Quality Practice - Spring 2008 Volume 7 Issue 1 Print
NP exams approved
In August 2007, new legislation granted the College the authority to regulate Nurse Practitioner specialty certificates. And now, for the first time, the College is offering examinations for the new NP-Adult and NP-Paediatrics specialty certificates.
A nurse can apply for registration in a specialty in the Extended Class if she or he meets the requirements, which include graduation from an approved educational program, evidence of safe practice and successful completion of an approved examination.
The College has approved the American Nurses Credentialing Center (ANCC) NP-Adult and NP-Paediatrics examinations and will offer them in several locations across the province.
The U.S. exams were selected because they test the Canadian Nurse Practitioner core competencies taught in the College’s approved NP education programs. These competencies include health assessment and diagnosis; health care management and therapeutic intervention; health promotion and the prevention of illness, injury and complications; and professional role and responsibility.
The exams also promote labour mobility because the same exams are being used in other Canadian jurisdictions.
The College recently changed the exam for the NP-Primary Health Care certificate from the Ontario-specific Extended Class Registration Examination (ECRE) to the Canadian Nurses Association’s Canadian Nurse Practitioner Examination (CNPE): Family All Ages exam.
The 2008 dates for the NP-Adult and NP-Paediatrics exams are March 14 to April 25, May 29 to July 17, and Oct. 28 to Nov. 27. Exam-writing locations include Hamilton, Kitchener, London, Ottawa and Toronto. The 2008 dates for the NP-Primary Health Care exam are May 21 in Ottawa and Toronto, and Oct. 22 in London, Ottawa, Sudbury, Thunder Bay and Toronto. Visit www.cno.org/rnec for more information.
Hiring nursing students
In the coming months, many employers will hire nursing students to cover for permanent staff members who will be away on vacation during the summer. But, what should be considered before students are hired and assigned care tasks?
First, nursing students are just that – students. They are still learning how to safely perform the controlled acts authorized to nursing. This means that, until their education is complete and they are registered members of the College, they cannot be permitted to perform any controlled acts.
A summer job is different than a clinical placement that takes place during the school term. The legislation states that, for the purpose of education, students enrolled in a nursing education program have access to controlled acts while being supervised by a member of the profession. Individuals hired for the summer will be acting in an unregulated care provider (UCP) role, not the student role.
In addition, “nurse” and its derivatives can only be used by registered members of the profession. Individuals enrolled in a nursing education program can only use the title “nursing student” during the school year. In their position as a summer hire, refer to nursing students as UCPs or personal support workers (PSWs).
Students have much to gain by working as a UCP. The experience can help them develop confidence and organizational skills for their future careers as regulated health professionals. It can enhance their ability to work collaboratively within a health care team and better their understanding of the health care system as a whole.
For more information, refer to the College’s Supporting Learners and Authorizing Mechanisms practice guidelines at www.cno.org/publications.
Administering methadone safely
Last October, the College completed a survey to help identify the needs of nurses who administer methadone.
The survey was distributed to nurses working in settings that administer methadone. Thirty-four RNs and one NP completed the survey.
Members of the College’s Mental Health and Correctional Services Advisory Group identified methadone administration as one of the major challenges in their practice settings. In the survey, 24 of the 35 nurses indicated they feel that not all of the members on their interdisciplinary team understand their role and responsibilities regarding the administration of methadone.
Only about one-half of the nurses surveyed reported feeling comfortable in their role administering methadone. Most of the respondents, though, indicated the College’s Medication practice standard adequately addresses administration of the drug. The survey results identified potential systems issues that nurses perceive may hinder their ability to practise according to the standard.
For example, the physical facility may not provide adequate security for the storage and administration of methadone, or for post-administration observation.
The Medication standard covers all types and classifications of drugs that nurses administer, including methadone. It specifies that nurses need to try to be aware of all medications – including prescription, non-prescription and street drugs – that clients are taking to be alert to potential drug interactions.
The College is participating on a panel with the Registered Nurses’ Association of Ontario (RNAO), which is creating a methadone best practices guideline as part of a provincial interprofessional partnership formed in 2007. The Ontario College of Pharmacists, the College of Physicians and Surgeons of Ontario and the RNAO are collaborating on best practice guidelines and training, quality assurance and enforcement, public awareness and community engagement.
