Week 8 - Ontario Regulated Health Professions Legislative Framework Flashcards
What are the different laws affecting nursing in Ontario?
RHPA NA Health professions procedural code Expanded nursing services for patients act Public hospitals act Long-term care homes act
The umbrella law that regulates how all regulated health professions are governed in Ontario
RHPA
What are the key features of the RHPA?
Outlines scope of practice (i.e. statement) and controlled acts authorized to regulated professions.
Sets out rules of each of the professional colleges (within health professions procedural code)
Things that could cause harm to the client if not performed by a regulated provider.
Controlled acts
What is the document that regulates the CNO?
RHPA
Sets out the practical rules of the regulatory colleges.
Health professions procedural code
Sets out, in detail, how nursing will self-regulate, according to the rules and regulations of the RHPA.
Nursing Act
Regulations of the nursing act deal with what aspects of nursing?
Registration Entry to practice requirements Title protection Controlled acts QA Professional misconduct
RETCQP
What two documents must one understand to understand the governance of nursing in Ontario?
NA + RHPA
Allows RNs who hold extended certificates of registration to provide PHC services.
Expanded nursing services for patients act
Expanded the scope of advanced practice nurses (NPs) by allowing them to perform certain controlled acts.
Expanded nursing services for patients act
What are some examples of extended practice for NPs?
Communicating a Dx to patients
Prescribing certain drugs
Ordering the application of certain forms of energy
Regulates hospital governance and operations in Ontario.
The Public Hospitals Act
Public hospitals also refer to these centers.
Mental health hospitals rehab hospitals addiction centers cancer centers etc.
Regulates governance and operation of long-term care homes
Long-term care homes act (2007)
What are some examples of legislative requirements from the long-term care homes act?
24 hour nursing care - one RN must be present at all times
Director of nursing care is not considered to be an RN on duty
What is self-regulation?
Someone within the profession is regulating the care of the profession
What is the main focus of the CNO?
Protect the public
Self-regulation allows the profession to do what?
Govern members Set standards for entry establish educational requirements deal with complaints discipline members
Above all else, what is the most important mandate of a self-regulated profession?
Protection of the public
What are the different categories of nurses in Canada?
Ontario
- RPN, RN, NP
Rest of Canada
- LPN, RN, RPN (registered psych nurse - BC, AB, SK, MB), NP
What is the main difference between RNs and RPNs?
RPNs can only care for patients that are less complex and have less of a chance of having negative outcomes
RNs take less predictable patients with a higher chance of getting complications
Match the description to the nursing organization/body.
A - Professional advocacy
B - Establishing requirements for entry to practice
C - Protects nursing jobs and makes things better for nurses
D - Provides nursing specialization certifications
A - RNAO/CNA
B - CNO
C - ONA
D - CNA
Match the description to the nursing organization/body.
A - Helps sit on workplace safety and insurance claims
B - Political advocacy
C - Engaging members in research
D - Enforces standards of practice and conduct
A - ONA
B - RNAO
C - CNA
D - CNO
Match the description to the nursing organization/body.
A - Helps nurses if they end up being called to the CNO for disciplinary hearings, or with criminal charges
B - Provision of professional malpractice insurance
C - National professional association
D - Administers its quality assurance program for Ontario nurses
A - ONA
B - RNAO
C - CNA
D - CNO
Match the description to the nursing organization/body.
A - Articulating and promoting practice standards
B - Lobby governments in nurses’ professional interests
C - Offers insurance plans
D - Membership included with annual registration for most of Canada except Ontario and Quebec
A - CNO
B - RNAO
C - ONA
D - CNA
Application and acceptance as a member of the college/association
Registration
Granting of license to practice
Licensing
Publicly recognized as a member of the profession.
Registration
What are the different licensing classes for nurses in Ontario?
General Temporary Extended Special Emergency
True or False?
You need a license to be registered with the CNO.
False - there is a non-practicing class
Which laws regulated nursing practice in Ontario?
RHPA and NA
For situations such as when a hospital wants a nurse with a particular set of skills, but cannot find one within the province and needs to bring someone from outside Ontario/Canada.
Special assignment class
What are the conditions/requirements for the special assignment class?
Registration of one year (license of one year)
The nurse must meet all the same requirements as a nurse working in Ontario (e.g. NCLEX, jurisprudence)
The nurse cannot practice nursing in any other area (e.g. if in cardiac, cannot work in PH)
For situations in which there is an epidemic or huge disaster and more nurses are needed to deal with the situation. Nurses brought in are often from outside of Ontario/Canada.
Emergency assignment class
What is the major difference between the emergency assignment class and special assignment class?
In Emergency assignment class, nurses do not have to meet the requirements to be registered in Ontario
They must still pay the fees to get the license, must have passed an RN/RPN program, have practiced within the last 3 years as a nurse, and are able to speak English/French
The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function
Scope of practice statement, NA
What is the process for applying to the temporary class?
Apply to the general class Apply to the temporary class Complete the jurisprudence exam Prospective employer confirms that you have an offer of employment Valid for 6 months
What is necessary to be able to apply to the temporary class?
Need an offer of employment from the hospital, healthcare organization, or health unit
What happens to your temporary license if you fail the NCLEX?
You lose your temporary license
What are the pros of temporary licenses?
income
continue/start working
clinical experience can help consolidate knowledge while studying for the NCLEX
Must be supervised by others
What are the cons of temporary liecenses?
May have less time to study
Only valid for 6 months
Cannot initiate controlled acts
Cannot delegate or accept delegation of a controlled act by another RN
Cannot supervise others or be “in charge”
What are the required steps to be able to apply to the general class (RN)?
