Quality Practice - A resource for nurses and nurse leaders
  February 2020 | Volume 19 Number 1
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What are my accountabilities as a nurse manager during the novel coronavirus outbreak?

Proper planning is key to determining how well a facility and its nursing staff will manage coronavirus. Employers are responsible for establishing a working environment that supports safe and effective patient care. This includes arranging appropriate staffing coverage and Personal Protective Equipment (PPE) for all nurses who require it. Your practice setting must also provide proper PPE training and fitting.

CNO’s Professional Standards, Revised 2002 specifies that nursing managers need to access and share up-to-date, evidence-based information and guidelines with staff. Nurse managers must also provide staff with clear policies on screening and managing the outbreak.

All nurses are accountable to take action when patient care may be compromised. This includes identifying strategies to prepare for, reduce and resolve situations that may leave patients without the nursing services they need. This accountability is found in CNO’s practice guideline, Refusing Assignments and Discontinuing Nursing Service.

To ensure a safe practice environment, nurse managers should consider:

  • Are there strategies in place for prioritizing patient care needs?
  • Have you explored concerns with your staff and clearly communicated your organization’s plan to address these concerns?
  • Have you included front line staff in the creation and implementation of these strategies?
  • Is there a readily available system for replacement staff?
  • Are strategies in place to facilitate the reorganization of workload, if needed?
  • Are there clear policies and lines of communication for nurses to follow when staffing is short?

Nurse managers can show leadership by working through dilemmas that nurses may have regarding assignments by following the decision-making process found on page 6 of the Refusing Assignments and Discontinuing Nursing Services practice guideline.

Resources for nurses

To help nurses find the information they need to provide safe patient care, we’ve created a resource page that contains coronavirus-related FAQs, info about accountabilities, and current infection prevention and control guidelines.

We will continue to closely monitor the situation. As more information becomes available, we will update our Novel Coronavirus webpage. You can also follow us on social media to stay up to date.

CNO’s role

CNO’s mandate is to protect the public—but patient safety is a responsibility we all share. Our role during the novel coronavirus outbreak is to support nurses’ ability to provide safe and competent care and understand their accountabilities.

If nurses have questions about their accountabilities when caring for patients affected with the new coronavirus, they can contact us. One of our Advanced Practice Consultants can help identify the appropriate practice standards and guidelines to guide their decision-making and help them understand their accountabilities.

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New Reporting Guide and updated Reporting form

We have published a new Reporting Guide and updated the Reporting form. The goal is to help employers, nurses and anyone who works with a nurse clearly understand what, when and how to report a concern they have about a nurse’s practice to CNO.

The guide replaces Mandatory Reporting: A process guide for employers, facility operators and nurses. We have also updated the Reporting form to make it easier to complete and submit to CNO.

CNO’s mandate is to protect the public. We achieve this by partnering with those who work with nurses. Patient safety is a collective responsibility—we need you to send us a report when you believe a nurse poses a serious risk of harm to patients.

The Reporting Guide is now an easy-to-navigate online document. It includes:

  • a table that easily explains what you should report to CNO
  • a section on a nurse’s professional accountability to act in the best interest of their patients and to protect them from harm
  • a section on your legal obligations to report certain conduct and concerns

We have also updated the Reporting form based on feedback. It now includes:

  • instructions on how to complete the form
  • a second contact person section, since more than one person might have information about the concern
  • more areas to list incidents, since the person submitting the form might have multiple concerns about the nurse’s practice
  • the ability to submit the form electronically on cno.org

We will be adding additional supporting resources to the File a Report section throughout 2020. We will inform you when we launch a new resource. And, we want to hear from you: Please email us your feedback about the new reporting information.



Our response to the Long-Term Care Homes Public Inquiry recommendations

On July 31, 2019, Commissioner Eileen Gillese released her Long-Term Care Homes Public Inquiry Report. The report made 10 recommendations specifically for CNO.

At the inquiry, CNO provided information to help improve the system and protect residents and patients from harm. We also made a commitment to publicly report on our response to each of the 10 recommendations.

We have listed all the actions and improvements we have made to meet the report’s recommendations in our new fact sheet, Our Response to the Long-Term Care Homes Public Inquiry Recommendations. All our actions have the core purpose of protecting residents from harm.

Actions include adding a new decision-making tool to our investigation process to help investigators assess the risk a nurse poses to patients, and developing a new Reporting Guide, so employers, nurses and those who work with a nurse know what, when and how to report a concern to us 

We will continue to find opportunities to strengthen and enhance our processes, as we have always done. You can read our full response to the recommendations here.



How to confirm your nursing staff are registered for 2020

Nurses who have not renewed their membership with the College of Nurses of Ontario before Wednesday, Feb. 19, 2020, will have their memberships suspended.

With a suspended membership, nurses will not be able to practice nursing in Ontario until they renew and pay all outstanding fees. This includes a late renewal fee of $113 and an additional administrative fee of $56.50 to lift the suspension.

If a suspended nurse does not renew or resign their membership before Friday, March 20, 2020, their membership will expire. If this happens, they will need to meet the requirements for reinstatement and pay additional fees in order to resume practicing in Ontario.

Keep in mind that it is a serious offence for a nurse to practice in Ontario while their membership is suspended, revoked or expired.