To learn more about the Outreach Advisory Groups, go to www.cno.org/outreach.
Increasing renewal efficiency
The 2008 membership renewal season was one of the most efficient that the College and its members have ever experienced, thanks to the continuing success of online renewal, which was accessed by even more members this season.
By the Dec. 31, 2007, deadline, over 117,600 members had renewed their membership, and almost half (49.8 per cent) chose to renew their membership online. This is an increase of more than 13 per cent compared to the preceding year when the College introduced online renewal.
Part of the increase in the use of online renewal can be attributed to word of mouth among nurses. Many nurses who used online renewal in 2006 said they would urge their colleagues to try it in 2007. In addition, the College supported a wider range of browsers, allowing more members to access online renewal.
Positive spin off
Online renewal has had other positive effects, too. For example, the College saw a significant decrease in the number of Annual Membership Renewal (AMR) forms that had to be returned to members because they were incomplete. Between Oct. 31 and Dec. 31, 2006, the College returned 4,728 AMR forms to members. In the same period in 2007, the number plummeted to 2,452.
When forms had to be returned, members were told that instead of correcting the paper form, they could resubmit online. Many members did this for the sake of expediency, especially if the deadline was close.
Also in 2007, the College’s AMR Call Centre saw a decrease in the number of phone calls related to renewal. In 2006, the College responded to more than 10,800 renewal-related calls between Oct. 31 and Dec. 31. For the same period in 2007, the number dropped to 8,944.
The decrease in incoming calls provided the College’s Call Centre representatives with time to conduct 795 courtesy calls to members whose payments couldn’t be processed. In many cases, the courtesy calls enhanced efficiency because some issues could be resolved immediately.
While member feedback on online renewal was generally positive in 2007, there is always room for improvement. The College will continue to listen to user feedback to enhance the renewal processes. Members are also reminded that throughout the year they can visit the Members’ Area at www.cno.org/members to submit an address change or update other personal information.
New parking permit form
When certifying parking permits for clients, NPs need to ensure that they sign the most recent form.
In January 2006, the Ministry of Transportation introduced the Accessible Parking Permit (APP) program to replace the Disabled Person Parking Permit (DPPP) program. APP uses different eligibility criteria to assess applicants. The Ministry has not accepted the DPPP form since Feb. 1, 2008.
Because some Ministry officials are not yet familiar with NP as a protected title, the College recommends that NPs sign the APP form with the RN(EC) title during this transitional time.
You can download the new “Application for Accessible Parking Permit” form (SRLV-129 07-08) from the Ministry’s website, www.mto.gov.on.ca. It’s also available at ServiceOntario driver and vehicle licence issuing offices.
Suspension date
April 10, 2008, is the suspension date for College members who have not paid their annual membership renewal fee for the current year. An updated list of suspended members will be posted at www.cno.org/employers on this date.
Individuals whose names appear on this list are no longer eligible to practise nursing in Ontario. These individuals are required to reinstate their memberships if they plan to continue working as nurses in Ontario on or after April 10.
The best way to check if your nursing staff have valid registration with the College is to ask to see their original and current Annual Payment Cards. Employers with a high number of nurses on staff can also use the College’s Automated Annual Verification of Renewal (AAVR) system to check the status of the nurses’ registration. For more information on suspension, reinstatement and the AAVR, visit the Registration and Employer sections of the College’s website.
Ask CNO: Terminating employment
The College notifies employers when an applicant’s temporary registration is revoked. The employer then has a few choices, including terminating the applicant’s employment or suspending the applicant until she or he successfully completes the national registration examination. The applicant cannot work as a regulated health care professional once temporary registration has been revoked. This also means the applicant cannot perform controlled acts; however, she or he can remain employed as an unregulated care provider. Successful completion of the exam is one of the College’s non-exemptible legislative registration requirements.
Individuals who hold temporary registration have met all of the registration requirements but have not yet written the national exam or have not received their results. This short-term registration category enables members to practise until they can register in the General Class. To protect the public, legislation requires that temporary registration be automatically revoked if the applicant fails the exam.
For more information, refer to the Temporary Class fact sheet.