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Publications & Resources > The Standard > December 2004

  Last modified Dec. 2, 2004

CNO News

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Practice standards essential for nurses involved in research

Recently, the College was asked to clarify the accountabilities and roles of nurses who are helping with or participating in research studies.

Regardless of the complexity of the research, who initiates the study or where the study takes place, nurses involved in research are accountable for practising within the standards and guidelines established by the College for safe, effective and ethical nursing care.

Some nurses may be confused about whether they are actually practising nursing. The CNO fact sheet Am I Practising Nursing outlines the factors that determine this. For example, if a person is working in research and meets the following conditions:

  • is registered with the College;
  • is applying knowledge, skill and judgment that has a direct or indirect effect on a recipient of health care;
  • is involved in activities commonly considered to be part of nursing practice; and
  • is in an environment that provides health services,

then this person is probably practising nursing and is responsible for initiating and maintaining the therapeutic nurse-client relationship.

The first document nurses involved in research should review is Professional Standards (Revised 2002). It outlines how nurses in a researcher role show their professional accountability. The term research nurse is not defined, but the College will recommend clarifying it in the next revision of this document.

Another important document is the Ethics practice standard. It provides an essential overview of the ethical issues involved in providing care within the therapeutic nurseclient relationship. In particular, it states that nurses need to use judgment at all times in deciding on a course of action. Thus, “… nurses who are involved in research need to respect clients’ well-being above all other objectives, including the search for knowledge.”

The Consent guideline is directly applicable to nurses involved in research studies. Research studies have strict requirements for informed consent, and all research involving humans must be reviewed by a research ethics board.

The Medication standard outlines considerations for investigational medications, including the administration of placebos. Nurses are responsible for asking clients if they have given informed consent, obtaining a physician’s order before administering a medication, and asking for the drug monograph from the pharmacist, investigator, physician, review board or from the client who may have been started on the medication pre-admission.

Nurses will also find useful tools in CNO’s Quality Assurance Program. For example, the Self-Assessment Tool provides a list of research indicators that nurses will want to consider.

Nurses with even limited participation need to be aware of their responsibilities. For example, nurses not officially involved in a study may be approached to ask clients if their names can be given to the investigator. If the study has been approved by an ethics review board, nurses may do this to support the search for knowledge.

However, it is the investigator’s responsibility to explain the study and get informed consent from the client. The investigator should also provide the client with contact information. If the nurse or the client has concerns about the research, the nurse should contact the investigator. The investigator is responsible for addressing those issues.

Research is essential to providing evidence-based care. Nurses can play an important role in supporting and participating in studies that further our understanding of how to care for clients.

The College’s practice standards and guidelines have been developed to be applied to any practice in any setting. Knowing and applying them is essential to ensuring that no matter where you practice, your clients receive safe, effective and ethical care.

Resources

All of the CNO fact sheets, standards and guidelines referred to here are available in the Compendium of Standards of Practice. The Self- Assessment Tool and the other documents are also available on the College’s website at www.cno.org, free of charge. To order a copy of the compendium or of individual documents, contact Customer Service.

The College recommends nurses involved in research review the Canadian Tri-Council Policy Statement; Ethical Conduct for Research Involving Humans, 1998 (with 2000 and 2002 updates), published by the Interagency Advisory Panel on Research Ethics. A direct link to this document is on the College website (www.cno.org) in the Nursing Standards section under Related Resources.

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Movie making at CNO

A film crew arrived at the College in late October to shoot footage for an interactive DVD that will be used as part of the College's outreach program with Ontario nursing students.

The DVD-guide to self-regulation compliments information being communicated by classroom instructors as part of the core nursing curriculum, helping students make an informed and positive transition into the profession.

It will provide clear and practical information about CNO by answering questions commonly posed by nursing students. These include:

  • What is the role of CNO?
  • What resources and services does the College offer?
  • How do I renew my membership?
  • What is leadership in nursing?
  • Can students take on a leadership role?
  • What are my options while I wait for General Class Registration?
  • Once registered, what does CNO require of me?

