Quality Practice - A resource for nurses and nurse leaders
  June 2017 | Volume 16, issue 2
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New Annual Report champions the public

Would you like to see what the College accomplished last year? Read about it now in our 2016 Annual Report.

Titled “Championing Safe Nursing Care,” the report emphasizes issues that affect the public most. One example is how the College used public input to help shape regulatory changes to support safe NP prescribing of controlled substances.

The information highlights the ways the College has strengthened its efforts in collaborating, making effective decisions and being accountable. All of these areas support our mission to regulate nursing in the public interest. 

Read the 2016 Annual Report.

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Questions about Wettlaufer

The Elizabeth Wettlaufer case is receiving much media attention. So why hasn’t the College responded to all the questions?

This is not by choice, nor is it motivated by a desire to protect the College’s reputation. In fact, we are prohibited by various laws (intended to protect the public) from disclosing certain information.

We would like to be able to be release information about a member to the public when there is compelling public interest, such as in this case. That is why we recently asked for changes to the confidentiality requirements in the Regulated Health Professions Act.

We take our mandate to protect the public very seriously. We are committed to responding quickly to any information that indicates patients may be harmed by a nurse’s actions. However, until these laws change, we are bound by the existing confidentiality requirements.

For what we can share at this time, read our most recent News statement.

NPs can now prescribe controlled substances

On April 19, 2017, the Ontario government passed regulations that enable NPs to prescribe controlled substances if they have completed approved controlled substances education. 

To ensure the public and other health professionals know who can legally prescribe controlled substances, NPs who have not completed the approved education will have the following restriction posted to their profile on the College’s public register, Find a Nurse: “Entitled to practice with restrictions.” A description of the restriction will be included: “This member cannot prescribe controlled substances. They have not completed the education needed to do so.” 

Prescribing controlled substances is a high-risk activity. Posting a restriction to the profile of an NP who has not completed the required education is a public protection mechanism. Meeting the education requirement gives NPs the competencies needed to support safe and ethical prescribing, and manage clients who are treated with controlled substances. Depending on practice setting and client population, an NP may have additional learning needs.

Practice resources
A new Nurse Practitioner practice standard is now in effect. When prescribing controlled substances, NPs are required to apply the expectations for public protection set out in the new practice standard.

The following practice documents have also been updated to reflect NPs’ expanded scope of practice:

Employers can find more information, questions and answers, as well as other resources to support clinical decision, on the NPs and Prescribing Controlled Substances page and in the NP section.

Read the revised Ontario Regulation 275/94 (General) under the Nursing Act, 1991.

Strengthening patient protection in Ontario

On May 30, 2017, the Ontario government passed the Protecting Patients Act, 2017.

It resulted in the following changes to the Regulated Health Professionals Act (RHPA) in response to the recommendations from the Ministry of Health and Long-term Care’s Sexual Abuse Task Force:

  1. Fines increased for failing to report
  2. Employers or health care professionals who fail to report an allegation of sexual abuse will now face increased fines. We will be regularly reminding employers and members of their obligation to report, and when appropriate, will notify the Ministry if we become aware of a failure to report.

  3. Additional information on the public register, Find a Nurse
  4. The College had already been posting on Find a Nurse most of what is now required in the RHPA. We will now also include information about whether a member is registered in other professions. Also, when a discipline hearing results in no finding of professional misconduct or incompetence, that outcome will be posted to Find a Nurse for 90 days. Some information, such as oral cautions or if a nurse is required to complete education or other remedial activities, will now remain on the register permanently.

  5. The College can order an interim suspension sooner in the process
  6. If it is determined that a member’s conduct or physical or mental state is likely to expose patients to harm or injury, the College can suspend the member or restrict the member’s practice. With the changes to the act, the College can now do this earlier in the process then it was able to do before. In addition, there is now an expanded list of acts of sexual abuse that will result in a mandatory revocation of a nurse’s registration.

  7. Government access to personal health information
  8. To determine if the College is fulfilling its duties or if action is required (such as changing a regulation or appointing a supervisor to oversee the process), the Minister may request the College to provide information. This information could include personal and personal health details about a nurse.

We have made necessary adjustments to our processes to implement these changes.

The College will continue to offer expertise to the Ministry as it reviews further potential changes.

Government changes will eventually lead to RN prescribing

On May 17, 2017, the Ontario government approved changes to the Nursing Act to permit RNs to prescribe medication according to a list, and to communicate a diagnosis for the purpose of prescribing medication.

Although the government has approved changes, RNs do not have the authority to perform either of these activities until the College makes regulations under the Nursing Act.

Diagnosing and prescribing are high-risk activities; the College is accountable for providing proper regulatory oversight that protects the public’s right to safe nursing care. We will be working on ensuring there are regulatory mechanisms in place to promote safe nursing practice.
We will define the scope of this new authority for RN practice and develop regulations that will implement this change safely, while supporting the government’s goal of improving public access to medication.

As part of our work, we will consult with a broad range of stakeholders. As well, Council will review the evidence and feedback to make decisions about:

  • the new RN scope of practice and how it fits, in the context of other nursing roles (such as NPs)
  • practice requirements, including the drugs that RNs are authorized to prescribe
  • requirements RNs must meet before gaining access to the new controlled acts (such as education)
  • requirements for maintaining ongoing competence through the College’s Quality Assurance Program
  • professional liability protection, and more.

Watch our website, Facebook page and The Standard for regular updates as this work develops.

RPN in a personal support worker’s role

Q: I am currently working part-time as an RPN. My organization is hiring a full-time personal support worker. Can I work in this role?
Yes, you can work as a personal support worker (PSW).

A PSW is an unregulated care provider but your RPN status means you are regulated as a member of the College. While you work in this role, you are still accountable as an RPN and the College’s standards apply to you. For example, if a client shows symptoms that are beyond the expectations of a PSW role, you are accountable for stepping out of your PSW role to identify and assess the problem as an RPN.

For more information, read the Working in Different Roles practice guideline.

Accepting gifts from clients

Q: My client overheard my colleagues talking about my upcoming birthday. On the day of my birthday he gave me a gift card for a local restaurant. Can I accept the gift?
To maintain appropriate professional boundaries in your therapeutic relationship with the client, you should not accept the gift.

Nurses are responsible for effectively establishing and maintaining professional boundaries with clients. A boundary is crossed when the professional and therapeutic relationship between a nurse and client becomes unprofessional and personal in nature. This can happen unintentionally, but it is still considered a misuse of the relationship. The client’s needs should be your priority.

However, if you are faced with a very rare situation where you believe that refusing would harm the therapeutic relationship, page 8 of the Therapeutic Nurse-Client Relationship practice standard provides information about the College’s expectations.