To confirm if the nurses at your facility are registered to practice, use Nurse Renewal Check. CNO provides this service to nursing employers, facility operators and others. It quickly checks the membership status of nurses you employ on a full-time, part-time, casual or contractual basis, which makes it ideal for organizations with a large nursing staff. Nurse Renewal Check is an efficient alternative to manually reviewing each nurse’s membership status by phone or using Find a Nurse.

Nurses should also remember to update any changes to their employment information on Maintain Your Membership within 30 days of change. This is essential not only during renewal, but throughout the year. We require this so that the public Register, Find a Nurse, is always up to date. 



Nurses can now initiate the controlled act of psychotherapy without an order

A recently approved initiation regulation will enable Ontario nurses who work in community settings to continue to provide the controlled act of psychotherapy without an order. The initiation regulation came into effect on January 1, 2020. When the controlled act of psychotherapy was proclaimed two years ago, an exemption period was created allowing nurses to practice the controlled act without an order. The exemption period ended on December 31, 2019.

RNs and RPNs can choose to use the title psychotherapist, provided they make it clear they are registered with CNO. For example, Jane Doe, RN, Psychotherapist. Nurses also may wish to register with the College of Registered Psychotherapists of Ontario, but if they choose to do so, CNO must be notified of such registration.

What is the controlled act component of psychotherapy?

Not all psychotherapy falls under the controlled act. If all five of the following criteria are met, it is the controlled act:

    1. You are treating a client

    2. You are applying a psychotherapy technique

    3. You have a therapeutic relationship with the client

    4. The client has a serious disorder of thought, cognition, mood, emotional regulation, perception or memory

    5. This disorder may seriously impair the client’s judgment, insight, behaviour, communication or social functioning

As with any procedure, nurses continue to be accountable for having the knowledge, skill and judgement to perform this controlled act safely.

Even with this new regulation in place, some nurses may still need an order due to workplace policies or requirements under the Public Hospitals Act. Delegation of the controlled act of psychotherapy by NPs, RNs and RPNs is also prohibited.

To learn more about the component of psychotherapy practice that is the controlled act, read our psychotherapy FAQs.


Chief Quality Officer appointed

CNO has appointed Carol Timmings, RN, as CNO’s Chief Quality Officer (CQO).

As CQO, Carol will enforce standards of practice and conduct and oversee the requirements for entry to practice. She will also articulate and promote practice standards and oversee the administration of our Quality Assurance Program.

“Carol's background as a highly effective and well-regarded nurse leader with broad experience in the health care system positions her well for the Chief Quality Officer role,” says Anne Coghlan, Executive Director and CEO.

Since becoming a nurse, Carol has been an active leader at both the provincial and national levels. She is the immediate past President of the Registered Nurses’ Association of Ontario, has served as the Chief Nursing Officer for Toronto Public Health and was recently appointed to the NCLEX Examination Committee of the National Council of State Boards of Nursing. She first joined CNO one year ago as Director, Practice Quality.

Timmings says she is excited to begin her new leadership role at CNO. “The College protects patients by regulating nursing in the public’s interest, and I’m honoured to be a part of that critical work in our profession,” she says.


How Practice Support can help nurses

Our Practice Support team can help nurses identify the appropriate practice standards and guidelines to guide their decision-making and understand their accountabilities.

How we can help nurses:

We can:

  • direct them to the practice standards and guidelines that apply to their practice issue
  • provide them with FAQs and other resources that explain how certain standards are applied
  • help guide their decision-making
  • help them understand their accountabilities

For example, if a nurse has a question about whether an RN or RPN can administer Botox, we would email them a link to the Decisions About Procedures and Authority practice document and our FAQ on administering Botox. Or, if their question is about the difference between a direct order and a directive, we would send them a link to the Authorizing Mechanisms practice document so they can learn the differences between the two and how they would be used.

Our resources, a nurse’s decision:

We know nurses often hope that we can answer a question with a simple yes or no, but we can’t. Nursing practice is complex, and it’s up to each nurse to consider their legislative scope, practice setting and reflect on their own knowledge, skill and judgment before making any practice-related decision. Only they can determine whether they have the knowledge, skill and judgment to proceed.

What we can do is make sure nurses have the tools they need to make the best possible decision. Nurses with questions should visit our Standards and Learning page to see all our educational resources, including answers to frequently asked questions, decision tools, webcasts and case scenarios. They can also contact us by completing our Practice Support form. We do our best to respond within three business days.


More nurses than ever are contributing to safe nursing care through regulation

We are thrilled with the great response we received when we invited nurses to apply to serve on CNO’s committees.

In September and October 2019, we received applications from 86 nurses for 14 committee vacancies—a 79% increase in the number of applications from the previous year. It’s encouraging to see so many nurses interested in contributing to safe nursing care through participation in nursing regulation.

As part of Council’s Governance Vision, this is our second year of piloting a new process for committee appointments, which includes:

  • Asking nurses to review education about committees before they apply
  • A competency-based application and assessment process supported by a third party

What’s next?

  • Third party assesses applications and resumés between October and December 2019
  • CNO’s Election and Appointments Committee reviews information to identify a short list of candidates and to prepare its recommendations to Council between January and February 2020
  • Council makes final committee appointments in March 2020

Nurses who submitted an application will hear about the outcome in late March 2020.

We will share key themes from the application process in an article in the April edition of The Standard.