This short look at the College also aims to help students understand the concept of self-regulation and the College's crucial role in regulating the profession.

The DVD will be structured in modules, making it easy for instructors to match the information with their class agendas. Those with Internet access will be able to view a preview of the DVD in early 2005.

English and French DVDs will be distributed to nursing schools in the new year.

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Volunteer and help regulate your profession

Want to help the College review a practice standard? Interested in participating in a round-table discussion about a CNO program? Join the College’s database of volunteer nurses, and you can use your experience and expertise to help regulate the nursing profession.

“Consulting with practising nurses is essential to successful self-regulation of the profession,” says Dina Franchi, Analysis and Evaluation Co-ordinator. “Volunteers help us continually integrate the reality of practice into our programs and standards.”

The College is looking for RNs, RPNs and RN(EC)s from a spectrum of practice and educational backgrounds to provide insight and feedback into projects, programs and publications.

“Volunteering is an opportunity for members to get involved in the development and regulation of their profession,” adds Practice Consultant Sharon Avey-Morrison, RN. “Sharing their input, experiences and expertise with their regulatory body helps ensure standards and programs are relevant and supportive to our members.”

Any RN, RPN or RN(EC) registered with the College can volunteer. If you are interested in joining the CNO volunteer database, please send an e-mail with your name, phone number, e-mail address, designation, registration number, area of practice, and area of specialty and/or interest to volunteerppd@cnomail.org.

CNO may contact you in the future and ask you to leave your mark on the nursing profession.

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FAQs about renewal

Time is running out to send your Annual Membership Renewal (AMR) form to the College by the December 31, 2004 deadline. If you haven’t received your renewal package, please contact Customer Service immediately.

Need help completing your form? Read the instruction guide with the form and visit the College website (www.cno.org) for helpful information and checklists.

Here are frequently asked questions about the renewal process. After you read this, try the quiz on renewal.

Why do I have to answer all the questions on the renewal form?

Completing all the questions that apply to you is an important part of self-regulation. As the regulator of the nursing profession, the College needs to know where you live and work and important information about your practice.

The renewal form is a source of vital annual data on 140,000 Ontario nurses. The College uses the data to support decisions on how resources will be spent. Ontario and Canadian stakeholders use the information to form a national picture of nursing and make decisions about nursing labour issues.

The data is also compiled into an annual statistical report. The report about how and where nurses are working is used by many stakeholders for human resource planning, trends analysis and research.

Who will see the information I provide on my renewal form?

The College takes the privacy of its members very seriously.

Some of the information is used to update the Public Register, a database maintained by the College. Upon request, the College uses the Public Register to provide the public and others with basic professional information about individual members. This includes a member’s name and business address, and education and registration information. When applicable, the Register will also list any terms, limits or conditions that are on the member’s certificate and information about discipline hearings.

Throughout the year, the College receives requests for members’ home mailing addresses. It will only release home addresses if the member has given consent, and only if the third party is conducting nursing research, notifying members of continuing education opportunities or is a nursing organization. The College does not release member information to commercial vendors.

What can I do to avoid delays in renewing my membership?

It takes four to six weeks to process your renewal and payment. Unfortunately, incomplete forms and payments will extend the processing time.

To avoid unnecessary delays, read both sides of the form carefully. Some sections have preprinted information and other sections require you to fill in a response. Review each section, change any information that is inaccurate and complete all sections that apply to you.

Still having trouble completing the form? Use the instruction guide and visit the CNO website (www. cno.org) for helpful information and checklists.

Processing membership fee payments can also cause delays. Credit card payments are the quickest to process. Make sure you have provided the correct card number, expiry date and signature in section F.

