Quality Practice - A resource for nurses and nurse leaders
  May 2018 | Volume 17, issue 1
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Use Nurse Renewal Check to verify a nurse’s registration status

Suspended members who did not complete annual membership renewal saw their memberships expire on Thursday, April 19. We have notified them by email.

If a person’s membership with the College has expired, they will need to meet the requirements for reinstatement and pay additional fees in order to resume practising in Ontario.

Practising in Ontario while your membership is suspended, revoked or expired is a serious offence. To confirm if nurses at your facility are registered to practise, use Nurse Renewal Check

Nurse Renewal Check is a service the College provides to nursing employers, facility operators and others. It quickly and efficiently checks the membership status of nurses you employ on a full-time, part-time, casual or contractual basis.

The service is an efficient alternative to manually reviewing each nurse’s membership status by phone or using Find a Nurse. This makes it ideal for organizations that employ a large number of nurses.

We encourage employers to use Nurse Renewal Check or Find a Nurse regularly. Recent changes in legislation mean that our public Register now contains more information. For instance, you can now search for a nurse by practice restrictions or hearings results.

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Meeting growing needs: Proposed fee changes

In the March issue of The Standard, we asked for feedback about proposed changes to fees that nurses and applicants pay to the College. We appreciate the feedback we have received so far and would like to address the great questions that have been raised. 

The proposed fee increases relate to membership renewal, new applications, and the PN exam and exam cancellation fee. The increases would ensure the College can meet the expanding needs of today’s regulatory environment and maintain a sound financial position.

We are aware that fee increases are never a popular topic, and that the proposed increase to the membership renewal fee is a substantial change. Some nurses were wondering what their membership fees pay for; why all nurses in Ontario pay the same membership fee; and why that fee doesn’t include professional liability protection. Find answers to these and other questions at www.cno.org/faq-fees.

Before the College’s Council decided to propose these fee increases, they considered a variety of ways to save costs. However, they found these would hinder our ability to effectively fulfil our legal accountabilities as Ontario’s regulator of the nursing profession. In turn, this would be a risk to the public.

Evolving and expanding

Over the past few years, our work at the College has evolved. Significant changes have increased the volume of work and service expectations from nurses, government, applicants, educators and the public. For instance, in 2017 we experienced a 93 per cent increase in the number of complaints and reports compared to two years before.

Also on the rise is the duration and volume of telephone calls we receive about applications, complaints, reports and general inquiries. This has resulted in long wait times when members try to reach the College by telephone. To address this, we are overhauling our telephone systems. We are also in the process of automating our business processes so we can provide you with more efficient service in the future.

We welcome your feedback on the proposed fee changes. Comment at www.cno.org/proposed-changes-to-fees. The deadline is Friday, June 1, 2018. Council will review all feedback before it makes a final decision in June.

Comment on changes: RN prescribing

The College is working on the standards that will guide nursing practice after RNs gain authority to prescribe medication. To help us do this, we are asking for feedback on the standards of practice and accountabilities for RNs who will prescribe, as well as for all nurses when dispensing medication.

Tell us what you think by completing this survey. The deadline is Monday, May 14, 2018. 

For more information, visit our Journey to RN prescribing page.

Help end the opioid crisis

Opioid-related mortality and morbidity continue to rise in North America. Since many nurses have a role to play in stopping this crisis, the College is committed to providing them with resources to support clinical decision-making.

Recently, the Ministry of Health and Long-Term Care released data about opioid-related deaths in Ontario. From January to October 2017, there were 1,053 opioid-related deaths in this province. This is an increase of 52 per cent, compared to 694 in 2016. In 2017, there were 7,658 emergency department visits related to opioid overdoses – up 72 per cent since 2016.

Our resource page includes links to evidence-informed resources about treating opioid use disorder and prescribing opioids appropriately. We recently added to the page three new quality standards that Health Quality Ontario (HQO) developed:

These standards are part of Ontario’s strategy to prevent opioid addiction and overdose. With a focus on patient safety, they outline the quality practices necessary when providing care for people who have an opioid use disorder, and when prescribing, monitoring and tapering opioids for acute and chronic pain.

Have your say: NP status on the Register

The College is proposing a by-law change related to the language we use on our public Register, Find a Nurse. The change will use different language to describe the status of NPs who have not completed the education required to prescribe controlled substances.

You can learn more about the proposed change and submit your feedback here. The deadline to comment is Friday, June 1, 2018.

Standardizing RPNs across the country

There’s a major initiative afoot to ensure RPNs across Canada have the same entry-level competencies needed to provide safe care. To do this, the College is working with nine other provincial/territorial regulators. The plan is to improve the mobility of RPN labour across the country, while keeping public safety the top priority. 

Next up are three steps. First, we need a comprehensive analysis of RPN entry-level practice. This will provide an overview of practical nursing practice across Canada. It will also identify any changes and differences among jurisdictions.

