Week 11 Nursing as a Regulated Profession PDF

NUSC 1P12: WEEK 11 NURSING AS A REGULATED PROFESSION WHAT IS PROFESSIONAL REGULATION Regulation o Establishes and enforces the rules to govern professional practice and conduct Regulated Health Professions Act (RHPA, 1991) o Is a single generic act which applies to all of the health professions (2...

NUSC 1P12: WEEK 11 NURSING AS A REGULATED PROFESSION WHAT IS PROFESSIONAL REGULATION Regulation o Establishes and enforces the rules to govern professional practice and conduct Regulated Health Professions Act (RHPA, 1991) o Is a single generic act which applies to all of the health professions (26 of them!) in Ontario o Outlines scope of practice and controlled acts o Regulates professions in the public interest (safeguard) to ensure accountability for practice Nursing Act (1991) – See Brightspace Week 6 o Delegates power and control of regulation to CNO for nursing; scope of practice; CNO mandate is to protect the public SELF-REGULATION o Some professions are granted the right to regulate their own members (rather than the government) – we call this a selfregulated profession (nursing=self) o This is granted when a profession shows they can put the interests of the public ahead of their own professional interest o When self-regulated, each profession has a regulatory body (for nurses it is the College of Nurses of Ontario or CNO) o CNO determines eligibility to practice, scope of practice, standards of practice, and follows-up on issues and concerns REGULATORY BODY (CNO) Oversees members’ practice (quality control and authority; investigations as needed for misconduct/incompetence/incapacity) Controls and monitors activities of all its professionals (licensing, annual renewal, where you work and what you do) Ensures that members: o Are properly educated (entry to practice competencies) o Meet entry standards o Maintain continued competence o Have required knowledge/skill/judgement to practice (remember requisite skills and abilities from last week?) o Are credentialed as professionals; licensed as RN o Are registered with the regulatory body *For regulatory bodies, the priority is always public interest before individual or professional interest* COLLEGE OF NURSES OF ONTARIO “The College of Nurses of Ontario is the governing body for Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) in Ontario The College fulfils its role by: o Establishing requirements for entry to practice o Articulating and promoting practice standards o Administering its Quality Assurance Program o Enforcing standards of practice and conduct The College also supports the regulation of nursing in the public interest by: o Participating in the legislative process o Sharing statistical information about Ontario’s nurses The College works in partnership with employers, educators and government so that everyone in Ontario benefits from quality nursing services” (CNO, 2020) https://www.cno.org/en/what-is-cno/ CNO VS. CNA VS. RNAO o o CNO – Regulatory Body o governing body, protects public, controls activities, issues and renews RN license, etc.) CNA – Canadian Nurses Association o o national and global voice for the nursing profession in Canada; advocacy at the national level, Code of Ethics) RNAO – Registered Nurses Association of Ontario o professional association, assists in political action at the provincial level, creates best practice guidelines, learning/career advancement, legal assistance program, special interest groups, and more) STANDARDS & LEARNING Purpose of CNO is to protect the public by promoting safe nursing practice. The CNO has practice standards and guidelines that apply to all nurses in Ontario regardless of their role, job, or area of practice. Practice Standards: expectations for nurses that contribute to public protection; inform nurses of their accountabilities and the public of what to expect of nurses Practice Guidelines: address specific practice-related issues, help nurses understand responsibilities and how to make safe and ethical decisions in their practice Which “Practice Standards and Guidelines” have we talked about in this course? https://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/ COMPETENCIES (refer to course outline Appendix B) BECOMING A NURSE https://www.cno.org/en/become-a-nurse/ Only members of the CNO are allowed to refer to themselves as nurses in Ontario o All members must be registered (e.g. RN, RPN, NP) o This program is designed to prepare you to meet the ETP competencies (see last slide and your course outlines). o You are responsible for the requisite skills and abilities - what goals did you identify last week? o You will then apply for registration with a regulatory body (e.g. CNO) and write the NCLEX licensing exam. You may choose to work on a temporary license in between: “Registered Nurse (Temporary)”. THE NURSING ACT The Nursing Act, 1991, along with the Regulated Health Professions Act, 1991 (RHPA), determine how the nursing profession is regulated in Ontario. The Nursing Act establishes the mandate of the College of Nurses of Ontario and defines the scope of practice for the nursing profession. The Nursing Act regulates: o Registration (E.g. classes of registration, entry-to-practice requirements, title protection), o Scope of practice for nursing o Controlled acts (procedures that can only be performed by an authorized healthcare professional), o Quality assurance (maintaining competence and ongoing self-assessment) o Professional misconduct (breach of ethical/professional standards of conduct) https://www.cno.org/globalassets/docs/prac/41064_fsnursingact.pdf NURSING ACT CONTINUED Nursing Scope of Practice Statement Registration Categories and Classes o Registered