Quality Practice - A resource for nurses and nurse leaders

  April 2019 | Volume 18, issue 2
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Why we’re putting more employment information on the Register

It’s important for the public and employers to have accurate information about nurses. It increases transparency, promotes trust and allows people to make informed decisions about who is providing their care. That’s why it’s the law that all regulated health professions in Ontario, including nurses, have a public register with information about their members. Our register is called Find a Nurse.

At the Long-Term Care Homes Public Inquiry, several participants, including victims’ groups and the Ontario Long Term Care Association recommended that we publish more employment information about nurses on Find a Nurse. This would provide employers with another consistent, efficient and reliable way to obtain information about nurses.

Although the Inquiry will deliver its final report and recommendations in July, we have reviewed and reflected on the publicly available material from the Inquiry. We have also reflected on evidence from our own literature review and the practices of other regulators. We have proactively identified improvements that can be made now. Posting more employment information on Find a Nurse is one such change.

In December, we published details about the proposed by-law changes that would expand the information on Find a Nurse, and asked for your feedback. At its March meeting, Council reviewed that feedback, and approved the changes. Council decided that these changes will help us meet our mandate to protect the public.

What’s changing on Find a Nurse?

From one primary to all current employers 
Currently, Find a Nurse lists each practicing nurse’s primary employer. This will be expanded to include all current employers. Since many nurses have more than one employer, this will provide a more accurate picture of a nurse’s employment. This is also consistent with what most other regulated health professionals list on their registers.

Adding employment history 
Currently, there is no information about a nurse’s past employment on Find a Nurse. Council has decided that Find a Nurse will list employers from the last three years. Other regulated health professionals also list this info on their registers.

We began working to make these changes immediately after Council voted. The updates are now on Find a Nurse.

During the consultation period, many nurses asked what CNO would do in situations where publishing employment information would put a nurse in danger. The Regulated Health Professions Act, 1991, enables CNO to remove information on Find a Nurse in extreme cases where a nurse’s safety is at risk. We do this after a careful review of a nurse’s particular situation.

The next step: remind nurses to update their info

If there’s a change in a nurse’s personal or employment information, they have 30 days to update their info. The 30-day window exists because Find a Nurse is only effective if it is current. This is not a new requirement. Keeping information up-to-date has been a long-standing reporting requirement for all practicing nurses.

To ensure that Find a Nurse is always current, Council approved charging a nurse a $100 fee if they fail to meet their self-reporting requirements.

Our goal is that Find a Nurse is as up-to-date as possible, so we’ll remind nurses to update their info frequently by posting reminders in The Standard and on our FacebookTwitterLinkedIn and Instagram. Remind your nurse employees to update their info as soon as it changes. They can update their information quickly and easily at any time on Maintain Your Membership. Nurses can also check this complete list of what they need to report to CNO.

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How to determine whether an RPN or RN should provide patient care 

How should RNs and RPNs working together determine who should provide care? And how can employers create policies that support a nurse’s ability to make that decision appropriately? 

The correct way for both employers and nurses to determine who should provide care is to use the three-factor framework. The three-factor framework is outlined in the RN and RPN Practice: The Client, the Nurse and the Environmen practice guideline.

Consider:

The patient

  • How complex is the patient’s condition?
  • Are the patient’s care needs well defined and established?
  • What is the risk of a negative outcome?

The nurse

  • Does the nurse have the knowledge, skill and judgment to provide safe care?
  • What are the practice expectations and competencies for nurses in this setting?
  • Are there supports in place for nurses with gaps in their competencies?

The environment

  • How stable and predictable is the practice environment?
  • Are adequate consultation and practice supports and resources available to staff? 

When both nurses and employers understand how to use the three-factor framework to support their decision-making, it leads to the appropriate utilization of nurses. 

You should also reflect on the RN and RPN Practice: The Client, the Nurse and the Environment practice guideline because it can help you identify the characteristics of practice environments that enhance collaboration between nurses and support their ability to provide safe, quality patient care. Effective collaboration among nurses leads to improved patient outcomes. 

To see the three-factor framework in action, read this scenario.

Do you have questions about the three-factor framework? Ask our Practice Support team.


What counts as recent “nursing practice”?

Did you know that if a nurse hasn’t practiced nursing anytime in the last three years they must either register in the Non-Practising class or resign from CNO?

CNO’s Registration Regulation requires all nurses in the General or Extended classes to make a declaration about their nursing practice within the previous three years. Nurses make this declaration when they renew annually, or if it has been three years since they practiced nursing. Employers aren’t required to prove anything at the time the nurse is making their declaration.

This regulation contributes to public protection by ensuring that nurses registered in the General or Extended classes have recent nursing practice. Members of the Non-Practising class are prohibited from practicing nursing in either a paid or volunteer position in Ontario.

An employer can’t hire a person registered in the Non-Practising class for a position that involves nursing practice (such as the performance of the controlled acts authorized to nurses) or one in which the person would be portraying her/himself as entitled to practice nursing. It is your decision whether to hire this person for a position that does not involve nursing practice.

