, 2005 had been circulated. Typographical errors were corrected on pages 368 under “Nominations” and 369 under “Officers”.

MOTION 3

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

That the minutes of the Council meeting of June 9, 2005 be approved as corrected.

CARRIED

EVALUATION OF JUNE COUNCIL

Council members had received the summary of evaluations of the June Council meetings.

STRATEGIC PLAN UPDATE

A. Coghlan highlighted the semi-annual update of the Strategic Plan, including the Results Report. As part of the review, H. Campbell and J. Anderson provided an update on the outcome of the evaluation of the Regional Education Network (REN). The College undertook an extensive review of the REN, including input from REN staff.

The need for the College’s ongoing outreach to address nurses in non-traditional roles and isolated areas was identified. Some concern was expressed about the current status of the program. Council was informed that currently booked sessions will be honoured and that other requests are being reviewed individually and prioritized. CNO will be attempting to build a model that will develop a better understanding of the needs of members, link with practice setting realities, enable the College to forecast and target activities, and link to other forms of consultation.

Council was informed that the College is currently developing a revised tool for the Practice Setting Consultation Program (PSCP) and hopes to launch the revised PSCP in May 2006.

HPRAC REVIEW -
CONTROLLED ACTS

The College is proposing using the opportunity of the Health Professions Regulatory Advisory Council’s (HPRAC’s) review of the Regulated Health Professions Act to proactively identify issues related to nursing practice.

The public interest rationale for the request for additional controlled acts being authorized to nursing was reviewed. In addition, it was suggested that the College recommend that legislative/regulation sections that address authorization mechanisms for controlled acts be reviewed.

It was noted that CNO has not consulted with other regulatory bodies on the specific proposed new controlled acts, pending Council input. There has; however, been ongoing discussion with a variety of professions around the need to revise the legislation to clarify authorization mechanisms.

If the additional controlled acts are approved by Council for inclusion in CNO’s submission, it will be the beginning of a lengthy process that will include consultation with other professions and nurses.

MOTION 4

Moved by D. Norling, seconded by S. Ireland,

That a request be submitted to HPRAC that nursing be granted access to the following controlled acts:

• Communication of a diagnosis;
• Dispensing and selling of drugs;
• Setting or casting of a fracture of a bone or a dislocation of a joint; and
• Application of a form of energy.

CARRIED

MOTION 5

Moved by D. Dietrich, seconded by S. Islam,

That Council support the inclusion of a recommendation from CNO to HPRAC that all legislative/regulation sections that address authorization mechanisms for nursing be reviewed for clarity and revised as necessary.

CARRIED

PRESCRIPTIVE AUTHORITY FOR RN(EC)S

The current list-based system for authorizing changes in prescribing authority for RN(EC)s is lengthy and cumbersome. The result is that clients of RN(EC)s do not have access to first-line treatments. It was noted that this process is of particular concern for the future regulation of Acute Care Nurse Practitioners (ACNPs) within the College.

Council agreed that it is important to provide up to date prescribing authority for members of the extended class and to adequately provide for the future inclusion of ACNPs in the Extended Class.

MOTION 6

Moved by B. Hood, seconded by B. Weichel,

That a request be submitted to HPRAC to change the current list-based approval process for RN(EC) prescriptive and diagnostic authority by moving to a broader, less restrictive model, more responsive to client needs, using options such as Drug Schedules or Formularies and open authority to order diagnostic tests.

CARRIED

TITLE PROTECTION FOR NURSE PRACTITIONERS

The HPRAC review offers the College an opportunity to move forward a previous Council decision by bringing to the attention of government the proposal for protection of the title “Nurse Practitioner”. This is a critical step for implementation of Acute Care Nurse Practitioners. At the time the regulations are amended to protect this title, Council will need to determine the qualifications for access to the title.

MOTION 7

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

That a request be submitted to HPRAC to protect the title “Nurse Practitioner”.

CARRIED

PSYCHOTHERAPY

The Ministerial referral to HPRAC included direction to make recommendations regarding the regulation of psychotherapy. HPRAC is in the midst of exploring this issue and CNO has been involved. The complexities around regulation of psychology were highlighted.

It is proposed that CNO support the regulation of psychotherapy because of the significant risk of harm. Given all of the complexities to be addressed, it is suggested that the College’s recommendation be broad.

Council confirmed that it will be important to be clear in the definition to ensure that psychotherapy does not include counseling and that the regulation of psychology does not limit services to marginalized groups.

MOTION 8

Moved by D. Dietrich, seconded by M.L. Sivilia,

That a recommendation be submitted to HPRAC that the performance of psychotherapy be regulated utilizing the most appropriate legislative strategy and that nurses with the required qualifications have the regulatory authority to practice psychotherapy.