Personal cheques take up to five business days to process. Avoid further delays by ensuring the amount is in Canadian funds, the date is correct (postdated cheques will be returned) and the cheque is signed.

Use the checklist on the website to ensure your renewal will be processed quickly.

How can I make sure the College received my form?

Get an instant update on the status of your renewal with the College's automated, self-service system.

By Web

  • Available 24 hours a day, this service can be accessed on CNO's Web site, at www.cno.org.
  • Click the "Check your renewal status online" button on the right side of the home page.
  • You will need your registration number and birthdate to use the system.

By phone

  • Available after business hours (1700 hrs to 0800 hrs), this automated service can be accessed by calling the College at 416 928-0900, or toll-free in Ontario at 1 800 387-5526.
  • Use a touch-tone phone and follow the instructions.
  • You will need your registration number and birthdate to use the system.

I’m trying to call CNO. Why am I getting a busy signal?

The renewal season is a very busy time. Between November 1 and January 1, the College will process almost 140,000 renewals. During this time, the number of inbound calls doubles to about 16,000 a month, or 800 a day. At peak call times you may be put on hold until a Customer Service Representative is available. Please be patient. All the calls are handled in sequence. If you can’t hold, try sending an email to customerservice@cnomail.org.

If you’re calling to check the status of your renewal, try using the automated service.

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Changes to consent to release personal information

The College is committed to protecting the personal information members provide each year on the Annual Membership Renewal form and in other ways.

The types of personal information the College collects about each member include name, home and business addresses, registration number, gender, age, education, type of employment and area of practice. The College uses this information to assess and maintain member registration and to conduct its own research into the Ontario nursing profession.

Periodically, third parties ask for the home mailing addresses of members. With the member's consent, CNO will provide the addresses for the following purposes:

  • Research in nursing — information on opportunities to participate in research. If you are contacted, you still have the right to refuse to participate or withdraw from the research at any time. The College will not have access to any personal information you might share with external researchers.
  • Continuing education opportunities — information from recognized continuing education organizations about educational opportunities.
  • Nursing organizations — information from nursing organization (e.g., unions, professional associations)

About 80 percent of members consent to have their personal information released for the above purposes.

When required, the College will use other personal information, such as age, workplace, education, etc., as a filter for selection before providing the mailing addresses. For example, a mailing for a survey may be targeted to nurses in a particular geographical area or practice setting.

The College receives about 45 requests for mailing addresses each year. To protect members’ privacy, the College reviews each request to ensure it meets the above criteria. All third parties who receive addresses must sign a confidentiality agreement to protect the information. Mailing addresses are never released to commercial vendors under any circumstances.

Providing Consent

Until now, members could indicate their consent or refusal to provide personal information on the Annual Membership Renewal form. To improve the process, starting in January 2005, members will be able to change their consent information any time during the year by completing the Consent to Disclose Personal Information form. The form will be on the website (www.cno.org) or can be requested by calling Customer Service. The consent information will no longer be included on the member renewal form.

What’s on the Public Register?

In its role to regulate the profession to protect the public, the College maintains a public register of information on each member. Upon request, the College will provide the public and others with basic information about individual members. This includes a member’s name, business address and registration information (number, category, class and date of initial registration). The public register also has information about a member’s education (school, program and year of graduation).

When applicable, the register will also list any terms, limits or conditions on the member’s certificate and information about the discipline hearings.

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ACNPs and the Extended Class

One of the legislated objectives of the College of Nurses is to develop, establish and maintain standards of entry and practice for nurses.

The 602 members in the Registered Nurse Extended Class in Ontario are all Primary Health Care Nurse Practitioners, but the Extended Class was envisioned to allow evolution of additional extended nursing roles.

It is estimated that some 300 nurses educated in graduate or postgraduate nurse practitioner programs practice as adult or child acute care nurse practitioners (ACNP)s.

