Nursing Legislation and Standards (NURS 72050)

Scopes and Standards (NURS 72050)

• Course agenda items include Nursing Legislation, Regulatory Bodies, Enforcement/Complaints, Discipline, Interprofessional Practice, and Group Assignment.
• Canadian nursing legislation is specific to each province/territory.
• Nursing Regulatory Bodies have a duty to protect public interest.
• Oversight includes categories of nurses, education, and entry into the profession, scope of practice, standards of practice, complaint and reporting processes, and disciplinary processes.
• Legislation and regulation govern the use of the title "nurse".
• Students are asked to choose at least 4 provinces/territories and examine the nursing practice legislation and registration requirements for each.

Legislative Process

• Nursing is self-regulating.
• Nursing Regulatory Bodies are responsible for overseeing practice, education, and standards of behaviour.
• Legislation defines scope of practice and nursing categories.
• Legislation holds regulatory bodies accountable for standards and practice.
• Legal processes include complaint and reporting, and disciplinary processes.

Typical Organizational Structure

• Regulatory bodies have a board of directors/council, CEO/executive director/registrar.
• These bodies oversee professional conduct (complaints, fitness to practice, discipline, and hearings).
• Professional practice and quality, entry to registration and practice, practice and education, and quality assurance are also managed.

Using the Nursing Title

• Provinces/territories restrict the use of nursing titles and practice.
• Nurses in good standing, or retired, suspended or revoked certificate holders can use the title.
• Continuing practice while under suspension is considered professional misconduct.
• RN is the common title.

Scope of Practice

• A framework outlines nursing practice.
• Clear distinction between nursing and other health professions.
• Aids in interpreting professional responsibilities.
• Establishes standards for misconduct findings.
• Defines controlled acts.

Controlled Acts

• Specific medical actions and procedures are defined by law in most provinces/territories.
• Individuals and those who may delegate them.
• Exemptions allow non-regulated individuals to assist people with routine activities or spiritual means.

Delegating Controlled Acts

• Controlled Acts require specialized training, skills, and judgment.
• Ontario's controlled acts include medications, invasive procedures, and specific health assessments.
• Delegation is transferring task responsibility from one professional to another.
• CNO Standards set regulations for delegating controlled acts.
• This helps maintain patient safety and public trust.

Essential Requirements for Delegating Acts

• Competence: The delegate must have the necessary skills, knowledge, and judgment.
• Supervision: Proper supervision and guidance are required to understand risks and responsibilities.
• Communication: Clear instructions, dosage, route, and potential side effects must be communicated.
• Documentation: Delegation must be documented in patient charts with date, time, controlled act, and delegate's name.

Critical Thinking (Case Study)

• A registered nurse (RN) is assigned to a patient requiring multiple medications (including controlled substances) via central line.
• High patient to nurse ratio causing overwhelm.
• RN chooses to delegate to a practical nurse (RPN).
• Students must analyse if delegation requirements were met.

Mandate of Regulatory Bodies

• Regulatory bodies oversee the entry of candidates into nursing.
• They ensure candidates possess necessary knowledge and competencies for safe and effective care.
• Regulatory bodies approve education programs and set practice standards.
• They conduct background checks.

Practice Support

• Groups review links related to CNO's approach to supporting changes in nursing practice.
• This includes prescribing and new practice standards for discontinuing/declining care.
• Resources from CNA are available.
• Students are prepared to share their learnings.

Practice Standards

• Established by Canadian regulatory bodies.
• Reflect nursing philosophy and ethical codes.
• Relevant to malpractice and negligence.
• Criteria for judging a nurse's conduct in legal or disciplinary proceedings is outlined. Evidence of care is required.

Continued Competence

• Nursing regulatory bodies ensure ongoing nurse competence.
• Examples include reflective practice, peer reviews, quality assurance programs, minimum practice hours, and personal practice reviews.

Enforcement

• Disciplinary proceedings are not criminal proceedings.
• Nursing regulatory bodies govern disciplinary actions.
• Ensures nurses' conduct adheres to ethical codes/regulations.

Enforcement: Addressing Complaints

• Complaints procedures: submission of complaint, interim investigation, full investigation, and disciplinary committee hearings.

Complaints

• Complaints, in written form and signed/dated, must name the professional, outline misconduct facts.
• Complaints may be filed by several parties.

Managing Complaints

• Students examine CNO process for complaints.

Investigations

• Members notified immediately of investigation.
• Must submit documents/information.
• Legal duty to cooperate with investigation.
• Immediate lawyer consultation recommended.
• Investigations may lead to committees/hearings.
• Patient safety/security allegations may lead to immediate suspension.

Disciplinary Committee

• After investigation, the committee can find the nurse innocent of wrongdoing, potentially incapacitated, incompetent/lacking skill, guilty of misconduct, or impaired by drugs.

Penalties and Appeals

• Penalties: reprimand, conditions on practice, suspension, licence revocation.
• Appeals: possible depending on province. This could involve a provincial court.
• Penalties/appeals are usually decided by relevant boards/committees.

Discipline

• Students review CNO Summarized Decisions to understand the code of conduct and professional practice standards

Class Tribunal

• Groups 1,3,5,7 lead in disciplinary decision-making.
• Tribunal examines standards/code of conduct violation.

Case Study 1

• RN (Sarah) gives medication to patient (John) with known allergy.
• Patient experiences anaphylaxis.
• Students analyze if delegation requirements were met.

Case Study 2

• RN (Sarah) discloses personal issues to a patient (John who is convalescing from a stroke).
• Patient reciprocates with offers of friendship/support.
• Students evaluate how this interaction might impact professional practice standards.

Interprofessional Practice

• Nurses understand their roles within interprofessional teams and client-centered care.
• Collaboration is teamwork by healthcare providers.
• Partnership, participation, coordination, and shared decision-making are part of Interprofessional collaborative practice.

Interprofessional Communication

• Four key aspects include affinity (valuing contributions), immediacy (attention to message), respect (competent member value), and control (limiting persuasive power).

Interprofessional Collaboration

• Role clarification (generic, focal, functional roles), team functioning (norms, interdependencies, shared responsibilities, and goals), and collaborative leadership (teamwork including clients and family; shared judgment) are essential components.

Interprofessional team Case Analysis

• Review case health history.
• Identify appropriate healthcare providers for involvement.
• Assess each professional's priority.
• Identify opportunities for interprofessional collaboration.

Group Assignment

• Students select real-world cases with ethical dilemmas.
• Cases can be from experience or a reputable source.
• Ensure case approval with faculty.

Plan for Next Week

• The next week focuses on ethical considerations and the group assignments.

This quiz explores the key elements of nursing legislation and regulatory standards across Canadian provinces and territories. Students will examine the enforcement, complaint processes, and the role of nursing regulatory bodies in protecting public interest. Engage with the specifics of scope of practice, professional categories, and entry requirements in nursing.