Second, we will need national entry competencies for RPNs across the country. Currently, they vary by jurisdiction, but they should be consistent. With the support of subject matter experts across the country, we’ll use what we learned from the entry-level practice analysis (and other sources of evidence) to update the competencies.

Third, we’ll use some of the competencies to develop a new regulatory RPN exam. 

On Feb. 5, 2018, a group led by the Canadian Council of Practical Nurse Regulators (CCPNR) issued a Request for Proposals (RFP) to find a vendor to assist with these steps.

CCPNR's goal is to have the new pan-Canadian examination in place by 2022.

We’ve asked Ontario educators of PN programs for feedback on the timeline they’ll need to revise their curriculum. We’ll continue to engage other stakeholders throughout the project.

We’ve updated two standards

We have made minor revisions to the Decisions About Procedures and Authority and Nurse Practitioner practice standards so they align with the recent change to controlled acts authorized to NPs.

What’s new?
On Jan. 1, 2018, NPs gained the authority to apply ultrasound without restrictions. Procedures may be performed for health assessment, diagnosis and/or therapeutic management. NPs should ensure reliable quality assurance systems are in place. For example, to ensure the equipment they are using is giving accurate results. These expectations are now captured in the NP standard.

As well, performing procedures at the point of care in practice settings where health services are routinely performed is an expectation for all nurses that is now included in Decisions About Procedures and Authority.

Why this change?
Whenever there are changes to nursing scope of practice, the College considers whether additional regulatory mechanisms are needed to ensure public safety. For example, we explore new practice expectations and develop content for practice standards, if required.

In early February, we consulted with NPs and other key stakeholders about proposed practice expectations associated with applying forms of energy. Their feedback helped refine new practice expectations necessary for supporting safe practice. 

The new standards are designed to reflect current and future practice. Council approved them at the March Council meeting.

Visit www.cno.org/np to learn more about NP practice standards and guidelines.

Guidance when reporting privacy breaches

The Information and Privacy Commissioner of Ontario has released further guidance on what information should be included in the new annual report that Health Information Custodians must make to the Commissioner. You can read the detailed requirements here.

To learn more about this new reporting requirement, read our article in November’s Quality Practice.

Most employers are considered custodians. If you are unsure if you are a custodian, check the Confidentiality and Privacy — Personal Health Information practice standard or contact the office of the Information and Privacy Commissioner of Ontario.

If you have any questions about the reporting process, contact the office of the Information and Privacy Commissioner of Ontario directly.

New info about prescribing Mifegymiso

Health Canada has increased the number of days Mifegymiso can be provided to a client. Mifegymiso can now be provided up to 63 days from the start of the last menstrual period. (Previously, it was 49 days.) The change is based on a review of evidence and scientific literature.

Women with a valid health card and prescription from a doctor or NP can now get Mifegymiso at no cost at participating pharmacies across the province. For more information, read the August issue of The Standard and What NPs should know about Mifegymiso

New entry-level competencies for NPs now in effect

As of Jan. 1, 2018, new national competencies for NPs are in effect.

The Canadian Council of Registered Nurse Regulators developed the new NP competencies. They regularly review and update entry-level competencies to reflect current practice. We shared the details of the new competencies in December 2016 to give stakeholders, such as universities, time to prepare.

The entry-level competencies for Nurse Practitioners are used across Canada and are the benchmark for the knowledge, skill and judgment an NP must demonstrate for safe, ethical and effective practice.
With the ultimate goal of protecting the public, the College uses them to:

  • approve NP education programs
  • assess the education of individuals applying to become registered as an NP
  • approve entry-level exams for NP registration
  • assess the continuing competence of NPs
  • inform the development of standards of practice for NPs.

The new competencies are reflected in the current Nurse Practitioner practice standard. They will be used to assess Ontario NP education programs when they are reviewed in 2018.

Get the numbers on nursing

The College has released our annual Membership Statistics report. It contains the most up-to-date information about our membership, plus an overview of current trends in Ontario nursing demographics and employment. You can read the report here.

We have also updated our data query tool with the 2017 renewal information. Use the data query tool to create multi-year tables based on information we collect annually.

The College is committed to sharing knowledge about nursing human resource trends in Ontario. Find out more about our statistical resources or sign up for statistics announcements at: www.cno.org/stats.

RNs can now fill out an Ontario Disability Support Program application

As of Jan. 15, 2018, RNs can now complete all parts of the Ontario Disability Support Program (ODSP) application. This includes the Disability Determination Package (DDP) and the Medical Review Package (MRP). Previously, RNs could only complete some sections of these forms.

For more information about the application process, and to access the e-Learning Modules on how to complete the forms, visit the Ministry of Community and Social Services website at www.mcss.gov.on.ca/en/mcss/programs/social/odsp/index.aspx.

For more information, visit our Ask Practice FAQS at www.cno.org/ask.