The ACNPs are advanced practice nurses who are registered in the General Class and in addition to advanced practice nursing incorporate, with appropriate authorization (e.g., delegation and medical directives), activities that fall within the traditional scope of medical practice, such as diagnosing and prescribing as well as specific procedures or technical skills.

To protect the public interest, the College is moving toward registering ACNPs in the Extended Class.

In 2002 the College began working with the Canadian Nurses Association (CNA) and other Canadian nursing partners to develop the National Nurse Practitioner Core Competencies (CNA, 2004). The national nurse practitioner competencies, designed for all entry-level primary and acute care nurse practitioners, were reviewed by both acute care and primary health care nurse practitioners in Ontario.

In May 2004, as the national core competencies were finalized, the responsibility for development of national nurse practitioner examinations based on the competencies moved from CNA to the Canadian Nurse Practitioner Initiative (CNPI) sponsored by the CNA and funded by the federal government.

The first national nurse practitioner examination based on the competencies will be an all ages/ family examination analogous to the PHCNP examination in Ontario. The work on the national adult and paediatric (child) nurse practitioner examinations may start as early as 2005. CNO is participating at the national level, but no decision has yet been made about changing Ontario’s Extended Class entry examination(s).

The work to describe the context of ACNP practice and provide direction for the regulatory framework began in the fall of 2004 with eight focus groups of nurse practitioners, educators and administrators. CNO believes that the best interests of the public are served by establishing entry-level qualifications, title protection, standards of practice, continuing competence and defining scopes of practice for adult and paediatric (child) nurse practitioners within the Registered Nurse Extended Class.

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RN(EC)s on the Web

Want information about RN(EC)s? The College’s website has a section of articles and documents that RN(EC)s and other nurses will find useful. For example, important information on the latest drug and lab lists for RN(EC)s is posted here. And nurses wanting to make recommendations for what should be included on the lists will find the forms and information on the approval process in the section. Go to www.cno.org and click on “More” on the navigation bar at the top of the home page.

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Extended Class gets updated Practice Review

Practice Review assessment for members in the Extended Class is being revised to serve a broader range of client populations and practice settings, such as clinics and long-term care and educational facilities.

Practice Review for RN(EC)s was first implemented in 1999 to assess the ongoing competence of RN(EC)s in direct clinical practice. In keeping with Quality Assurance regulations, every RN(EC) is expected to participate in Practice Review after 1800 hours of practice or three years of registration, whichever comes first.

The focus of the review is on the RN(EC) consultation network and adherence to the expectations for consultation with physicians as outlined in Standards of Practice for Registered Nurses in the Extended Class (Revised 2003).

While RN(EC)s demonstrate autonomy within their scope of practice and possess advanced knowledge and decision-making skills in assessment, diagnosis, therapy and health care management, they are also expected to establish a consultation network with physicians and other health professionals.

RN(EC)s consult a physician when a diagnosis or treatment is beyond their scope of practice, a chronic condition of a client destabilizes or potentially life-threatening situations develop.

The updated Practice Review will be ready for implementation in early 2005.

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Orientation and Education for the REN

The 85 members of the Regional Education Network (REN) team gathered in Toronto for their annual meeting in October. The education day provided team members with new information for presentations, as well as the opportunity to network and discuss presentation strategies.

The annual meeting highlights the sense of achievement REN team members get from teaching their nursing colleagues about selfregulation and the practice standards. Last year, over 2,000 REN education sessions were given with almost 20,000 nurses attending.

The education day was followed by a two-day orientation for 13 new team members. The new recruits learned about their roles as Local Facilitators and the topics they will be offering.

These new members represent several regions, including South Porcupine, New Hamburg, Kenora, Oshawa, Oakville, Newcastle and Georgetown.

What do the team members think of the annual meeting? “Thank you for a wonderful education day,” wrote one of the Local Facilitators on her evaluation form. “It was important to come together. The meeting helped us to focus and energize. I think if you asked nurses what the College does to support them, this network would be high on their list.”

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