Quality Practice - Winter 2009 Volume 8 Issue 4 Print
Renewal deadline quickly approaching!
The Dec. 31 deadline for receiving membership forms and fees for 2010 is only days away. If you haven’t renewed, do so today at www.cno.org, and take advantage of our fast and easy online renewal service. If you know of staff members who have not yet renewed, remind them of the online service. Or, if they don’t have Internet access at home, allow them some time to renew at work. Renewing online takes less than 10 minutes!
Online renewal is used heavily during the final weeks of December, making this the time when its benefits are most felt by members. By renewing online at this late date rather than mailing in a paper form, members reduce the risk of their renewal arriving at the College after the Dec. 31 deadline. This results in a late fee being charged and delays in the processing of the renewal.
College ending paper form
This is the last year members will be able to renew using the paper form. Next year, members will have to renew online.
Starting in 2010, the College is required to collect additional information from nurses. New questions will address languages in which members can provide nursing services, additional education obtained outside of nursing, hours of work, multiple employers and other topics. Adding these questions to the existing paper form would have resulted in a multi-page document that was more time-consuming for nurses to complete, and more expensive to mail and process. The College was concerned that a longer, more complicated form would have resulted in an increase in the number of incorrectly completed forms being returned to members.
The College has seen steady growth in the number of members who used online renewal since it was first offered in 2007. As of Dec. 14, approximately 72,000 nurses had renewed their memberships for 2010. Of that number, over 60 per cent went online to complete the form.
These nurses recognize, as the College has, that 24-hour-a-day online services are the way of the future.
Earlier suspension date
The suspension date for 2010 is March 11, which is one month earlier than last year’s date. Individuals who have not obtained a current and valid membership with the College by this date are legally prohibited from practising nursing.
Elements of Safe Client Transfers
A recent study initiated by CNO examined the challenges nurses face when the care of clients is transferred from one health care provider to another, and between health care teams. CNO wanted to learn if the existing practice standards support current practice-setting realities, and whether enough is being done from a regulatory perspective to support safe client transfers.
The study found that the risk of harm to clients and breaches of client safety are most likely to occur during the transfer of client care from one caregiver to another. Transfers can also be complex and context-specific, so adhering to a set of rigid procedures can be difficult. Nurses should use critical thinking skills, consider any unique factors relating to a particular transfer or client, and consider whether those factors could affect her or his ability to care for the client.
To conduct the study, CNO collaborated with the College of Physicians and Surgeons and the Ontario College of Pharmacists, as well as Sunnybrook Health Sciences Centre St. Michael’s Hospital and York University’s School of Nursing. The research involved interviews with 85 health care professionals and themes about what constitutes a successful transfer (such as information needs, flexibility and collaboration) arose. The study also examined accountability and overcoming obstacles in the transfer process.
The study found that health care teams are addressing challenges that transfers of care present by developing policies about face-to-face transfers at the client’s bedside, or systems in which in-person communication is reinforced by written documentation. Face-to-face transfers with written documentation support client-focused care, and consider the environment and the needs of the nurse.
Because the study found that health care teams were already using good clinical judgment when conducting client transfers, participants felt that it is unnecessary to develop guidelines for all settings and practitioners. For this reason, CNO has discontinued its Transferring Clients practice guideline.
Nurses can access other CNO resources such as the Medication, Revised 2008, Infection Prevention and Control, Documentation, Revised 2008 and Professional Standards, Revised 2002 practice documents by visiting www.cno.org/publications. Read the report, Transferring Clients Safely: Know Your Client and Know Your Team, at www.cno.org/transferring_clients.
New guidelines around end-of-life care
The care that nurses provide to clients who are dying is the same as the care they provide in any other situation. What sets end-of-life care apart is the circumstance in which care is given – it is often an especially sensitive period for clients and their families.
To help nurses guide their clients in making decisions about care at the end of their lives, the College has developed a new practice document. Guiding Decisions About End-of-Life Care replaces Resuscitation, Revised 1999, which focused on the single procedure of resuscitation. The new document relates to more than just resuscitation by accounting for the fact that end-of-life care is guided by the wishes that clients express about treatment. As a result, its aim is to guide nurses’ practice on end-of-life care issues such as client’s wishes, consent, treatment plans, advance directives, substitute decision-makers and relevant legislation.
The content of the new document emerged from feedback provided by members of the Outreach Program’s Advisory Groups and randomly selected nurses from across the province. The result is an updated document that is relevant to current nursing practice and can be applied by nurses in all practice settings.
For more information on this document, see the Winter 2009 issue of The Standard, or download Guiding Decisions About End-of-Life Care.
Statutory committees seeking members
In March and early April of 2010, the College is accepting applications for membership on its statutory committees. Volunteers can come from:
- any practice setting, such as long-term care or mental health;
- any role, such as staff nurse, educator, or senior manager; and
- any region in the province.
Years of nursing experience are not necessary. Members can volunteer even if they are new to the profession.
