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  Publications & Resources > The Standard > June 2004 

 Last modified June 9, 2004  

A Question of Regulation

What are the regulation and legal issues for nurses practising harm reduction strategies with clients?

As the regulator for nursing in Ontario, the College of Nurses of Ontario (CNO) sees harm reduction settings the same way it views any other practice setting. All nurses in all settings are expected to practise within the regulations and the professional and ethical standards. As regulated health professionals, all nurses need to consider the following questions: Is the practice legal? Is it within the legislation as it applies to nursing? Do I have the knowledge, skill and judgment to practise safely? Do I know and can I apply the practice and ethical standards relevant to this practice?

So what does this mean for nurses working in settings that provide clients with clean needles that they know will be used to inject illegal drugs? The nursing scope of practice statement refers to the provision of care for health conditions by supportive, preventive and therapeutic means. “Teaching about the proper techniques to prevent infection and further harm to the individual falls into the scope of nursing practice,” says Janet Anderson, Manager of Practice at CNO.

“The nurse is not injecting the substance, but is providing the necessary information and education about safe technique,” she adds.

Drug trafficking and possession is illegal in Canada. And although the first legal injection drug site opened in British Columbia last year, there are no similar sites for drug users in Ontario.

In harm reduction facilities that reach out to drug users, those facilities, law enforcement agencies and the community work together to set the parameters for what activities will be tolerated. Nurses may know that their clients may be using illegal substances, but it is always done out of the sight of staff.

At Seaton House, a men’s shelter in Toronto, open use of drugs is not permitted, and is reported to management if it occurs. In keeping with the practice and ethical standards, nurses are upfront with their clients about what is expected and about the nurses’ and clients’ obligations.

“We are aware that people do this in our facility and want to make it as safe as possible,” Ross Smith, RN, Nurse Manager at Seaton House, explains. “The police usually have a hands-off policy, unless trafficking or intimidation is going on, which health care providers and other staff are obliged to report.”

The nurses discourage sharing or reusing of drug equipment such as needles, and provide clean equipment and safe disposal units for those who require them. “We want to ensure that clients and staff are protected from infectious disease. The nurse’s role is a form of health teaching — health promotion and encouraging safe practices — not to monitor or supervise injecting.”

Nursing is a complex and diverse profession, adds Anderson, “but for practising nurses, understanding and applying practice and ethical standards and the regulation foundation on which it is built are key to determining how to provide the best care possible to your clients in any environment.”

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