Complete the nursing education requirement - BScN
Pass the NCLEX
Pass the jurisprudence exam
Demonstrate language proficiency in English or French
Provide proof of citizenship, permanent residency or authorization under the immigration and refugee protection act
complete a declaration of registration requirements
Program used to assure the public that nurses demonstrate their commitment to continuing competence and continuing quality improvement
Quality assurance program
Will conduct audits of members at random to ensure their commitment to continued learning.
QA program
QA program
- send in ______ goals
- Shows our commitment to nursing
- Engage in _______ practice and produce a set of learning goals that you accomplish every _____
- ________ for registration
- Must present to re-register each _____
smart reflective year required year
(CNO) Disc-pline
- Distinct from ________ charges
- _______ to nursing regulatory body - (i.e. ______ from the courts)
- Could involve violation of these
criminal
internal (exclusive)
code of ethics, professional (mis)conduct
The CNO complaints and discipline committee is used to address serious cases of _______ and ________
misconduct and incompetence
What are two things that can occur for discipline by the CNO?
1 - Resolution process
2 - Disciplinary hearing or proceeding
Nurse and person who formed the complaint sit down at the college and try to resolve the issue between them without having to go through a hearing
Resolution process
At which point does the resolution process progress to the discplinary hearing?
If a resolution cannot be found or;
serious cases of incompetence or misconduct
Describe the need to report colleagues.
Legal obligation to report improper professional conduct and/or failure to meet SOPs
______ to report is professional misconduct.
failure
What does the college recommend prior to reporting a colleague? What exception exists?
College recommends approaching the person first and the employer if needed; try to resolve the issue prior to contacting the college
Exception - SUSPECTED (or confirmed) case of sexual abuse of a client must be reported IMMEDIATELY
What does “sexual abuse” of a client by a member mean?
Sexual intercourse or other forms of sexual relations between nurse and patient
Touching, of a sexual nature, of the client
Behaviour or remarks of a sexual nature by nurse towards the client
Fitness to pratice:
- includes _______ _______, but often deals with ________
professional misconduct
incapacity
Fitness to practice (eval):
- may require ______/______ examinations
- may result in _____ to decide if a nurse is fit to practice
- Nurses are entitled to a _____
physical/psychological
hearing
lawyer
An act that could cause harm if performed by someone who does not have the knowledge, skill and judgement to perform it
Controlled acts
In ontario, controlled acts are regulated by what document?
RHPA
How may controlled acts are there under the RHPA?
How many can nurses do?
NPs?
14
nurses - 5
NPs - 8
Document points out which controlled acts are allocated to nurses.
NA
Which controlled acts can nurses perform?
1 - Performing a procedure on tissue below the dermis, below the surface of a mucous membrane
2 - Administering a substance by injection or inhalation
3 - Putting an instrument, hand or finger:
- (beyond external ear canal/nasal passage where they normally narrow/larynx/urethra opening/labia majora/anal verge; artificial body opening
4 - Dispensing a drug
5 - Treating, by means of psychotherapy, an individual’s serious disorder of thought, cognition, modd.
Preparing and packaging drugs for patients to take them at a later time
Dispensing a drug
Controlled act most relevant to someone working in a mental health role
Psychotherapy controlled act
What additional controlled acts can NPs perform?
1 - Communicate a Dx
2 - apply or order the application of a prescribed form of energy
3 - Set or cast a fracture of a bone or dislocation of a joint
4 - prescribe, dispense, sell or compound a drug in accordance with the regulation
What is needed for RNs to discuss a diagnosis?
A medical directive
Meds are made in the lab - i.e. need to be formulated on the spot
Compounding
What are the exceptions for others to perform controlled acts?
Lay people can perform CAs if they are required for ADLs and they are trained and competent to perform them properly
First aid or emergency situations
Nursing students learning from other nurses
When treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment
What are some additional exceptions for controlled acts?
Body piercing, tattooing, electrolysis, male circumcision as part of religious ceremony, lab personnel taking blood at a licensed lab
What are the broad criteria for initiating a controlled act?
Competence Client factors Environmental factors Documentation requirements A nurse's accountabilities
Describe the criteria of competence for initiating a controlled act.
Must have the competence to correctly do the skill
Must be able to determine whether or not the client’s condition warrants performing the CA
Describe the criteria of client factors for initiating a controlled act.
Nurse must have a NC relationship with patient
Determine if the condition warrants the procedure by:
- knowing the risk and benefits
- predictability of outcomes
- other relevant factors
Describe the criteria of environmental factors for initiating a controlled act.
Must have the appropriate resources to perform the CA safely and manage expected outcomes
Describe the criteria of documentation requirements for initiating a controlled act.
Must document the initiation and outcome in the client’s chart
Describe the criteria of a nurse’s accountabilities
for initiating a controlled act.
The nurse accepts sole accountability for the decision to initiate and ensure potential outcomes are managed
Can an RN in Ontario:
A - Care for a wound below the dermis or the mucous membrane by cleansing, soaking, irrigating, probing, debriding, packing or dressing?
B - perform acupuncture (if trained and competent)?
C - initiation of an activity that requires the use of a prescribed drug?
A - yes
B - yes
C - no
What are the 7 categories of standards of practice in Ontario for nursing?
Accountability Continuing competence Ethics Knowledge Knowledge application Leadership Relationships (NC and professional)
The standards of practice for Ontario nurses communicate what to the public?
Tells the public what to expect from us
True or False?
The SOPs apply to only nurses in clinical practice.
False - also applies to education, research and administration
