Staying skilled

Lifelong learning lets you continually reflect on your practice. It forces you to ask questions, increase your knowledge and improve your skills — all essential for safe, high-quality care.
Meredith Muscat, Nurse Practitioner who recently completed education needed to prescribe controlled substances

Because health care is advancing rapidly, the way nurses must do their job and what you should expect from them are always changing, too.

So nurses can continue to provide you with safe care, CNO provides them with information to help them understand all standards. In addition, we manage a Quality Assurance Program through which nurses demonstrate their commitment to learn and continue to improve their knowledge and skills.

Keeping nurses in the know

CNO provides practice standards and guidelines to support nurses in providing you with safe and ethical nursing care.

Practice standards inform nurses of their accountabilities. Practice guidelines, which often address specific practice-related issues, help nurses understand their responsibilities and how to make safe and ethical practice decisions.

In 2016, we updated, reminded and sought feedback from Ontario nurses about proposed health care and standards changes, including:

  • Medical Assistance in Dying (MAiD): In June 2016, it became legal for eligible people to receive medical assistance in dying in Canada. The law establishes safeguards for patients and offers protection to health professionals who provide medical assistance in dying, along with those who assist in the process in accordance with the law.

    CNO kept nurses up to date on their role as laws were put in place, and we continue to monitor for additional changes. You can read more in CNO’s Guidance on Nurses’ Roles in Medical Assistance in Dying.

  • Privacy and confidentiality: Privacy breaches are serious offences that negatively affect the trust between nurses and their clients, as well as public trust in the nursing profession. It’s illegal for a nurse to access a person’s health care information if the nurse isn’t involved in their care. CNO and the government have been taking legal and regulatory steps to protect the public and hold individuals and organizations accountable when they commit privacy breaches.

    In 2016, CNO kept nurses, employers and facility operators informed of the Ontario government’s changes to the Personal Health Information Protection Act (PHIPA), including new requirements making it mandatory to inform CNO of any disciplinary action they take against a nurse who unlawfully accesses health records — even if that discipline does not result in a nurse’s firing or resignation.

  • New standard for practice of NPs: In 2016, CNO began the work to align the Nurse Practitioner practice standard with changes to national competencies for NPs and make it easier to apply in any practice setting. We sought feedback on the changes from current NPs and other stakeholders. We expect to release the revised standard in 2017.

Nurses prescribing

NPs prescribing controlled substances

Nurse Practitioners are Registered Nurses who have received additional training and experience. They have authority to diagnose, prescribe certain medications, perform procedures, and order and interpret diagnostic tests. CNO and the Ontario government worked on regulation changes to enable Ontario NPs to prescribe some medications restricted by federal law (known as controlled substances). In December 2016, Council reviewed draft regulations and approved them for circulation to nurses and stakeholders for feedback. These changes were passed into law in April 2017.

NPs frequently assess clients with conditions that may require controlled substances for management. Allowing NPs to prescribe controlled substances lets clients get the treatment they need without delay. NPs will be required to complete specific education before they can prescribe these medications.

RNs prescribing medications

In January 2016, CNO participated in the Health Professions Regulatory Advisory Council's consultation about possible models for implementing RN prescribing in Ontario. We flagged regulatory considerations for safe prescribing, which generally occurs as part of a continuum of care that includes a health assessment, diagnosis, therapeutic management and follow-up. Regardless of which RN prescribing model the Ministry chooses, we'll work with the Ministry to draft regulations and develop mechanisms that support safe practice.

Assuring quality of nursing care

Lifelong learning is essential to continuing competence. In Ontario, nurses show their commitment to remaining competent in their practice by participating in our Quality Assurance Program. The program supports nurses in practising according to CNO’s standards and helps them develop in the areas for which they have identified they have learning needs.

We randomly selected 775 nurses in 2016 to participate in a practice assessment and have a review done by their peers. Of those selected, 92 per cent completed this assessment within the year (up from 73 per cent in 2013). To improve this measure, we’re enhancing technology, revising our web-based resources for nurses and making our consultants more accessible.

In 2016, CNO began a major review of its Quality Assurance Program, and we’ll be using evidence from many sources to make any needed changes. The revised program will continue to promote education and development of skills and competencies throughout a nurse's career.

Establishing a Nurse Health Program

CNO completed a review of its process for addressing nurses who suffer from substance use or mental health issues that may impact their ability to practise safely. The goals are to develop a treatment and monitoring program as an alternative to the current regulatory process, and increase prevention and public awareness through education and outreach services. This program’s development will continue in 2017.