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 Created March 29, 2004  

Quality Practice

A Resource for Employers of Nurses

Spring 2004 (Vol. 3, No. 1) [PDF]

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Managing Temporary Registrants

The College of Nurses of Ontario (CNO) grants Temporary Registration to nursing graduates so they can practice while waiting to write the national nursing examination. However, graduates face many challenges in their new roles and, even though they have achieved Temporary Registration, they are still new to the profession and need assistance as they start their careers. Employers can foster the transition from novice nurse to expert practitioner by providing supports, such as in-depth orientation, mentoring and supervision, and encouraging continued growth and development.

Temporary Registration

Temporary Registration is granted for 12 months for a facility/location, is non-renewable and is suspended if employment is terminated. Graduates awaiting Temporary Registration cannot provide nursing care or perform controlled acts on clients, even in a preceptored capacity, until they are registered. They can, however, work as unregulated care providers and can participate in orientation initiatives such as in-services, hospital infra-structure, policies of the workplace, technical equipment and skills (not involving clients) and job role through shadowing. CNO policy requires that new RNs be supervised by experienced RNs and new RPNs be supervised by experienced RPNs.

Temporary registrants can use the title nurse, identify themselves as registered nurses (temporary) or registaered practical nurses (temporary) and perform controlled acts authorized to nursing. They cannot accept delegation from anyone to perform a controlled act not authorized to nursing.

Supporting Novice Nurses

Employers are responsible for having sufficient resources available for direct or indirect monitoring, consultation and collaboration for temporary registrants. This supervision must be done by a General Class member of CNO who should be readily available for trouble shooting and assistance in complex situations. Also, temporary registrants are not permitted to supervise members of any class.

New members of the profession need to learn how to balance larger client loads, conflicting priorities and the demands of clients, families and other staff. Employers should consider the resources necessary for novices as they relate to the complexity of client care needs and the practice setting in which nurses will be working. For example, if new nurses are to work in a fast-paced environment, such as an acute care setting, more supports may be required. In some situations, there may not be enough time for new nurses to think things through and they need to have accessible resources on-hand.

If such supports are not available, new nurses may flounder and practice problems can arise. Proper orientation and support can contribute to temporary registrantsí success and help to ensure they provide safe, effective and ethical care.

For more information, refer to the Temporary Registration fact sheet and the Regulated Health Professions Act: Scope of Practice, Controlled Acts Model available online at www.cno.org or by calling 416 928-0900, toll free (Ontario) 1 800 387-5526.

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Connecting with Council

Visit CNO's website for updates on developments at CNO's Council. The new "Connecting with Council" feature is updated within two weeks of CNO's Council meetings, allowing members and stakeholders more immediate access to information about decisions made at Council. Click on the "About CNO" link and navigate over to the Council and Committees tab to learn more. CNO's next Council meetings are March 10 and 11 and June 9 and 10.

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Creating Learning Opportunities

CNO's Regional Education Network (REN) provides nurses with exceptional learning opportunities. It gives them the chance to participate in continuing education and problem-solving, as well as learn from, and network with, their colleagues.

The goal of the REN is to provide leadership in self-regulation to the profession by offering educational sessions covering a broad spectrum of topics including self-regulation, quality assurance, documentation, client consent and professional standards. Last year, over 22,000 nurses attended REN sessions throughout the province.

The hour-long sessions are held in your area and may even be held at your facility. The instructors are CNO representatives who live and work nearby and can answer questions or clarify issues affecting health care in your area. Participation in REN sessions may help nurses fulfill their Reflective Practice requirements and improve their daily practice.

A new session on the Medication practice standard (2003) has been added to our offerings. This session provides information on how to administer medications safely and effectively, expectations for nursing roles and accountabilities, and suggestions for creating supportive practice settings to facilitate proper medication practices, including preventing errors and automated medication systems.

For more information on REN sessions in your area or to contact a REN coordinator, visit www.cno.org or call 416 928-0900, toll-free in Ontario 1 800 387-5526.

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Why you should check renewal status

As an employer, it is in your best interest to ensure that nurses you employ have renewed their membership with the CNO and are legally eligible to practise in Ontario. Employing nurses who have been suspended for non-payment of fees can become problematic should an incident occur.

All nurses must renew their CNO memberships annually or face suspension for non-payment of fees. Once suspended, they can no longer practice in Ontario or use the protected title of nurse, RN or RPN. Those who practice while under suspension are practicing illegally and may be charged under the Regulated Health Professions Act and/or the Nursing Act (1991).

Verifying renewal status also gives you that opportunity to see if any terms, limitations or conditions that may affect her/his duties have been placed on a nurse's practice in the last 12 months. A list of members suspended in 2004 for non-payment of fees will be posted on CNO's Web site after the suspension date in late April. To confirm membership renewal, check the nurse's Annual Payment Card or contact the College. For facilities that employ a large number of nurses, CNO's Automated Annual Verification Renewal (AAVR) system can quickly and easily check the status of many nurses at once.

To verify membership (limit six nurses) call 416 928-0900, toll free in Ontario 1 800 387-5526. For more information on the AAVR, visit www.cno.org and click the Employer tab or contact Jelena Veljovic at ext. 6260.

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Exposing Illegal Practitioners

Requiring proof of membership has another benefit: exposing illegal practitioners.

Illegal practitioners — individuals who do not have a valid membership with CNO — are most often discovered by employers because they cannot provide proof of College membership. There are times, however, when illegal practitioners may present fraudulent credentials to gain or maintain employment. Illegal practitioners are a threat to public safety, as well as to real nurses and other health care providers working unknowingly alongside them. If you suspect someone of practicing illegally, check the online list of convicted illegal practitioners at www.cno.org or contact the College directly to confirm that person is a registered member of the College.

