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Expanding NP prescribing to include controlled drugs

The College is actively working with the Ontario government to draft regulations that will enable Ontario Nurse Practitioners (NPs) to prescribe controlled substances.

In December, Council will review the draft regulations and decide if they can be circulated to nurses and stakeholders for feedback.

Since the prescribing of controlled substances is a high risk activity, implementing the regulations will require mechanisms to ensure public safety. This may include education requirements and practice expectations specific to prescribing controlled substances.

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Being fair about what we share

Certain information about nurses will no longer appear on the College’s public register, Find a Nurse. The College has changed the processes used to ensure that nurses suffering from physical or mental health conditions are practising nursing safely.

These changes affect information available on Find a Nurse for all nurses who previously went through the Fitness to Practise process as well as for nurses who will undergo the new process. The College will still post restrictions about a nurse’s practice on Find a Nurse, but will not post more personal health information than is reasonably necessary to protect the public interest.

We made these changes as part of our ongoing efforts to improve our Fitness to Practise processes and to meet both our obligations to our members under Ontario’s Human Rights Code and our regulatory obligation to protect the public.

The greatest difference you will notice is the information available about a nurse on Find a Nurse. Read more about this.

If you have any questions about the Fitness to Practise process, contact the College’s Monitoring Team at monitoring@cnomail.org.

New name for employer verification service

The College’s renewal service for employers has a new name: Nurse Renewal Check.
The Nurse Renewal Check used to be called the Automated Annual Verification of Renewal of Membership, or AAVR. Nurse Renewal Check is a service that allows employers and facility operators to easily confirm the membership status of nurses working for them.

The service allows you to know which nurses are registered to practice and which nurses have had their membership suspended or revoked, or have terms, conditions or limitations in effect. This can help you schedule your nursing staff appropriately. Read more about this service


Membership renewal is open

Membership renewal opened on November 7. Nurses can now renew their membership for 2017.

They have until midnight EST on Saturday, December 31, 2016 to renew. After this date, additional fees are imposed.

You can use the Nurse Renewal Check service to confirm that a nurse has renewed for 2017.

How to protect clients’ health information

Changes to the Personal Health Information Protection Act, 2004 (PHIPA) mean tougher consequences for breaching the law. Do you know how nurses can use the College’s standards and legislation to avoid privacy breaches?

Watch our new Confidentiality and Privacy webcast to find out.

The 21-minute audio-visual presentation was created to educate nurses and other stakeholders about the serious legal responsibility of protecting personal health information.
It is divided into two chapters:

  • Chapter one provides an overview of nurses’ accountabilities for maintaining the privacy and confidentiality of personal health information. It also discusses the changes to PHIPA, including new mandatory reporting requirements and the consequences of privacy breaches.
  • Chapter two uses case studies to help nurses reflect on how to apply the concepts in the first chapter, to situations that could result in privacy breaches.

Privacy breaches are serious offences that negatively affect the trust between nurses and their clients, as well as public trust in the nursing profession. The College 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.

Watch the Confidentiality and Privacy webcast now.

Four regulators. Two provinces. One great opportunity.

CNO is collaborating with nurse regulators in British Columbia to find new ways to align programs and regulatory tools.

Recently, CNO and the College of Licensed Practical Nurses of B.C., the College of Registered Nurses of B.C., and the College of Registered Psychiatric Nurses of B.C. met to discuss initiatives they could pursue together, including programs like quality assurance, competency assessments and the review of nurse education programs.

A longer-term goal of the collaboration is to reduce barriers between the two provinces to allow for greater movement of nurses.

Read the announcement to learn more.

Signing prescriptions with “as per…”

Q:  I’m an RN working in a family physician’s office. The other day, Dr. Smith asked me to give a client a new prescription on her behalf because she was busy with another client. She instructed me to write the prescription and sign my name followed by, “as per Dr. Smith.” Can I do this?    

A: No, you cannot sign the prescription as the physician requested. Even if you write “as per Dr. Smith,” signing your name would mean you authorized the prescription. RNs and RPNs do not have the authority to do this.

Since Dr. Smith was physically present in the office to instruct you, the safest practice would be for her to personally write and sign the prescription. Then, you could either give the prescription to the client or fax it to the client’s pharmacy through a secure fax line.

Furthermore, Dr. Smith’s instruction is a verbal order which is not appropriate in this situation. Verbal orders are only allowed in emergency situations or when the prescriber is unable to document the order. (For more information on verbal orders, read the Authorizing Mechanisms practice standard.)

If a client needs a prescription and Dr. Smith isn’t in the office, Dr. Smith could communicate the order by telephone. You should repeat the order back to Dr. Smith to make sure the information is accurate and document it in the client’s chart. Then, phone the pharmacy with the prescription and speak directly to the pharmacist; do not leave the telephone order on voice mail. After giving the pharmacist the prescription, ask the pharmacist to repeat the prescription back to you. Document the details of the phoned-in prescription in the client’s chart – this should include the name of the pharmacy, day and time you phoned in the prescription and the name of the pharmacist who transcribed it. Pharmacists may request your name and registration number for their records.

For more information, read the Decisions About Procedures and Authority practice standard.


Distributing naloxone

Q: The clinic where I work has started stocking naloxone for distribution to clients who are at risk for opioid overdose. As a nurse, am I authorized to distribute naloxone to clients?

A: Nurses are permitted to distribute naloxone when it is indicated for emergency use for opioid overdose outside hospital settings. Naloxone no longer requires a prescription under such circumstances.

You should ensure that your practice setting supports nurses performing this activity and review any relevant legislation that is specific to your practice setting.

The College does not require nurses to complete any specific training or education to distribute naloxone. However, as with any other activity, you must ensure that you have the knowledge, skill, and judgment required to distribute naloxone safely.