The regulation also includes if a nurse has been on a long-term medical leave. If the nurse remains employed while on an extended medical leave, CNO doesn’t recognize this as evidence of practice. You can find more information in our medical leave FAQ.

If you have questions about nursing evidence of practice, you can find more information on the Declaration of Practice web page.

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RN entry-to-practice competencies changing in 2020

Every five years, the Canadian Council of Registered Nurse Regulators leads a review and update to make sure the RN entry-to-practice competencies are current and consistent across the country. We recently collected feedback from RNs about the proposed competencies. This feedback, along with feedback from RNs across Canada, informed the final version.

The final version will come into effect in September 2020. You can read the new competencies at Entry-to-Practice Competencies for Registered Nurses.

In the new revision, a roles-based model organizes the competencies under the multiple roles nurses assume when providing safe care. The roles are: clinician, professional, communicator, collaborator, coordinator, leader, advocate, educator and scholar. The competencies also reflect changes in the health care environment, such as increased focus on patient acuity, use of social media and continuous quality improvement. As well, the competencies include recommendations from the Truth and Reconciliation Commission of Canada: Calls to Action.

Next steps

Between now and 2020, we will update our Program Approval documents to align with the new competencies. RN nursing education programs will integrate the new competencies into their curriculums.

Visit Become a Nurse for more information on entry-to-practice and Nursing Education Program Approval.

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Making it easier for nurses to return to practice

CNO has launched a new program for nurses in the Non-Practising class who want to return to practice after being away for more than three years but less than five years. The program is called the Supervised Practice Experience (SPE). 

SPE is for RNs and RPNs who are not able to meet CNO’s evidence of practice requirement. Also, former CNO members who wish to reinstate and are willing to become members in the Non-Practising class can participate in the program. 

The program allows nurses to demonstrate competence and meet CNO’s evidence of practice requirement while under the guidance and supervision of a nurse supervisor. 

Nurses who are interested in starting the SPE will need to contact potential sponsoring organizations in Ontario and begin making inquiries and arrangements. Employers that agree to be a sponsoring organization will need to assign a supervisor to the nurse. Once a nurse and an organization agree to proceed with the SPE, they will need to complete some documents and submit them to CNO. Both the nurse and the supervisor must be approved by CNO before they can start the SPE.

Employers benefit from participating in SPE. It gives them an opportunity to assess the nurse as a potential new or returning employee. It allows their nursing staff to develop additional mentoring and supervisory skills, and allows the nurse taking part in the SPE to return to nursing practice safely. Overall, the organization will be supporting activities that help nurses maintain their competence. 

Visit our Returning to Practice page to learn more about this program.

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New language on Find a Nurse describes NPs who don’t prescribe controlled substances

We have changed the language on our public Register, Find a Nurse, that describes NPs who have not completed controlled substances education.

Previously, the status said, “entitled to practise with restrictions.” It also included this description in the NP’s information tab: “This member cannot prescribe controlled substances. They have not completed the education needed to do so.”

Some of you told us you were concerned that “restrictions” might be mistaken as a conduct matter. Based on feedback we received from nurses, employers and other stakeholders, we decided to change the wording to more accurately describe a nurse’s practice status.

The new statement now says: “Entitled to practice. Cannot prescribe controlled substances until specialized education is completed.”

Specialized education includes a course that Council has approved or an NP program that has controlled substances content in its curriculum.

Visit our NPs and Prescribing Controlled Substances page for more information.

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What’s happening with RN prescribing?

At its March meeting, following discussion of feedback and how it aligned with the vision that RN prescribing will be safe for patients, Council agreed to send the proposed RN prescribing regulation to government for review and approval. The regulation will not take effect until government approves it.

We recently surveyed nurses and other stakeholders about the proposed regulation. Read the results of our survey in the March issue of The Standard.


Psychotherapy: Initiation regulation moves onto next phase

At its recent meeting, Council agreed to send the proposed changes to the controlled act regulation related to psychotherapy to government for their review and approval.

If approved by government, the changes will allow RNs and RPNs who work in community settings to independently initiate the controlled act of psychotherapy without an order beginning January 2020.

The controlled act of psychotherapy only applies to a very distinct component of the broader psychotherapy practice. It is a controlled act because of its significant risk of harm to patients. To understand when a component of psychotherapy becomes a controlled act, read Psychotherapy and the controlled act component of psychotherapy.

What’s next?

When the controlled act of psychotherapy was proclaimed in 2017, the Ontario government provided nurses with a two-year exemption before it would be enforced. This means RNs and RPNs can continue to practice the controlled act without an order until Tuesday, Dec. 31, 2019.

The exemption does not apply to NPs because they are authorized to perform this controlled act. It also does not apply to nurses who work in practice settings where an order is required. For example, the Public Hospitals Act requires nurses to obtain an order for any treatment.

The proposed changes are now with government for their review. We should know the results of their decision in the near future.

We will continue to keep you informed with updates at www.cno.orgThe Standard and our Facebook page.