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COVID-19: Practice resources
This page provides COVID-19 practice information. In addition to the information below, CNO’s Practice Support staff can help with your nursing practice-related inquires. Please review our statement on the standard of care in the Standards & Guidelines section of this website.
For updates on alerts and orders currently in force, please refer to the resources in the links below:
During these challenging times, nurses are being asked to do more than ever before. It is important to remember to keep your own health and well-being a priority too. The following resources offer mental health support:
- Canadian Mental Health Association: Information, resources and tips for health care workers dealing with COVID-19
- Government of Ontario: Support for health care workers
- CAMH: Mental health and COVID-19 resources for health care workers
- CNO: Supporting nurses in self-care and self-care fact sheet
- Your employer’s Employee Assistance Program (if applicable).
All nurses are accountable to …
- Take action when patient safety may be compromised. This includes identifying strategies to prepare for, reduce and resolve situations that may leave patients without the nursing services they need.
- Role model and follow public health directives that keep patients safe.
- Self-reflect, determine learning needs and actively updating knowledge and skills to maintain continued competence.
- Practice according to CNO's standards and guidelines during the pandemic. However, if there is conflict between the Ontario government reopening response and a CNO practice standard or guideline, then you should follow the government’s order while in effect.
If you have questions about your accountabilities when caring for patients affected with COVID-19, please complete and submit a practice support form.
Who can perform a COVID-19 point-of-care test?
The Ministry of Health has created an exemption in the Laboratory and Specimen Collection Centre Licensing Act, 1990 to allow any person to perform a COVID-19 point-of-care test. Anyone performing a test must follow the product label instructions and/or receive training to make sure they administer the test correctly.
Point-of-care tests involving controlled acts:
Nurse Practitioners (NPs) are authorized to perform and order point-of-care tests involving controlled act, such as nasopharyngeal swabs.
Registered Nurses (RNs) and Registered Practical Nurses (RPNs) need an order or directive from an authorized provider (i.e., physician or NP).
An unregulated care provider will require delegation from an authorized health care provider e.g. RN or RPN .
As nurses, your primary accountability is to patients. When deciding whether to provide care in a particular situation, exercise your professional judgment and follow an ethical decision-making process.
We recognize nurses are being asked to do more than ever, including working overtime, covering extra shifts and working in new practice environments, perhaps outside a nurse’s comfort zone. Nurses may be concerned that declining work could be considered abandonment. This is how CNO defines abandonment:
Abandonment occurs when a nurse has accepted an assignment and discontinues care without:
- the patient requesting the discontinuation.
- arranging a suitable alternative or replacement service; or
- allowing a reasonable opportunity for alternative or replacement services to be provided.
When deciding whether to refuse an assignment or discontinue nursing services, you are accountable to:
- Assess the potential for harm to yourself and your patients, consider the circumstances and your practice setting. Continue to work within your knowledge, skill and judgement. This includes completing a point-of-care risk assessment and stating any personal health concerns you have.
- Use a variety of evidence-based sources to inform your decision making as well as consider the context of the situation.
- Communicate your concerns to your employer. You must communicate to your employer that you are considering refusing an assignment and why, and you must consider your employer’s response. If, after doing so, you choose to refuse the assignment, ensure that another caregiver is available, or allow a reasonable opportunity for alternate services/replacement to be found.
- Document your decision-making process, actions and decision.
- Recognize that health care providers, including nurses are being asked to be more flexible and adaptable than ever due to the pressure on the health care system.
As a nurse, you must ensure you have the knowledge, skill and judgment, and the appropriate authority before performing any activity or procedure.
If you are deployed to an area that you are not familiar with:
- Perform activities you are competent to do.
- Find ways to address your learning needs specific to the new practice setting.
- Seek role clarity and discuss your competency and expected responsibilities with your employer.
- Seek advice, collaborate and support your health care team to uphold safe patient care and work together with other health care experts to improve your patients’ care.
For more information on orders related to work deployment and staffing, search for “work deployment” under the Ministry of Health resource web page.
NPs reporting deaths from COVID-19
When completing medical certificates of death, it is very important to distinguish clearly between deaths that are directly caused by COVID-19 and deaths where the person may have tested positive for COVID-19 but the death resulted from another primary cause.
NPs who sign medical certificates of death caused by any disease of public health significance, or for which the disease of public health significance was a contributing cause of death, have a legal obligation to report these deaths to their local Medical Officer of Health.
NPs issuing medical exemptions for COVID-19 vaccine
NPs need to be aware of the Ministry of Health's direction that there are very few acceptable reasons to issue a medical exemption for the COVID-19 vaccine, for example:
- the patient has a confirmed severe allergy or an adverse (anaphylactic) reaction to a previous COVID-19 vaccine or to any of its components that cannot be mitigated
- the patient has a diagnosed episode of myocarditis/pericarditis after receipt of an mRNA vaccine1
To comply with the Ministry's direction, NPs must clearly document any medical exemption including the reason the patient cannot be vaccinated and the effective time period for the medical reason (unlimited or time-limited).
You can find additional information in the Ministry of Health’s Medical Exemptions to COVID-19 guidance document.