The College encourages employers to support nurses in their interest in joining a statutory committee. Having nurses on staff who understand self-regulation, and who possess a broad knowledge of the standards, can help support safe and effective nursing practice in the workplace. Serving on a committee provides nurses with opportunities to strengthen their critical thinking, decision-making and leadership skills, which many of them will bring back and apply within the workplace. Although nurses will require time away from work and some costs may not be covered by the College’s stipend, employers find that these benefits of involvement far outweigh the costs.
A broad range of skills and experience benefits the work of the committees. Committee members use their knowledge of the nursing profession, and the settings in which nurses practise, to make decisions that protect the public and are fair to nurses and applicants.
Each committee has a specific role that is determined by legislation and requires input from a broad range of nurses to meet its mandate. For more information about volunteering, the mandate of each committee and the time commitment, visit www.cno.org in March and early April and go to “get involved”.
Public Register Notice
The following notices are posted to assist the College in meeting its public protection mandate.
Heather Cox # HE03047, was found to be incapacitated by the Fitness to Practise Committee on June 1, 2001 and voluntarily surrendered her Certificate of Registration. Heather Cox is therefore not currently entitled to practise nursing.
It is against the law for individuals without valid registration with the College to seek nursing employment.
Individuals who practise nursing while under suspension pose a risk to patients and undermine public confidence in the profession. For these reasons, it is important for facilities to check the status of every nursing job applicant’s College registration before hiring. This can be done by accessing the Find a Nurse member register at www.cno.org or by contacting a Customer Service representative at (416) 928-0900; toll-free 1-800 387-5525.
What’s on the Web?
The College’s website is a hub of self-regulation information where you will find something new almost daily. For example, to support the new Quality Assurance (QA) Program, the College recently updated the QA section of its website (www.cno.org/qa).
There, you will find the new QA Program documents (Self-Assessment: A Guide to Developing Your Learning Plan 2009–2010, Self-Assessment: Learning Plan Form and the Program Requirements fact sheet), links to frequently asked questions about the program, and other resources to help you develop, fill out and maintain your learning plan.
The QA materials are only one of the many resources available on the website 24 hours a day, seven days a week. At www.cno.org, look up and read current or previous issues of Quality Practice and The Standard.
Find the latest versions of practice standards and guidelines in the online Compendium at www.cno.org/compendium. Or, visit the Learning Centre to watch a learning module or sign up for an upcoming teleconference.
Click on the Members’ Area logo to quickly update your contact information or renew your annual membership by the Dec. 31, 2009 deadline. On the home page, you also will find the latest updates and information on preparing for an emergency.
Lastly, check the Nursing Noticeboard for announcements from nursing-related organizations, associations, colleges and universities about conferences, reunions and requests for members and volunteers at www.cno.org/noticeboard.
New NP learning module
A new learning module based on the Nurse Practitioners practice standard will help NPs better understand what is expected of them in the practice environment. You can view the module at the online Learning Centre web page: www.cno.org/learning.
The new module examines all aspects of NPs’ accountabilities. By viewing the module, nurses can examine the standard of practice for NPs, understand their responsibilities regarding interprofessional collaboration and consultation, and identify the components of continuing competence and Quality Assurance (QA), including those that are specific to NPs. Nurses can also review practice examples and case-based scenarios, which cover a variety of settings and situations. You can also take the quiz and test yourself on the practice standard.
‘Nurse Practitioners’ is the 10th learning module on the College’s website. All of the modules are self-directed, and aim to further a nurse’s understanding of practice standards and guidelines.
Using the NP title
To use the title Nurse Practitioner (NP), you must be registered in the Extended Class (RN[EC]).
The NP title was legally protected in August 2007. Since then, the College has been educating members, employers and members of other health professions about NP title protection.
Only nurses who have met the Extended Class registration requirements can call themselves NPs. The registration requirements include additional education and successful completion of a Council-approved entry-to-practice examination. There are currently about 1,200 NPs registered with the College.
The purpose of a regulatory title is to provide role clarity. It is misleading and illegal for nurses who are not registered in the Extended Class to use the NP title.
Employers also have a responsibility to ensure appropriate use of the title, and should only use NP as a job title for nurses who are registered in the Extended Class with the College. This includes references on websites, newsletters, business cards and other media.
The title “Nurse” is also protected and cannot be used by anyone who is not a member of the College. Employers can confirm a nurse’s registration and title by searching the Find a Nurse register at www.cno.org. For more information on NPs, visit www.cno.org/np.
Developing a directive for multiple sites
To create a directive, you need the collaborative involvement of the health care workers affected by the directive (such as the nurses in the clinics) and the workplace’s administrative authority that is required to approve the directive. The administrative authority may be a professional advisory committee, the professional practice chairs, and/or the nurse managers and directors who will be affected by the directive.
As the NP, you are responsible for the directive. The directive represents the NP’s order for the administration of the vaccine; the nurses administering the vaccine are implementing the order. The NP must date and sign it. The administrative authority also needs to date and sign the directive.
Once the directive is in place, other nurses in the clinics can administer the vaccine to clients if they belong to the group specified in the directive, and meet the conditions and circumstances in the document.
Find a template for creating a directive on the Federation of Health Regulatory Colleges of Ontario’s website, www.regulatedhealthprofessions.on.ca. For more information, refer to the College’s Authorizing Mechanisms and Directives practice guidelines at www.cno.org/publications.