Week 8 Scope of Practice, Competency and Legislation

Question 1

The conceptual framework organizes the
competencies into the four main categories of the
nursing process:

Answer 1

assessment
■ planning
■ implementation
■ evaluation.

Question 2

The regulatory impact is identified by the arrows
directed toward the nursing process and is divided
into six categories

Answer 2

■ professional responsibility and accountability
■ ethical practice
■ service to the public
■ self-regulation
■ knowledge
■ knowledge application.

Question 3

Professional Responsibility and

Accountability

Answer 3

Demonstrates professional conduct; practises in
accordance with legislation and the standards
as determined by the regulatory body and
the practice setting; and demonstrates that
the primary duty is to the client to ensure
consistently safe, competent and ethical care

Question 4

The scope of practice model is set out in the
Regulated Health Professions Act, 1991 (RHPA)
and consists of two elements

Answer 4

a scope of practice
statement and a series of authorized or controlled
acts.

Question 5

An authorizing mechanism—

Answer 5

an order, initiation,
directive or delegation—is a means specified in
legislation, or described in a practice standard
or guideline, through which nurses obtain the
authority to perform a procedure or make the
decision to perform a procedure.

Question 6

Profession:

Answer 6

Specialized knowledge base
Regulation/legislation
Continuing competence

Question 7

What are the guiding principles for the nursing profession?

Answer 7

1. In Ontario, nursing is one profession with two categories: RN AND RPN
2. The foundational knowledge base of RNs and RPNs is different.
3. This principle builds on the foundational knowledge base through formal and informal education, experience and reflective practice.
4. RNs and RPNs are accountable for their own decisions and actions. They are not accountable for what someone else does, or for what they are not informed about.
5. The client is the central focus of the professional service nurses provide and is a full partner in the decision-making process.
6. The overall goal is to obtain the best possible outcome for the client with no unnecessary exposure to risk of harm.

Question 8

Professional Standards

Answer 8

Accountability
Continuing Competency
Ethics
Knowledge
Knowledge Application
Leadership 
Relationship

Question 9

RHPA: What’s New as of June 4, 2009?

Answer 9

Increased openness, accountability, public safety and confidence are the key points of the amendments to the legislation that governs nursing practice in Ontario.

Suspension of registration for non-payment of annual fees decreased to 30 days. Non-payment is part of the permanent online register

Members self-report any court findings of professional negligence or malpractice, and any findings of guilt for offences (this is added to the register as well)

Organizations must report if they believe that a health professional is incompetent or incapacitated

Question 10

WHAtd new 2009

New Inquiries, Complaints and Reports (ICR) Committee

Answer 10

ICR will be required to consider all prior decisions regarding a member, except if no action because complaint was incomplete or invalid

ICR Committee may order regulated health professional to complete specified continuing education or remedial program.

Question 11

The Quality Assurance (QA) Program is based

Answer 11

on the principle that lifelong learning is essential to continuing competence. The program measures a member’s knowledge and application of the College’s practice standards and guidelines.

Question 12

The QA Program includes three components:

Answer 12

Self-Assessment; Practice Assessment; and Peer Assessment

Question 13

The Nursing Act 1991

Answer 13

Contains a scope of practice statement that describes in a general way what the profession does and the methods that it uses

Contains provisions and regulations specific to the nursing profession:

1. Definitions of the classes of nurse registration
2. Entry-to-practice and title protection regulations
3. Regulations on initiating controlled acts
4. Defines Professional misconduct

Question 14

College of Nurses

Answer 14

Regulates nursing to protect the public interest
Sets requirements to enter the profession
Establishes and enforces standards of nursing practice
Assures the quality of practice of the profession and the continuing competence of nurses
Ensures individual members are responsible for following the standards of practice, remaining current and maintaining competency

Question 15

Professional Misconduct relevant to a nurse’s decision to accept delegation and perform procedures

Answer 15

1. Disobey a standard of practice of the
   profession or failing to meet the standard
   of practice of the profession (break the rules)
2. Directing a member, student or other
   health care team member to perform
   nursing functions for which she/he is
   not adequately trained or competent to
   perform
3. Failing to inform the member’s employer
   of her/his inability to accept specific
   responsibility in areas in which specific
   training is required or for which the
   member is not competent to function
   without supervision

Question 16

The RHPA established 13 controlled acts

Answer 16

Controlled acts are considered potentially harmful if performed by unqualified persons
The Nursing Act authorizes nurses to perform 3 of the controlled acts

Question 17

An RN or RPN is authorized to perform a
procedure within the controlled acts authorized
to nursing:

Answer 17

■ if initiated in accordance with conditions identified in the regulation; or
■ if the procedure is ordered by a physician, dentist, chiropodist or NP

Question 18

Controlled Acts

Answer 18

Controlled acts are not the only procedures
that may cause harm
Having the authority to perform a procedure
does not automatically mean it is appropriate
to do so
Each nurse is accountable for her/his decisions
and actions.

Question 19

The Regulated Health Professions Act, 1991, provides several exceptions allowing unauthorized members of regulated profession to perform controlled acts

Answer 19

1. When providing first aid or temporary assistance in an emergency
2. Under the supervision or direction of a member of the profession, a student is learning to become a member of that profession and
   the performance of the procedure is within the scope of the professional’s practice;
3. treating a member of a person’s household and the procedure is within the second or third controlled act authorized to nursing;
4. When assisting a person with his/her routine activities of living and the procedure is within the second or third controlled act
   authorized to nursing;
5. When treating a person by prayer or spiritual
   means in accordance with the religion of the
   person giving the treatment.
6. Others: ear-piercing or body piercing for the purpose of accommodating a piece of jewellery, electrolysis and tattooing, male circumcision as part of a religious tradition or ceremony, and taking a blood sample by a person employed by a laboratory licensed under the Laboratory and Specimen Collection Centre Licensing Act.

Question 20

General Class

Answer 20

Received by most RNs and RPNs upon initial registration with the College.

Question 21

Temporary Class

Answer 21

For recent graduates or applicants from outside the province who meet all entry requirements except for having passed the registration exam. Some restrictions and conditions apply to those in the Temporary Class.

Question 22

Special Assignment Class

Answer 22

For experienced nurses who come to Ontario for a limited period on exchange or for a special assignment. This class can also be used for nurses who come from outside Ontario to assist during large-scale emergencies.

Question 23

Extended Class

Answer 23

RNs in this class are Nurse Practitioners (NPs) and have met additional competency requirements beyond those required in the General Class. There are four specialty certificates in the Extended Class: NP-Primary Health Care, NP-Adult, NP-Paediatrics and NP-Anaesthesia.

Question 24

Retired Class

Answer 24

This class is available to current and previous members of the College who are age 65 or older and have retired from active nursing.

Question 25

In Ontario,

Answer 25

only members of the College can use the titles of nurse, Registered Nurse, Registered Practical Nurse, or any variation, abbreviation or equivalent in another language.

Individuals who refer to themselves as nurses or attempt to obtain employment as nurses in Ontario without being registered with the College are illegal practitioners

Question 26

Entry to practice

Answer 26

1. Completion of an approved nursing or practical nursing program
2. Evidence of recent safe nursing practice
3. Passing the national registration examination
4. Evidence of fluency in written and spoken English or French
5. Registration or eligibility for registration in the jurisdiction where nurses completed their nursing program
6. Proof of Canadian citizenship, landed immigrant status, or authorization under the Immigration and Refugee Protection Act (Canada) to engage in nursing practice
7. Good character and suitability to practice.

Question 27

Client Factor Three components:

Answer 27

complexity
predictability
risk of negative outcomes

Question 28

Nurse Factors

Answer 28

One profession 
Accountability 
Foundational knowledge 
Enhanced knowledge 
Autonomous practice 
Consultation 
Collaboration

Question 29

Environment Factor Three components:

Answer 29

practice supports
consultation resources
stability and predictability

Question 30

Benner’s model

Answer 30

Stage 1: Novice
will usually ask to be shown or told what to do.

Stage 2: Advanced Beginner
cannot reliably sort out what is most important in complex situations and will need help to prioritize.

Stage 3: Competent
lacks the speed and flexibility but competence is characterized by a feeling of mastery and the ability to cope with and manage contingencies of practice.

Stage 4: Proficient
considers fewer options and hones in on the accurate region of the problem.

Stage 5: Expert
has an intuitive grasp of the situation and focuses in on the accurate region of the problem without wasteful consideration of a larger range of unfruitful possibilities.

Question 31

The entry-level RPN is accountable for:

Answer 31

■ All client care she or he provides.
■ All decisions about assigning care to other care providers.
■ Knowing and recognizing her or his competence level (knowledge, skill and judgment) when making decisions and providing care to clients.
■ Knowing and meeting the College’s standards of practice and entry-to-practice competencies.
■ Understanding the scope of practice/controlled acts model
■ Understanding the roles and responsibilities as documented in the practice setting in which she or he is employed.
■ Actively identifying and asking questions of self, colleagues (including members of the interprofessional health care team) and clients.
■ Applying a consistent framework to practise decision-making.
■ The application of theory to practice via the use of critical thinking and problem-solving skills

■ Providing safe, competent and ethical nursing care

Question 32

The Three-Factor Framework

Answer 32

the nurse
the client
the enviroment

Question 33

Authorizing mechanism.

Answer 33

An authorizing
mechanism is a means by which the authority to
perform a procedure is obtained or the decision
is made to perform a procedure. The appropriate
authorizing mechanism depends on the nurse’s
category or class, role and practice setting.
Examples of authorizing mechanisms include
orders, initiation, directives and delegation.

Question 34

Delegation.

Answer 34

Delegation is a formal process
that transfers authority to perform a controlled
act. A regulated health professional who has
the legislative authority and the competence to
perform a procedure within one of the controlled
acts can delegate it to others. This process
includes educating, determining competence
and establishing a process for assessing ongoing
competence. A written record of the process must
be kept by the nurse or the employer.

Question 35

Directive.

Answer 35

A directive is an order for a procedure,
treatment, drug or intervention that may be
implemented for a number of clients when specific
conditions are met and specific circumstances exist.
Most often a directive is a physician’s order, and it
is always written.