CARRIED

RECESS

Council recessed at 12:30 p.m., to reconvene at 9:00 a.m. on Thursday, September 29, 2005.

HPRAC SUBMISSION

Council reviewed the College’s draft submission to HPRAC “Review of the Legislative Framework of the Health Regulatory Colleges”.

SECTION A – REGULATORY CHANGES FOR NURSING PRACTICE

Council reviewed Section A of the draft submission, addressing regulatory changes for nursing practice. It was confirmed that the draft reflected the decisions made by Council on September 28th.

SECTION B – ISSUES REGARDING REGULATORY FRAMEWORK

Council’s discussion was informed by the Think Tank on Regulatory Reform, held the afternoon of September 28th. Copies of the summaries of the Think Tank discussions were distributed. Council reviewed each recommendation in detail. A show of hands was used to determine support for each recommendation.

RECOMMENDATION 7

There was extensive discussion about the appropriate level of information to be included on the public register with regards to Complaints/Executive Committee decisions. It was acknowledged that the public wants information about nurses who have been unsafe but that they do not necessarily understand that an action by a screening committee, for example a letter, does not mean that there has been a finding.

Council noted its dilemma – while it supports enhanced openness and transparency for the public, it is not clear what the public really wants nor is it clear whether the public will understand the meaning of the information that might be shared. Without more information, Council was not able to come to consensus on a specific recommendation regarding the appropriate level of information to be included on the public register.

Council did agree; however, that when terms, limitations or conditions are applied to a member’s registration, that should be included on the public register. With a show of hands, Council agreed to the following recommendation to HPRAC:

CNO recommends that:

• terms, limitations and conditions noted within undertakings be included on the public register; and

• that HPRAC explore with stakeholders, including the public, the merits of providing outcome information to the public with regards to Complaints / Executive investigations, including:

  • letters of concern,
  • letters of caution, and
  • oral cautions.

  Investigations that result in a “Take no Action” would not be available to the public.

RECOMMENDATION 8

There was extensive discussion about the public register contents with respect to Discipline decisions. Council supported expansion of the public register to include all reprimands, fines, terms, conditions and limitations resulting from a disciplinary proceeding. Council identified that this information would be helpful to employers and the public.

RECOMMENDATION 9

Council supported the concept of merging screening functions into one committee to provide internal consistency, increase administrative efficiency, and remove confusion about the roles of the two screening committees.

RECOMMENDATION 10

The role of the Board of Inquiry was clarified. Council supported removal of the Board to increase the timeliness of decisions and allow screening committees to address a range of issues more efficiently and effectively.

RECOMMENDATION 11

Council discussed the concept of merging of adjudicative committee functions. It was noted that there is a philosophical difference between Discipline and Fitness to Practise hearings. While supporting the merging of the adjudicative functions into one committee, CNO’s submission also points out that the philosophical differences between those two types of hearings will need to continue.

RECOMMENDATION 12

Complainants and members are parties to the complaints process. Council identified that this recommendation will enshrine equal rights for complainants and members in legislation.

RECOMMENDATION 13

It was confirmed that the current 120 day timeframe for disposal of complaints is not realistic. Council confirmed that the recommendation to increase the timeframe to 150 days respects the complexity of the process.

RECOMMENDATION 14

Council supported continuing Discipline Committee discretion with respect to penalties for most matters.

RECOMMENDATION 15

This recommendation, addressing systems issues, is consistent with the College’s strategic plan. Council identified that there needs to be an ongoing collaborative mechanism for colleges to work with the health care system in addressing systemic issues. It was suggested that the role of the Task Force be to develop the ongoing collaborative mechanism.

RECOMMENDATION 16

Council supported this recommendation, addressing the substance of the Quality Assurance Program.

RECOMMENDATION17

Council identified that it is appropriately within the role of individual colleges to evaluate the effectiveness of the college’s regulatory programs, including Quality Assurance Programs.

SECTION C – STANDING RECOMMENDATIONS

Council was provided with the opportunity to discuss standing recommendations included in the draft submission. Section C of the submission was supported as presented.

SUBMISSION

It was noted that Council had made changes to recommendation 7 and supported all other recommendations in the draft submission.

MOTION 9

Moved by S. Ireland, seconded by M. Taylor,

That the draft submission on nursing issues and the regulatory framework be approved for forwarding to HPRAC, with inclusion of direction from Council.

CARRIED

REGISTRATION REGULATION -
SUNSET CLAUSE

The Minister of Health and Long-Term Care had written asking that Council consider removal of the sunset clause from the Transitional Class provisions of the registration regulation. The purpose of the Transitional Class, and particularly the sunset clause, was highlighted.

