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Here For You

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Here for You - Vol 5, Issue 1

Your Update on Nursing in Ontario

Volume 5 issue 1

Contents

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We're Your College Too!

Since 1963, the College of Nurses of Ontario (CNO) has set the standards - and ensured that nurses meet these standards - for excellence in nursing practice.

Despite the name "college", CNO isn't an educational institution but a self-regulating body, one of 21 colleges that regulate health care professions in Ontario. No one can practise asa nurse in Ontario without a valid certificate of registration from CNO. Like other health colleges, CNO decides what education and other qualifications are necessary to become a member. CNO also offers ongoing standards documents that guide nurses in their everyday practice, and support for nursing educators who design teaching programs.

While CNO's membership consists of nurses, we're your college too. Our mission is to protect the public's right to quality nursing services. In fact, CNO's Council — responsible for shaping policies that influence the quality of nursing care in Ontario — is made up not only of nurses who are elected by their peers, but of members of the public.

We welcome your inquiries, and can answer your questions on anything from professional ethics to our standards.

Here's how to reach us:

Phone: 416 928-0900 (Toronto), 1 800 387-5526 (Toll Free Ontario)

E-mail: cno@cnomail.org

Website: www.cno.org

Mail: College of Nurses of Ontario, 101 Davenport Road, Toronto, Ontario, M5R 3P1

Fax: 416 928-6507

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The Science and Art of Caring

Defining a "nurse" as someone who simply cares for the ill and injured doesn't begin to get at the true meaning of the word. Nor does this simple definition illustrate what a valuable member a nurse is within a health care team. A nurse considers the whole range of needs of clients and their families. She or he combines a wealth of knowledge with just the right dose of support. No longer is it enough to say that a nurse's therapeutic tools are a pair of helping hands and a gentle smile. Nursing today combines both the science and the art of caring.

Of all the types of health care professionals, you will encounter nurses most often. Think of all the settings where nurses provide care to you or your loved ones — hospitals and doctors' offices, community clinics, public health units, retirement homes, even in your own home.

In Ontario, 140,000 women and men proudly call themselves nurses. They maintain that designation through the College of Nurses of Ontario (CNO), the province's regulatory body for the profession. In these pages, you'll learn more about how CNO protects the public by regulating the nursing profession, how CNO sets the standards for nursing practice and supports nurses to provide safe, ethical and effective care to the people of Ontario.

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Providing Safe, Effective and Ethical Care

There has been an explosion of knowledge in the nursing profession. Nurses are changing and growing, and contributing more than ever to the health of the public.

By registering individuals who have met the requirements, including completion of an approved nursing program and passing the national nursing examination, CNO assures the public that new nurses are able to meet high standards of practice and professional behaviour.

But a nurse's education does not stop the day of graduation or registration. To maintain competence and ensure public safety, nurses pursue life-long learning, whether it's reading professional journals, attending courses and conferences, or pursuing higher degrees or specialized education, such as certificates in community nursing or intensive care.

CNO not only sets, but continuously monitors and updates, nursing practice standards, with the input of practising nurses. Every year, CNO publishes and distributes a number of practice standards and guidelines to nurses. These documents contain a wealth of information that ensures safe, ethical and effective nursing care. Standards and guidelines cover a variety topics such as the nurse-client relationship, consent, resuscitation, ethics, documentation and infection control.

Another key CNO role is providing consultation and advice to keep nurses informed about the practice standards.

CNO Practice Consultants handle more than 13,000 inquiries a year from nurses via phone, e-mail and workshops.

For instance, Practice Consultants — nurses who haveexpert knowledge of the standards — respond to questions from nurses via the phone, e-mail and workshops. The consultants handle over 13,000 inquires a year, and help keep CNO in touch with working nurses. This helps ensure that the standards are effective and current for today's health care environment. CNO also has a Regional Education Network, which travels Ontario to deliver sessions to nurses on topics ranging from client consent to professional accountability.

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Staying on Top of the Profession

It takes a lot of education to become a nurse and even more to stay competent. Before becoming eligible to practice, nurses must complete an approved nursing program and pass a national exam. But the learning doesn't stop the day a nurse becomes registered with the College.

Being able to provide quality care throughout their careers means nurses must always be learning. To support nurses in this, and to ensure the public receives safe, effective and ethical nursing care, CNO has a Quality Assurance program. The three-part program includes Reflective Practice, Practice Review and the Practice Setting Consultation Program™.

Reflective Practice is a self-directed program. Each year, all nurses practising in Ontario must undertake a self-assessment, receive peer feedback and create and follow a learning plan to address areas that need development.

Practice Review is an objective assessment for nurses selected to participate. It includes a written assessment, and may also include an interview with a Practice Consultant and, when appropriate, a remedial program.

The Practice Setting Consultation Program is a voluntary program that helps nurses and their employers work together to identify areas in the workplace that support quality nursing, and those that could use improvement.

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Who is a Nurse?

The generic title "nurse" is not enough to describe the range of members within our profession.

Ontario has about 107,000 registered nurses (RNs) and 33,000 registered practical nurses (RPNs). RNs and RPNs must successfully pass national nursing examinations and complete a thorough registration process. Once they are registered members of the College, nurses are expected to adhere to a high level of practice standards. The differences between RNs and RPNs is the level of education they receive, which affects their "scopes of practice" (or the range of care they are authorized by law to provide). RNs study in greater depth and breadth over a longer period of time, and can therefore provide care to clients with more complex health issues.

A third type of nurse is RN in the Extended Class (EC). RN(EC)s have additional education and have passed an examination that assesses their knowledge. They have an expanded scope of practice in assessment and diagnoses, and can order certain tests and prescribe certain treatments. RN(EC)s can diagnose and treat common, everyday illnesses, as well as minor infections and injuries. There are about 600 RN(EC)s in Ontario. You will find them practising in primary health clinics and community settings as nurse practitioners.

Only people who have met the requirements and are registered with CNO can use the titles "RN", "RPN", "RN(EC)" or "nurse", and can practise as a nurse. You can be sure that anyone using these designations is prepared to provide you with care according to the highest standards in nursing.

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Protecting the Public Interest

CNO's mission is to protect the public's right to quality nursing services. To CNO, public protection doesn't just mean ensuring nurses have met the requirements to provide high quality nursing care. It also means taking action when you have concerns about a nurse's practice.

CNO investigates every allegation of professional misconduct, incompetence or incapacity (an inability to practise due to a mental or physical disorder). When necessary, a number of options are available, some rehabilitative or remedial and others disciplinary, depending on the severity of the case. Disciplinary options can range from a reprimand to revoking the nurse's Certificate of Registration.

What do complaints revolve around? Everything from nurses who make medication errors, to failing to conduct a complete health assessment, to theft and fraud, to physical or sexual abuse.

"Everything from inappropriate language to sexual abuse is investigated."

CNO takes your concerns about nursing care very seriously and every allegation gets treated with a high level of respect. When issues of concern are found, the focus is on protecting the public while helping the nurse to learn and improve her or his practice.

Investigations also cover "illegal practitioners" - people who claim to be nurses without being registered with CNO. In some cases, these people were nurses in another province or country, and simply don't have CNO registration. In other cases, they are former CNO members who've resigned or had their registrations revoked. And in still other cases, they've had no nursing education or experience anywhere.

Illegal practitioners of any type undermine the public's trust in nurses and endanger your safety. If you suspect someone is practising as a nurse who shouldn't be, contact CNO; a quick check in our public register will confirm whether that person is a College member.

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Improving the Nursing Profession for the Public

When the province of Ontario created an independent commission in 2003 to look at how Severe Acute Respiratory Syndrome (SARS) occurred and spread, the College of Nurses of Ontario (CNO) quickly went into action. CNO's Executive Director and the President of its governing Council met with the head of the commission, the Honourable Mr. Justice Archie Campbell, to discuss the regulatory issues that arose during the SARS crisis. A CNO team began developing a written report for the commission. The College recognized that the infection control standards for nurses needed to take into account such situations as presented by SARS. The updates to these nursing practice standards outline expectations regarding measures to be taken to prevent and avoid transmission of infection.

These are prime examples of how CNO strives to influence improvements in the quality of nursing care in Ontario. Ensuring that nurses follow the highest standards in their practice is the obvious method. But CNO also has an active policy function that helps it respond in the most appropriate and effective way to major events, trends, issues, pending legislation and other government initiatives.

The bottom line is ensuring that CNO contributes to major policy directions that may affect the way nurses provide services and care, and that support the best interests of the public.

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SARS: Toronto Nurse Sounds the Alarm

During the SARS outbreaks in 2003, nurses played a key role on the frontlines, caring for patients and helping to contain the spread of this infectious disease. But did you know that it was also a nurse who helped to identify the arrival of the virus in Toronto?

Agnes Wong, RN, is the patient care manager and a nurse educator at The Scarborough Hospital. Every weekend, she reviews a week's worth of Chinese community newspapers, which her mother-in-law saves for her. In one of them last spring, she was struck by a story from Hong Kong about a father and daughter who had died, from unknown causes, within a short time of each other.

"That story stayed with me because it was so tragic," says Wong.

The Monday after reading the article, she learned about a male patient who had been admitted the previous Saturday with a suspected case of tuberculosis (TB). The man was in isolation, and a few of his family members were also showing signs that might indicate TB. But Wong had her suspicions.

"Going by the description the primary nurse gave me, his case did not match my experiences with TB. I asked the primary nurse to check the patient chart for any travel history," says Wong. "We soon found out that his mother had gone to Hong Kong, returned sick and had died. The patient fell sick just a couple of days after his mother's funeral. I was struck by the similarities between the family in Hong Kong and this family. It was very unusual."

The case, of course, was SARS. Wong's alertness helped the hospital properly identify the case. She continued to be an integral part of the health care team throughout the outbreak.

"We had to work as a team and trust each other," says Wong. "Everyone took this very seriously. If we hadn't, things could have been a lot worse. For me, SARS highlighted the importance of collaboration."

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Praise for Nurses: In Your Own Words

What kind of impact do nurses make on the people with whom they come into contact? The College of Nurses of Ontario regularly receives letters in praise of the province's nurses and publishes them in its quarterly journal, The Standard. Here are a few.

This is a letter of thanks to a group of fantastic Labour and Delivery nurses at St. Joseph's Hospital in Hamilton. Last September, while 39-weeks pregnant, I was travelling with my husband and three-year-old son to the city for an appointment with my obstetrician. While on route, we were involved in an accident that left our van a wreck. We soon found out that the baby had flipped to breech position, and I had fetal blood in my circulation. We immediately headed for St. Joseph's. From the moment we arrived, I felt confident that my baby and I were in the best hands. The nurses were wonderful and made me feel secure. I was so nervous about my C-section and my baby's health, but the nurses' confidence, skill and easy manner made me feel comfortable. This was one of the scariest and most vulnerable times of my life. I am so grateful to the nurses for helping me through it. I applaud you all.

— T. M., Simcoe

On Feb. 17, 2003, I was admitted to St. Michael's Hospital, Toronto, for triple bypass surgery. Having never spent time in the hospital before, and being young for bypass surgery, I was very nervous. I was immediately calmed and relaxed by the confidence the nurses exuded in their abilities. All four nurses displayed empathy and graciousness toward both my wife and I. Any questions we had were answered, and any problems were quickly resolved. I am grateful for their professionalism, knowledge, bedside manner and senses of humour.

— C. B., Courtice

Words can not express the gratitude and respect my family and I feel for the nursing staff and all members of the multidisciplinary team of the CCU at the Hospital for Sick Children. My niece was transferred to this unit following complications from her chemotherapy. The staff was professional and competent, and their compassion for our whole family shone through. My niece passed away very peacefully and with dignity because of the attentive respectful care she received. These health care providers practice family-centered care. I am an RN with 20 years experience in pediatrics, and these nurses made me proud of my profession.

— C. P., Mississauga

If you know of nurses you would like to "praise" in writing, send your letter to: In Praise of Nurses, College of Nurses of Ontario, 101 Davenport Rd., Toronto, Ontario M5R 3P1.

Copyright © College of Nurses of Ontario, 2004.

Material published in Here for You may be re-printed without permission, provided that credit is given to the publication and to the College of Nurses of Ontario. To order a printed copies of Here for You, please contact publications@cnomail.org.

ISSN 1708-9638

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