Week 9 - Ontario Regulated Health Professions legislative framework - Part 2 Flashcards
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.
Interprofessional collaboration
______ deal with less complex and more stable patients; do not anticipate negative outcomes for patients
RPNs
RNs and RPNs have the ______ scope of practice
same
What is the difference between RNs and RPNs in terms of initiation of controlled acts?
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)
What are the factors considered for RN vs. RPN patient assignment?
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
What are the 3 ways for nurses to get authority to perform procedures?
Orders, delegation, initiation
The independent decision that a controlled act is required and then carrying out the performance of that act
Initiation
Prescription or direction from a RHP with legislative authority for a procedure, treatment, drug or intervention that permits performance of a procedure by another
order
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
Direct order
When are orders required?
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
True or False. Orders are not only for controlled acts.
True - e.g. orders for ambulation
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
Medical directives
Medical directive:
- who writes it?
- if something goes wrong, who is to blame?
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
What are the major differences between orders and medical directives?
Medical directives are applied to a series or group of people when they meet a certain set of criteria
Orders are client-specific
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
Delegation
When might an RN delegate to an RPN in Ontario?
(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
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
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
Granting legal authority to perform a skill
delegation
Instructions of how and when to perform a skill
Order
If a doctor in a hospital wrote an order for something a nurse does not have the authority to do, what is required?
A delegation, and the order on top of it
A medical directive is a type of _____, but not a ______ ______
order, direct order
Within most practice environments, nurses can delegate to?
UCPs
family members of clients
other RHPS who do not have the legal authority to perform CA authorized to nursing
Delegation can be provided in what form?
Written or orally, but there must be documentation in either case
What can NPs delegate?
Cannot delegate prescribing, compounding, selling, administration of energy, setting a fracture –> only communicating a diagnosis
What forms of energy can NPs order?
X-rays, not MRIs or CTs
When is delegation necessary for a family member of UCP?
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
RNs and RPNs cannot delegate the controlled act of ________ a drug
dispensing
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
dispensing a drug
UCPs:
- accountable to their _________, not an external _______ ____
employer
regulatory body
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?
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
When does a UCP have the authority to perform a CA?
By exception, or when an individual with the authority to order or perform the act delegates this authority to the UCP
What are the exceptions for controlled acts?
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)
Describe when teaching is required/not required for UCPs or family members.
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
What are the requirements for teaching family/UCPs?
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
Review the 7 requirements for accepting delegation in your readings
Do the reading dammit
What is required for documentation of delegation?
Date of delegation
the delegator’s name
delegatee’s name
the conditions, if any, application to the delegation
When would professional misconduct occur related to delegation?
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
Can nurses delegate the dispension of drugs?
No, we are not authorized to dispense drugs in the first place (sub-delegation)
Support physicians in a range of healthcare settings and provide care under the supervision of a registered physician
PA
PAs
- can do CAs delegated to them by a _______
- ___ regulated
- Nurses ____ accept delegation from PAs
physician
not
cannot
The act of determining or allocating responsibility for particular aspects of care to another individual
Assigning
Must assigning be for controlled acts?
No, for all aspects of care
Monitoring and directing of specific activities of UCPs
Supervising - direct or indirect
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?
During an emergency - must remain until they can be relieved
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’
moral distress
Happens in situations when you feel you cannot fulfill your ethical obligations and commitments
Moral distress
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
D
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
A, C, D
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
A
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
E
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
C
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
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