Council considered the options. It was noted that, should Council decide to remove the sunset clause, it would be a decision “in principle” only as it needs to be circulated to members and stakeholders.

Council took note of the comment from Minister that the current regulation does not go far enough in meeting government policies and expectations in providing ongoing accommodation.

MOTION 10

Moved by B. Weichel, seconded by C. Genereux,

That draft revisions to the registration regulation be prepared for consideration by Council in December, removing the sunset provisions for the Transitional Class.

CARRIED

RN(EC) DRUGS, LABORATORY AND DIAGNOSTIC TESTS

A report of the responses to the proposed amendments to the RN(EC) drug, laboratory and diagnostic test list, published in The Standard in June, was reviewed. Council noted that the list-based approach limits the College’s ability to provide RN(EC)s with access to first line treatments and is a barrier to effective practice. Council’s concerns have been articulated in CNO’s HPRAC submission, approved earlier.

MOTION 11

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

That Council approve amendments to Schedule 2 and Schedule 3 of Ontario Regulation 275/94, as amended to Ontario Regulation 433/04 under the Nursing Act, 1991 ("General Regulation”), as set out in Attachment 1 to the briefing note, on the understanding that each addition, deletion and revision to each of the items in each of the Schedules shall be considered an amendment which has been approved by Council independent of the other amendments.

And that Council directs that the amendments be forwarded to the Ontario Ministry of Health and Long-Term Care with a request that the government take such action as shall be required to amend the General Regulation as well as such other Statutes and Regulations, if any, as may be required to allow Registered Nurses in the Extended Class to prescribe and administer the immunizing agents and drugs referred to therein.

CARRIED

It was noted that the laboratory and diagnostic tests are articulated in other legislation and need to be addressed differently.

MOTION 12

Moved by C. Ritchie, seconded by D. Bishop,

That Council directs that the College write to the Ontario Ministry of Health and Long-Term Care to request that the Ontario government take such action as shall be required, including amending Statutes and Regulations, to allow Registered Nurses in the Extended Class to order the laboratory and diagnostic tests referred to in Attachment 2 to the briefing note.

CARRIED

PRACTICE STANDARD: DECISIONS ABOUT PROCEDURES AND AUTHORITY IN NURSING PRACTICE

Council reviewed the draft Practice Standard: Decisions about Procedures and Authority in Nursing Practice. It was noted that, while the ideal situation is to expand the legislated scope of practice to include activities that nurses regularly carry out, legislative change takes time and nurses require guidance at this time.

The decision tool included in the Practice Standard is designed to reflect the complexity of practice in 2005. Some areas for clarification were identified.

There was discussion about action being taken to address legislative barriers to implementation of Acute Care Nurse Practitioners. CNO is meeting with the Ministry of Health and Long-Term Care to discuss implementation of Acute Care Nurse Practitioners and discusses legislative barriers. It was noted that these issues also arise frequently at the Joint Provincial Nursing Committee.

MOTION 13

Moved by G. Hayward, seconded by B. Weichel,

That Council approve the draft document entitled: Practice Standard: Decisions about Procedures and Authority in Nursing Practice.

CARRIED

TELEPRACTICE

In June, Council had reviewed the Practice Guideline: Telepractice and asked that it be revised and return to Council for review. The process to revise the Practice Guideline to reflect Council’s input was highlighted.

MOTION 14

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

That Council approve the draft document entitled Practice Guideline: Telepractice.

CARRIED

COMMITTEE REPORTS

Semi-annual reports of statutory committees had been circulated to Council, for information.

FINANCE COMMITTEE

M. A. Murray highlighted the report of the Finance Committee meeting of September 1, 2005.

FINANCIAL STATEMENTS

Financial statements as at July 31, 2005 were presented. It was noted that there is a significant positive variance over the 2005 budget and that the College is in a strong financial position.

MOTION 15

Moved by M.A. Murray, seconded by M. L. Sivilia,

That the unaudited financial statements for the seven month period ended July 31, 2005 be accepted.

CARRIED

BYLAW REVISIONS

The Finance Committee is recommending revisions to College Bylaws to facilitate maintaining the integrity of the College’s data. The impact of the proposed changes was reviewed in detail.

It was noted that the proposed administrative fee is not sanction, rather it recognizes the additional work required when the renewal form and fee are separated.