Nurses o Registered Practical Nurses o General Class o Extended Class (NP) o Temporary Class Act provides title protection (anyone referring to themselves as nurses or attempting to work as nurses without being registered are illegal practitioners and can be prosecuted for breaking the law) NURSING ACT CONTINUED REQUIREMENTS FOR ENTRY TO PRACTICE ü successfully meet the nursing education requirement ü provide evidence of nursing practice ü successfully complete the national registration examination (NCLEX) ü successfully complete the jurisprudence examination ü demonstrate proficiency in either English or French ü provide proof of citizenship, permanent residency or authorization under the Immigration and Refugee Protection Act (Canada) to engage in the practice of nursing in Ontario ü complete a Declaration of Registration Requirements form NURSING ACT CONTINUED CONTROLLED ACTS Different professions are legally able to perform certain restricted activities and in Ontario the RHPA lists these as “14 Controlled Acts”. The Nursing Act authorizes nurses to perform 5 of the “controlled acts”: 1. performing a prescribed procedure below the dermis or mucous membrane; 2. administering a substance by injection or inhalation; 3. putting an instrument, hand or finger: i. beyond the external ear canal ii. beyond the point in the nasal passages where they normally narrow iii. beyond the larynx iv. beyond the opening of the urethra v. beyond the labia majora vi. beyond the anal verge or vii. into an artificial opening 4. dispensing a drug 5. treating by means of psychotherapy technique CNO PROFESSIONAL STANDARDS Nursing standards are expectations that contribute to public protection. They inform nurses of their accountabilities and the public of what to expect of nurses. Standards apply to all nurses regardless of their role, job description or area of practice (CNO) CNO PROFESSIONAL STANDARDS CONTINUED Framework for the practice of nursing and a link with other standards, guidelines and competencies developed by the College of Nurses of Ontario (CNO). It describes in broad terms the professional expectations of nurses and applies to all nurses, in every area of practice. These are specific to: o Nurses o Nurse administrators o o Nurse educators Nurse researchers https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf CNO PROFESSIONAL STANDARDS CONTINUED Guiding Principles o in Ontario, nursing is one profession with two categories — RN (which includes NPs) and RPN; o the foundational knowledge base of RNs and RPNs is different because of differences in basic nursing education; o all nurses are accountable for their own decisions and actions and for maintaining competence throughout their career; o clients are the central focus of the professional services that nurses provide and as partners in the decision-making process, clients ultimately make their own decisions; o the goal of professional practice is to obtain the best possible outcome for clients, with no unnecessary exposure to risk of harm; and o all nurses continually enhance their knowledge through education, experience and selfassessment. Nurses can become experts in an area of practice within their category. CNO PROFESSIONAL STANDARDS Accountability to the public, for their practice, for meeting the standards, for their actions and conduct Continuing Competence QA program, knowledge/skill/judgment etc., quality nursing practice Ethics understands and upholds the values and beliefs of CNO’s Practice Standard: ‘Ethics’ (ct well-being, ct choice, privacy and confidentiality, respect for life, maintaining commitments, truthfulness, fairness) + integrity, honesty, professionalism Knowledge basic/ foundational education of an RN + ongoing learning Knowledge Application application of knowledge to practice in all that we do (cannot separate what we do from what we know) Leadership all nurses, requires self knowledge, respect, trust, integrity, shared vision, learning, participation, good communication, and ability to facilitate change Relationships establish and maintain respectful, collaborative, therapeutic, and professional relationships; therapeutic nurse-client relationship; professional relationships based on trust + respect CNA – SELF REGULATION (CNA, 2015, p.8) WHAT ARE YOU CURIOUS ABOUT? Consider what you have learned this week about regulation, scope of practice, and professional standards in nursing. What questions or curiosities do you have? Let’s make a list… NUSC 1P12: WEEK 11 PART 2: CNO (2012) REQUISITE SKILLS & ABILITIES FOR NURSING PRACTICE IN ONTARIO CNO (2012) Fact Sheet: Requisite Skills and Abilities for Nursing Practice in Ontario REQUISITE SKILLS & ABILITIES (CNO, 2012) o o o o The purpose of this document, and our discussion of it, is to understand as nursing students the general demands and performance expectations of nurses in Ontario. These entry to practice capabilities may be used to gauge personal fit with the requirements for nursing practice as a career choice. Meeting the entry-to-practice competencies set out by the CNO requires certain skills and abilities. These are organized into 7 categories identified by CNO as capturing the components necessary for practice. Each skill, ability, and it’s corresponding examples provide a “snapshot of the nature and kinds of activities expected of a student once they become an RN… and enter into typical entry-level nursing practice” (CNO, 2012, p. 2). REQUISITE SKILLS & ABILITIES (CNO, 2012) These 7 categories represent reasonable and justifiable skill and ability requirements for entry-level nursing practice in Ontario: Cognitive demonstrate thinking capacity: memory, problem-solving, concentration, reasoning, critical thinking, math