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   Last modified: Apr. 15, 2005

Here For You

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Here for You - Vol 5, Issue 1

Your Update on Nursing in Ontario

Volume 6 issue 1

Contents

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Who is a Nurse?

What’s in a name? A lot, when that name is “nurse”. While many people use that title generically, there are actually three categories of nurses in Ontario.

In all, the province includes about 107,000 Registered Nurses (RNs) and 33,000 Registered Practical Nurses (RPNs). RNs and RPNs must successfully complete education programs, pass national nursing examinations and undergo a thorough registration process. Once they are registered members of the College of Nurses of Ontario (CNO), nurses are expected to adhere to a high level of practice standards.

RNs and RPNs differ in the education level required for entry into the profession, and in ongoing nursing knowledge and competencies. 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 category of nurse is RN in the Extended Class (EC). RN(EC)s have additional education and have passed an examination that assesses advanced knowledge. They have an expanded scope of practice in assessment and diagnosis, 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 that have been defined in legislation. There are about 300 RN(EC)s in Ontario providing such services. 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 standards set by the College.

 

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The Science and Art of Caring

The profession of nursing combines both the science and the art of caring. The science comes from knowledge gained from years of education and professional development. The art comes from experience, from attending to the whole range of health care needs of clients and their families.

Nurses care for patients of all ages and in a broad range of health care settings. Think of all the places where nurses provide care to you or your loved ones — hospitals and doctors’ offices, community clinics, public health units, retirement homes, and even in your own home.

As highly educated health care professionals, nurses are invaluable members of the health care team. They also form the largest health profession in Ontario, with approximately 143,000 women and men proudly calling 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, setting the standards for nursing practice, and supporting nurses to provide safe, ethical and effective care to the people of Ontario.

 

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Setting the Standard for 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, the College of Nurses of Ontario (CNO) assures the public that new nurses are able to meet the standards of practice and professional behaviour.

CNO is the body that not only sets those standards, but continuously monitors and updates them. Every year, CNO publishes and distributes a number of practice standards and guidelines, which draw on the most reliable research and the input of practising nurses.

These documents cover a variety of topics, from the nurse-client relationship to ethics, and resuscitation to infection control. CNO’s standards and guidelines contain a wealth of information that ensures safe, ethical and effective nursing care.

CNO also provides consultation and advice to keep nurses informed about the practice standards. For instance, CNO has a Regional Education Network, which travels across Ontario to deliver information sessions to nurses on topics ranging from client consent to professional accountability.

CNO Practice Consultants — nurses who have expert knowledge of the standards — also respond to questions from nurses via the phone, e-mail and workshops. The consultants handle over 13,000 inquiries a year, and help CNO keep in touch with working nurses. Just another way that the CNO ensures that nursing standards are effective and current for today’s health care environment.

 

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The Learning Never Ends

It takes a lot of education to become a nurse — and even more to stay competent.

Before becoming eligible to practise, nurses must complete an approved nursing program and pass a national exam. On January 1, 2005, new educational requirements came into effect for those who want to register with the College of Nurses of Ontario (CNO) to practise nursing in Ontario. Registered Nurses must now complete a four-year baccalaureate degree in nursing, while a twoyear college diploma in practical nursing is required to practise as a Registered Practical Nurse. The changes recognize the need to enable both categories of nurse to meet the challenges of today’s increasingly complex health care system.

But the learning doesn’t stop the day a nurse becomes registered with the College. That’s why CNO has a three-part Quality Assurance program, which is made up of the following three elements:

  • Reflective Practice is a self-directed program. Each year, all nurses practising in Ontario 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 randomly selected to participate. It includes a written assessment, and may also include an interview with a Practice Consultant (a nurse who is an expert in interpreting the College’s practice standards) and, when appropriate, a remedial program. The purpose of this is to provide nurses with an objective assessment of their practice. The feedback that nurses receive contributes to the maintenance of their competence.
  • The Practice Setting Consultation Program is a voluntary program that assists nurses and their employers to work together to identify areas in the workplace that support quality nursing, and those that could use improvement.

In addition to the Quality Assurance program, CNO encourages other avenues of 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.

By supporting professional development throughout a nurse’s career, the College helps ensure that the public continues to receive safe, effective, ethical and competent nursing care.

 

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Advancing Nurses’ Knowledge

Nurses, like any professional group, always aim to provide the best possible service. Nurses do this individually by living up to the profession’s high standards, and by striving to create an environment in which nursing services — and health care in general — can be delivered most effectively.

How does the College of Nurses of Ontario (CNO) support nurses with this? In part, by continuously monitoring pending legislation, other government initiatives, and a variety of major events and trends that can have a direct or indirect impact on nursing care, and by sharing this information with its members.

Throughout the year, CNO’s policy team conducts research, assesses information, and puts forth positions that bring the perspective of the nursing profession to the table when legislation that affects health care delivery is being considered.

CNO also works with employers and partners in the health care system to create the safest possible health care system.

For example, CNO is working with long-term care facilities across the province to identify issues that affect the quality of care that nurses are providing. CNO is assisting and supporting nurse leaders and facility administrators in this sector to build environments that support quality nursing care.

The bottom line — CNO supports the best interests of the public by bringing the nursing perspective to any issue that may affect the way nurses, and the system as a whole, provide services and care.

 

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Privacy Legislation Reinforces Patient Rights

How do nurses build positive therapeutic relationships with patients? Aside from providing the best and most appropriate care, one way is by preserving the patient’s privacy. Nurses have both an ethical and a legal responsibility to maintain the confidentiality and privacy of information that is obtained in the course of providing care.

The issue of confidentiality and privacy in health care was raised in November 2004, with the enactment of the Personal Health Information Protection Act (PHIPA).

While PHIPA does not significantly affect how nurses handle information, the College of Nurses of Ontario (CNO) took the opportunity to review and consolidate its standards and guidelines around confidentiality and privacy.

PHIPA emphasizes that personal health information belongs to the patient; nurses and other health care providers are simply the caretakers of the information. Patients have the right to instruct that all or part of their personal health information not be shared with other providers, and also have the right to correct any personal health information that they believe is inaccurate or incomplete.

In addition to revisiting its standards, CNO provided a link to the legislation and the office of Ontario’s Information and Privacy Commissioner via its website (www. cno.org) and informed employers of how to support nurses in meeting the legislation. It’s all part of ensuring that nurses understand and respect the safeguards in place to protect the use of your personal health information.

 

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Protecting the Public Interest

The College of Nurses of Ontario's (CNO) 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 it receives 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 to deal with concerns, some rehabilitative or remedial and others disciplinary, depending on the severity of the issue. Disciplinary options can range from a reprimand to revoking the nurse’s Certificate of Registration.

What do complaints revolve around? CNO receives complaints about everything from nurses who make medication errors, to failing to conduct a complete health assessment, to theft and fraud, to physical or sexual abuse. CNO takes your concerns about nursing care very seriously. 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 may 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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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.

In the early morning hours of last April, my father experienced a severe heart attack. Upon his arrival at Huronia District Hospital in Midland, the emergency team of doctors and nurses were diligent and compassionate.

They quickly realized he needed more specialized care and airlifted him to St. Michael’s Hospital in Toronto. Once again, the entire Coronary Care Unit was outstanding.

At both facilities, our family witnessed nursing care at its finest. They not only treated the ailing patient but provided compassion and care for our family. This is to be applauded.

Please accept my sincere gratitude and appreciation to all the health professionals who gave my father the compassionate care he received.

– G. L. M., Penetang

 

Just a note to commend the nurses at the Grey Bruce Regional Health Centre in Owen Sound.

My husband and I arrived in the emergency unit of the hospital after a very long drive from the U.S. I had a fractured right leg and ankle — yet to be treated.

The triage nurse was kind and compassionate and expedited things. She also followed up later to see how I was managing.

Every one of the nurses I saw during my initial visit was kind, efficient, comforting and encouraging. My safety and comfort were always a priority and my pain relief a concern. I felt so well cared for and secure in the care I was receiving that I had very little anxiety about the surgery I was facing.

Since my initial admission I have had to return twice for cast adjustments and have encountered the same cheerful, caring, kind and competent response from the nursing staff. I appreciate it. I applaud it.

– S.R., Markham

 

On behalf of my mother and sibling, allow me to express our gratitude to the nurses of the Palliative Care Unit of Providence Continuing Care Centre — St. Mary’s Lake Hospital in Kingston.

The care and compassion shown to my father, and indeed our entire family, was truly moving. My mother commented many times on how she felt as though we were the only people the nurses had to care for, which, of course, was far from true. These remarkable nurses reminded me of all that our profession stands for.

– M. K. R., Dallas

 

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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