MOTION 16

Moved by C. Beemer, seconded by A. Grant,

That Council approve the following changes, for consultation:

1. Amend Bylaw No. 1: General and specifically Article 44.2 to add the following new provisions:
44.2.01.2 The form required by this article shall be fully completed by the member and returned to the College by the December 31st next following the forwarding of the form to its members.
44.2.01.3 Where a member fails for any reason to return a fully completed form, the Executive Director shall cause the member to be notified in writing of that failure.
44.2.01.4 Where the Executive Director causes written notice to be given to a member in accordance with Article 44.2.01.3, the fee required by the bylaws (Bylaw No. 2: Fees) shall immediately be payable by the member.

2. Amend Bylaw No. 1: General and specifically Article 44.3
add to the beginning of article 44.3.01 the words
“Subject to Article 44.3.02,”
And to delete the current Article 44.3.02 and substitute the following:
44.3.02 The annual payment card shall be sent out to each member within a reasonable period of time after receipt by the College of payment of any fee owed by the member to the College, including the member's annual fee, and the fully completed form referred to in Article 44.2.

3. Amend Bylaw No. 2: Fees to add Articles 9.1.01 and 9.1.02 (immediately before Article 10.01) as follows:
9.1.01 Subject to Article 9.1.02, a member who is notified of his or her failure to return to the College the fully completed form referred to in Article 44.2 of Bylaw No. 1: General, shall pay a fee of $23.36.

9.1.02 The fee referred to in Article 9.1.01, shall be waived if the fully completed form required by Article 44.2 of Bylaw No. 1: General is received by the College on or before the January 31st next following the forwarding of the form to its members.

CARRIED

Council will receive a report on feedback and make a final decision in December.

EXECUTIVE DIRECTOR UPDATE

C. Stanford provided an update on key initiatives in the Knowledge Management Department, including the new information system, statistical reports, and a web-based data project.

A. Coghlan reported that Phase 1 of the new information system will “go live” on November 7, in time for the 2006 renewal process. She also reported on activities related to the HPRAC review, including the Federation of Heath Regulatory Colleges’ work on a joint submission. The final Federation submission will be sent to Council for information.

There was a question about the impact of the change in the format of the nurse registration examination on the results. Council was informed that the average pass rate in June 2005 was comparable with other June writes, with the exception of 2004 (which was an anomaly due to the number of people writing to become registered before the change in requirements on January 1, 2005).

EXECUTIVE COMMITTEE MINUTES

Minutes of the Executive Committee meetings of June 9, 2005; July 6 and 7, 2005; July 28, 2005; August 17 and 18, 2005; and September 12 and 13, 2005 had been circulated.

MOTION 17

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

That Council ratify the appointments of F. Bari and S. Islam to the Client Relations Committee until June 2006.

CARRIED

MOTION 18

Moved by B. Weichel, seconded by C. Ritchie,

That Council ratify the following committee appointments for public members: L. Bracken to Discipline, S. Padda to Complaints, B. Stewart to Discipline and N. Mohabir to Fitness to Practise.

CARRIED

ELECTIONS COMMITTEE

D. Dietrich reported on the meeting of the Elections Committee to review the election process. The Committee is recommending a Bylaw change to clarify intent.

MOTION 19

Moved by D. Dietrich, seconded by D. Bishop,

That the provisions of the Bylaw relating to the filing of a conflict of interest declaration, for election purposes, be amended in accordance with attachment 1 of the Elections Committee report.

CARRIED

D. Dietrich noted that one of the responsibilities of the Elections Committee is to explore enhancing participation in the election.

The committee explored ways to further support employers in supporting nurses’ involvement. The College has a number of strategies in place to encourage employer support. Staff have been asked to explore further a recognition award for employers of Council and committee members.

Two issues were raised for preliminary Council feedback: a shift to publication of the names of elected candidates rather than the full election results and a change in the elections process to combine the RN and RPN elections. There has been no policy work up on either of these issues, since the committee wanted Council’s initial feedback prior to further exploration.

Council members did not express concerns about the proposed change in publishing results but did ask that there be further exploration to determine if publication is a deterrent to participation.

With respect to the concept of combining the elections, such that RNs would be able to nominate and vote for RNs and RPNs and vice versa, Council members expressed a variety of perspectives. While there is strong support for the philosophy of nursing being one profession, there was concern expressed about the large majority of RNs over RPNs and the perception that might create. This is a major policy change that requires considerable work up. In the future, information could be brought regarding the work that would be required and where this issue might fit within the operational plan.

ELECTIONS COMMITTEE

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

MOTION 20

Moved by C. Genereux, seconded by D. Norling,

That the following be ratified as the 2006 Elections Committee:
L. Bracken, R. Graham, A. Grant, L. O’Hearn-Grant, B. Stewart, and B. Taa.

CARRIED

CONCLUSION

At 4:00 p.m., it was,

MOTION 21

Moved by D. Bishop, seconded by L. O’Hearn-Grant,

That Council conclude.

CARRIED