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Supporting Palliative Care Nurses

Employers play an important role in supporting palliative care nurses who work in the community. In general, community nursing is more autonomous than nursing in hospitals, long term care facilities, and other institutional settings. In caring for palliative care clients in their homes, community care nurses may experience more work-related stressors such as isolation, lack of support and separation from the traditional notion of the health care team. Support from employers and the health care team can help community nurses provide safe, effective and ethical care to their clients.

Employers could consider having palliative care delivered by a health care team that can provide consultation and collaboration that will support the client, family and direct care providers. When providing care in the community, it may be advisable to have at least two nurses share the care for seriously ill and dying clients. This gives nurses more opportunity to consult with a peer/colleague regarding client care. Further, it also enhances collegial support and communication within the health care team.

Facilities, nursing agencies and Community Care Access Centres are primarily responsible for developing and implementing policies and procedures regarding storage, control of, access to and disposal of controlled substances and other medications. CNO has standards that provide guidance and support to nurses in many practice areas, including medication administration. In fact, the revised Medication practice standard specifically addresses the disposal and transport of prescribed medications and controlled substances in various settings, including in the community.

Employers can support community nurses by developing and implementing appropriate medication policies and communicating their expectations to nurse employees. If medication disposal or transport is deemed part of the nurse's role, employers should consider developing policies that are consistent with CNO's Medication practice standard with nurses. Policies may include the following:

  • expectations for medication disposal and transport in the nursing role;
  • processes that facilitate and support communication with clients and families around expectations for handling narcotics/controlled substances; and
  • requirements for appropriate documentation.

Supportive activities could also include: continuing education and orientation on policies and legislation affecting palliative care practice; having nurses participate in the development of policies and procedures affecting their practice; and providing resources and support that assist nurses in implementing policy decisions.

For more information on supporting nursing practice or creating a quality practice setting, contact a CNO Practice Consultant at 416 928-0900 or toll free in Ontario 1 800 387-5526.

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New publication now available

CNO's annual newsletter for the public, Here for You is now available. In it, the College discusses its role in protecting the public interest, how nurses participate in self-regulation, how the public can identify who is (and who isn't) a nurse, and the steps nurses take in Ontario to ensure the provision of safe, effective and ethical care.

Here for You (formerly published as Nursing and You) has been completely redesigned into an eight-page, full-colour, glossy magazine format. This format can be easily displayed in waiting rooms or in magazine racks at your facility. The College appreciates the assistance of employers in making this information available to the public.

Here for You is a free publication that can be requested throughout the year. To order copies for your facility, contact Taryn Nirenberg at 416 928-0900, ext. 6367; toll free in Ontario 1 800 387-5526, or e-mail tnirenberg@cnomail.org.

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What's New with the PSCP

Since its inception in 1999, the Practice Setting Consultation Program® (PSCP) has assisted nurses and their employers in working together to build quality workplace settings. This self-directed program facilitates the identification of workplace issues that hinder nurses' ability to deliver quality care. As well, it assists practice environments to build upon strengths in the workplace.

Throughout 2004, CNO will be reviewing and evaluating the PSCP. As well as evaluating the program, the College is looking at options for delivery of the PSCP. Working with colleagues in practice settings who have participated in the program, the CNO aims to enhance the program's ability to meet the unique needs in each practice setting.

CNO will keep employers informed of these exciting new directions in the PSCP through the website, this publication and The Standard. For more information about the PSCP, please contact Janet Anderson, Manager, Practice, by email at pscp@cnomail.org or 416 928-0900, ext. 6317.

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Ask CNO: Medication self-administration

Q: More and more, in the community and in retirement homes, clients and their families are self-administering medications. As an employer, how can I facilitate self-administration for clients? What are my responsibilities? What are the nurses' responsibilities?

A: One of the goals of nursing is to help clients become independent. Administrating their own medications builds client independence by giving them some control over their own health. Families often participate in client care and medication administration, as well.

However, when it comes to self-administering medication, employers and nurses have certain responsibilities to ensure they provide safe and effective care.

As an employer, be certain your nursing staff has the knowledge and the tools to assess the capability of clients and/or their family to self-administer medications. You need to establish clear policies and procedures on self-administration and facilitate access to educational resources about medications and assessment. Storage facilities should be secured to prevent medications from being accessed by anyone other than the intended client. Implement a documentation system that enables nurses to indicate medications are self-administrated.

Sometimes clients self-administer medication from a dosette, which nurses prepare for them from the clients' own drugs. An employer needs to have policies and procedures relating to dosettes and provide a space free of distractions where nurses can concentrate while filling individual dosettes.

Nurses are responsible for following the policies and procedures of the facility/agency or, if policies don't exist, to advocate for them. Part of nurses' responsibility in medication self-administration is teaching clients and families about the medications and continuously assessing their capability to self-administer medications safely. Nurses also need to monitor the client to ensure medications are being taken and assess the medication's effectiveness and/or any side effects. Finally, nurses should intervene in unsafe situations.

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Annual Meeting

CNO's Annual Meeting takes place on Thursday, June 10, 2004 at 0900 hrs. A reception will follow. Members and the public are welcome as we recognize CNO's accomplishments in 2003!

If you plan to attend, please contact Jenna Hofbauer at 416 963-7566 or e-mail at jhofbauer@cnomail.org.

Copyright © College of Nurses of Ontario, 2004. Material published in Quality Practice may be re-printed without permission, provided that credit is given to the publication and to the College of Nurses of Ontario. ISSN 1496-7618

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