Communication express and receive written, verbal or non-verbal language and interact with others Interpersonal create good relationships, develop rapport, maintain boundaries, self + other Behavioural professional conduct, manage own behaviour, engage/ respond/ react appropriately, manage time Psychomotor stand, dexterity, push/ pull, repetitive movements, hand-eye coordination, bend, reach, lift, walk, climb, carry Sensory sight, hearing, touch, smell Environmental function in the presence of smells, disease agents, distractions, noise, chemicals, unpredictable behaviour Why would each of these categories be important in nursing practice? What are some examples? COGNITIVE REQUIREMENTS (CNO, 2012) Ability to perform skills that demonstrate thinking capacity: o o o o o o Remember information from past experiences Demonstrate problem-solving skills Demonstrate concentration skills Use reasoning to develop professional judgment Exercise critical thinking skills to develop professional judgment Apply arithmetic skills and abilities EXAMPLES The student: o o o o uses past experiences to inform current decisionmaking; perceives when situations require further inquiry; performs mathematical/arithmetic skills to safely administer medication; can make sense of complex information. COMMUNICATION REQUIREMENTS (CNO, 2012) Ability to express and receive written, verbal and/or non-verbal language and the ability to interact with others in a respectful and professional manner: o o o Speak, read, listen and write in the English and/or French language at a level that provides for safe and accurate understanding of words and meanings Recognize own non-verbal signals and interpret those received from others while considering individual differences in expression and associated meaning Elicit and respond to information from clients, colleagues and others EXAMPLES The student: o o o accurately obtains and records client information in the chart; communicates clearly with other health care providers; listens appropriately to clients and demonstrates awareness that each individual’s behavior may have different meanings. INTERPERSONAL REQUIREMENTS (CNO, 2012) Ability to create good relationships between oneself and other people: o o o Develop professional relationships and rapport with individuals and groups Recognize the importance of maintaining interpersonal boundaries Recognize the needs of clients and colleagues EXAMPLES The student: o o identifies that others have needs and perspectives that might be different from his/her own; recognizes the importance of client perspectives and feelings. BEHAVIOURAL REQUIREMENTS (CNO, 2012) Ability to conduct oneself in a professional manner: o o o o o o Manage own behavior well enough to provide safe, competent and ethical nursing care Engage with self and others to create a safe environment Respond appropriately in situations that are stressful or involve conflict React appropriately to giving and receiving physical touch and working in close proximity with a full range of clients Fulfill responsibility as part of a team Manage time appropriately EXAMPLES The student: o o o responds appropriately in conflict situations; remains calm in stressful situations; recognizes priorities in the face of multiple demands. PSYCHOMOTOR REQUIREMENTS (CNO, 2012) Ability to perform each of the following requisites well enough to provide client care and participate in educational activities: o o o o o o o o o o o o Stand and maintain balance Manual dexterity Move within limited spaces Push/pull Perform repetitive movements Perform hand-eye coordination Bend Reach Lift Walk Climb Carry objects EXAMPLES The student can: o o o o o help lift, turn and/or transfer clients; climb stairs for a home care visit; enter information into a computer while taking client health history; remove sutures and staples; give injections. SENSORY REQUIREMENTS (CNO, 2012) Ability to utilize each of the following senses well enough to provide care and participate in educational activities: o o o o Sight Hearing Touch Smell EXAMPLES The student: o o o o can see and read lines of demarcation and numbers on a syringe; can hear verbal communication or sounds of a client in distress; can feel a client’s pulse; can detect an odor. ENVIRONMENTAL REQUIREMENTS (CNO, 2012) Ability to function in the presence of each of the following commonly encountered and unavoidable environmental factors: o o o o o o Noxious smells Disease agents Distractions Noise Chemicals Unpredictable behavior of others EXAMPLES The student: o o o can tolerate unpleasant odors; can deal with the distraction of a crying baby while providing care to a sibling; can recognize dangers in the client environment. IN SUMMARY… o o o The CNO encourages those considering a career as a nurse in Ontario to assess their ability to meet the criteria. “The Requisite Skills & Abilities serve as a benchmark, outlining the requirements to meet the minimum standard necessary to ensure public safety” (CNO, 2012). If you have questions, please contact the Nursing Advisors and/or the CNO. CNO has a duty to work with prospective members to determine reasonable accommodation provided that accommodation does not compromise client safety and well-being. Strategies I will adopt to improve areas of weakness to ensure I have the necessary skills and abilities to be a nursing student and future nurse… My areas for improvement are... SELF-ASSESSMENT Resources I may consider are… What I will do to maintain my strengths… My strengths are… GOAL SETTING: IDENTIFY 3 GOALS 1) Goal: o Why it is important: o Strategies: o Resources: 2) Goal: o Why it is important: o Strategies: o Resources: 3) Goal: o Why it is important: o Strategies: o Resources: