Week 9 - Ontario Regulated Health Professions legislative framework - Part 2

Question 1

when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings.

Answer 1

Interprofessional collaboration

Question 2

______ deal with less complex and more stable patients; do not anticipate negative outcomes for patients

Answer 2

RPNs

Question 3

RNs and RPNs have the ______ scope of practice

Answer 3

same

Question 4

What is the difference between RNs and RPNs in terms of initiation of controlled acts?

Answer 4

Both RNs and RPNs can initiate controlled acts

Only RNs can initiate controlled acts and order RPNs to perform it (RPNs do not have the ability to write that order)

Question 5

What are the factors considered for RN vs. RPN patient assignment?

Answer 5

Client factors - e.g. complexity, predictability, risk of negative outcomes
Nurse factors - e.g. leadership, decision-making, critical thinking, consultation
Environmental factors - e.g. practice supports, consultation resources, stability and predictability of the environment

Question 6

What are the 3 ways for nurses to get authority to perform procedures?

Answer 6

Orders, delegation, initiation

Question 7

The independent decision that a controlled act is required and then carrying out the performance of that act

Answer 7

Initiation

Question 8

Prescription or direction from a RHP with legislative authority for a procedure, treatment, drug or intervention that permits performance of a procedure by another

Answer 8

order

Question 9

Client specific and a HCP such as a doctor or NP gives the order for a specific intervention to be administered at a specific time or times

Answer 9

Direct order

Question 10

When are orders required?

Answer 10

When a procedure falls within one of the CAs authorized to nursing when the nurse doesn’t have the authority to initiate the procedure

Required under the Public Hospitals act, healing arts radiation act, or other legislation governing client services

Required by practice-setting policy or as agreed upon within the physician’s plan of care

Question 11

True or False. Orders are not only for controlled acts.

Answer 11

True - e.g. orders for ambulation

Question 12

Order for a procedure or series of procedures that may be implemented for a number of clients when specific conditions are met and specific circumstances exist

Answer 12

Medical directives

Question 13

Medical directive:

• who writes it?
• if something goes wrong, who is to blame?

Answer 13

Written by a RHP who has the legislative authority to order the procedure for which she/he has ultimate responsibility

If the nurse follows the directive perfectly, the onus is on the person who wrote the directive

Question 14

What are the major differences between orders and medical directives?

Answer 14

Medical directives are applied to a series or group of people when they meet a certain set of criteria

Orders are client-specific

Question 15

Formal process by which a RHP, who is authorized and competent to perform a procedure under one of the controlled acts, delegates the performance of that procedure to someone, regulated or not, who is not authorized by legislation to perform it

Answer 15

Delegation

Question 16

When might an RN delegate to an RPN in Ontario?

Answer 16

(Except in Hospitals due to the Public hospitals act) - RN determines that a patient needs their wound debrided and asks a competent RPN to do it

Question 17

Which of the following statements are true? Describe your reasoning.

A - Delegation requires an order
B - An order requires delegation
C - Delegation provides the legal authority to perform a controlled act
D - An order outlines how to perform a controlled act
E - orders are only used for controlled acts

Answer 17

A - False - delegation doesn’t necessarily require an order for nurses OUTSIDE the hospital

B - False - if the delegation is not a controlled act, doesn’t require an order; or, if the person has the authority to complete the act, delegation is not required

C - True - that’s the definition

D - True - that’s the definition

E - False - e.g. orders for vital signs

Question 18

Granting legal authority to perform a skill

Answer 18

delegation

Question 19

Instructions of how and when to perform a skill

Answer 19

Order

Question 20

If a doctor in a hospital wrote an order for something a nurse does not have the authority to do, what is required?

Answer 20

A delegation, and the order on top of it

Question 21

A medical directive is a type of _____, but not a ______ ______

Answer 21

order, direct order

Question 22

Within most practice environments, nurses can delegate to?

Answer 22

UCPs
family members of clients
other RHPS who do not have the legal authority to perform CA authorized to nursing

Question 23

Delegation can be provided in what form?

Answer 23

Written or orally, but there must be documentation in either case

Question 24

What can NPs delegate?

Answer 24

Cannot delegate prescribing, compounding, selling, administration of energy, setting a fracture –> only communicating a diagnosis

Question 25

What forms of energy can NPs order?

Answer 25

X-rays, not MRIs or CTs

Question 26

When is delegation necessary for a family member of UCP?

Answer 26

Procedures below the dermis or mucous membrane
- required for both family and UCP

Administering a substance by injection or inhalation

• family member - exception
• UCP - exception if part of routine ADLs

Putting an instrument, hand or finger into a body orifice or artificial opening into the body

• exception for family
• exception if part of ADLs

Procedures not included in CAs
- no authority required for both UCP and family member

Question 27

RNs and RPNs cannot delegate the controlled act of ________ a drug

Answer 27

dispensing

Question 28

The preparation, packaging, labelling, record keeping and transfer of a prescription drug to a patient or an intermediary, who is responsible for administering the drug

Answer 28

dispensing a drug

Question 29

UCPs:

- accountable to their _________, not an external _______ ____

Answer 29

employer

regulatory body

Question 30

Delegating to UCPs in Ontario
- ________ delegate CAs to UCPs
- Nurses cannot ________ that a UCP is competent to perform a procedure, regardless of how straightforward it is
Expectations of UCP when delegating?

Answer 30

can
assume
Expectations:
1 - UCP understands the extent of his or her responsibilities in performing procedure(s)
2 - knows when and who to ask for assistance
3 - knows when, how and to whom to report the outcome of the procedure

Question 31

When does a UCP have the authority to perform a CA?

Answer 31

By exception, or when an individual with the authority to order or perform the act delegates this authority to the UCP

Question 32

What are the exceptions for controlled acts?

Answer 32

Treating a member of her/his household, and the procedure falls within the second or third controlled act authorized to nursing

Assisting a person with routine ADLs and the procedure falls within the second/third CA authorized to nursing

(second = med by injection/inhalation; third = instrument in orifice or cavity)

Question 33

Describe when teaching is required/not required for UCPs or family members.

Answer 33

Procedure below the dermis or mucous membrane
- may teach if part of delegation for both UCP and family

Administering a med by injection or inhalation
- may teach family member; may teach UCP if part of client’s routine ADLs or part of delegation

Putting an instrument….

• may teach family member
• may teach to UCP if routine ADL or part of delegation

Procedures not within CA
- may teach to both

Question 34

What are the requirements for teaching family/UCPs?

Answer 34

1 - The nurse can do the procedure
2 - the nurse can teach the procedure
3 - the nurse accepts sole responsibility for teaching the procedure
4 - the nurse feels confident that the UCP can perform the procedure (i.e. supervised/saw perform)
5 - nurse may teach the procedure to a UCP to perform it on more than one client if appropriate
6 - the nurse continually evaluates the UCP’s competence to do the procedure

Question 35

Review the 7 requirements for accepting delegation in your readings

Answer 35

Do the reading dammit

Question 36

What is required for documentation of delegation?

Answer 36

Date of delegation
the delegator’s name
delegatee’s name
the conditions, if any, application to the delegation

Question 37

When would professional misconduct occur related to delegation?

Answer 37

Fails to meet SOP
Delegates a task when the nurse can’t do it
nurse fails to inform their employer that they are unable to accept responsibility for the act/complete the act
Contravenes a provision in the RHPA, NA or other regulations appended within RHPA

Question 38

Can nurses delegate the dispension of drugs?

Answer 38

No, we are not authorized to dispense drugs in the first place (sub-delegation)

Question 39

Support physicians in a range of healthcare settings and provide care under the supervision of a registered physician

Answer 39

PA

Question 40

PAs

• can do CAs delegated to them by a _______
• ___ regulated
• Nurses ____ accept delegation from PAs

Answer 40

physician
not
cannot

Question 41

The act of determining or allocating responsibility for particular aspects of care to another individual

Answer 41

Assigning

Question 42

Must assigning be for controlled acts?

Answer 42

No, for all aspects of care

Question 43

Monitoring and directing of specific activities of UCPs

Answer 43

Supervising - direct or indirect

Question 44

Although a nurse can abstain from being involved with the care of a client or a procedure for the most part, in what circumstance is this not true?

Answer 44

During an emergency - must remain until they can be relieved

Question 45

The emotional and psychological pain that occurs when ‘one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’

Answer 45

moral distress

Question 46

Happens in situations when you feel you cannot fulfill your ethical obligations and commitments

Answer 46

Moral distress

Question 47

The nurse is working in Ontario and wishes to delegate wound care for Mr. Ali to a PSW who will be assisting him daily in his home. The nurse should asses:
A - the environmental supports available in Mr. Ali’s home
B - the PSWs understanding of their responsibilities
C - the PSW competence in performing the task
D - All of the above

Answer 47

D

Question 48

A PT assistant asks the RN to explain the scope of practice of nurses in Ontario. Which of the following statements indicate the need for further learning? Select all that apply.

A - In Ontario, RPNs and RNs can both perform 4 controlled acts
B - in Ontario, RPNs care for more stable patients while RNs can care for less stable patients
C - in ontairo, only RNs use nursing judgement
D - in Ontario, RPNs must be supervised by RNs
E - in ontario, RPNs and RNs are both regulated by the CNO

Answer 48

A, C, D

Question 49

The nurse educator on a vascular unit is discussing delegation guidelines to a group of new graduates. Which statement from the group indicates the need for more teaching?

A - the UCP will be practising on my brand-new license
B - i will still retain accountability for what i delegate to the UCP
C - i must make sure the UCP to whom I delegate is competent to perform the task
D - when I delegate, I must follow up with the UCP and evaluate the task

Answer 49

A

Question 50

You are working in an Ontario hospital. Which of the following tasks would be most appropriate to assign to a UCP?

A - injection of insulin
B - testing BS levels
C - starting an IV
D - cleaning a wound
E - Helping with personal care
F - suctioning a trach

Answer 50

E

Question 51

The cardiology unit has a protocol to follow for patients after cardiac surgery. This is best descriebd as:
A - an order
B - delegation
C - directive
D - assignment

Answer 51

C

Question 52

An RN working in Ontario would like a UCP to help give medications to her patients and give her access to her med cart. Which of the following should she do before delegating this task?

A - assess her own knowledge, skill, and judgement to perform the act
B - assess the knowledge, skill and judgement of the UCP to perform the act
C - assess the given rights of delegation
D - all of the above
E - none of the above

Answer 52

E
administering meds is not a controlled act - i.e. doesn’t require delegation
Access to the med cart is not allowed
Needs to be an activity of daily living for a UCP to give meds