Novel Coronavirus (COVID-19)
The College of Nurses of Ontario is engaging with the Ministry of Health and Long-Term Care to mitigate the spread of the novel coronavirus (also known as COVID-19), and to protect the health and safety of patients and nurses.
CNO understands the impact of this outbreak on all nurses. We are closely monitoring this situation and will update this page as more information becomes available. Check back often for updates.
About the novel coronavirus
In December 2019, the novel coronavirus emerged in the city of Wuhan, China. Since then, this respiratory virus has been reported in multiple countries, including Canada. On Thursday, Jan. 30, 2020, the World Health Organization declared the novel coronavirus (also known as COVID-19) to be a public health emergency of international concern.
Symptoms of the virus range from mild to severe. They can include fever and cough, difficulty breathing, pneumonia and kidney failure. In severe cases, it can cause death.
The Ministry of Health and Long-Term Care has created a website for health care professionals with up-to-date information about the virus, guidance documents for various health care sectors, case definitions and more.
Public Health Ontario has also curated a resource page with helpful information for health care providers about the novel coronavirus.
Guidance and best practices
- At-a-Glance Risk Levels and Precautions for COVID-19
- FAQs on COVID-19
- Government of Canada COVID-19: For health professionals
- Guidance for Acute Care
- Guidance for Home and Community care
- Guidance for Independent Health Facilities
- Guidance for Long Term Care
- Guidance for Primary Care Providers in a Community Setting
- Guidance for Public Health Case Management and Monitoring for COVID-19
- Home and Community Care Provider Positive Screen Algorithm
- Ministry of Health and Long-Term Care - Case Definitions and Guidance for Health Care Workers and Health Sector Employers on novel coronavirus associated with Wuhan, China (COVID-19)
- Ontario Medical Association – Information chart for primary care givers
- Public health management of cases and contacts of COVID-19 in Ontario
- Public Health Ontario – Novel Coronavirus (COVID-19)
What are my accountabilities when providing care to a patient diagnosed with (or suspected of having) the coronavirus?
You are accountable for making decisions that are in the best interests of your patients and for protecting them from harm. You are also accountable for protecting patients from infection risks. You can do this by:
- applying hand hygiene principles
- choosing appropriate measures to prevent and control infection transmission such as wearing personal protective equipment (PPE)
- understanding your workplace’s organizational policies about infection prevention and control
- working with your employer to develop new policies as needed
- using sources of evidence to inform your practice
We encourage you to work collaboratively with your employer to recognize real or potential threats, review relevant organizational policies, and if needed, develop policies and guidelines specific to your practice setting.
All nurses are expected to understand and apply precautionary measures to minimize the risk of infecting themselves, colleagues, patients and others. To learn more about these topics, refer to Public Health Ontario’s novel coronavirus info page.
Can I refuse to work with an infected patient?
When your professional obligation to a patient conflicts with your personal obligations, you have an accountability to demonstrate leadership and work out the best possible solution while still making decisions in the patient’s best interest. Refusing assignments or choosing to discontinue care is an ethical dilemma without one clear answer. CNO encourages all nurses to review the Refusing Assignments and Discontinuing Nursing Services practice guideline, because it contains information about resolving this dilemma and also how to prevent such a situation from occurring in the first place.
Ultimately, you do have the right to refuse assignments that you believe will subject you or your patients to an unacceptable level of risk. But you also have a professional accountability to advocate for practice settings that minimize risk to both you and your patients. Advocating for quality practice settings is one of the many ways nurses are leaders in patient care.
CNO’s practice guideline, Refusing Assignments and Discontinuing Nursing Services, states:
- the safety and well-being of the patient is of primary concern
- nurses are accountable for their own actions and decisions and do not act solely on the direction of others
- nurses have the right to refuse assignments that they believe will subject them or their patients to an unacceptable level of risk
Abandonment occurs when a nurse has accepted an assignmentand discontinues care without:
- the patient requesting the discontinuation;
- arranging a suitable alternative or replacement service; or
- allowing a reasonable opportunity for alternative or replacement services
Nurses should review relevant organizational policies and guidelines related to staffing and workload. If needed, you should advocate for and develop policies and guidelines driven by patient interest and safety.
Nurses are accountable to all standards of practice. A few key practice standards to keep in mind during the coronavirus outbreak are:
Nurses are expected to:
- not impose personal beliefs or biases on patients
- use accurate sources of information such as research to inform their practice
- work with other health care experts to improve their patients’ care
- advocate for improving the quality of their practice setting to support safe patient care
Nurses are accountable for:
- using a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-patient relationship
- incorporating a patient-centred care approach to make sure all professional behaviours and actions meet patient’s therapeutic needs
- Nurses must also understand their accountabilities as they relate to the practice standard which includes accountability, continuing competence, knowledge and knowledge application.
- Nurses have an obligation to maintain the commitments they assumed as regulated health professionals. Maintaining commitments means keeping promises, being honest and meeting implicit or explicit obligations toward their patients, themselves, each other, the nursing profession, other members of the health care team and quality practice settings as stated in the practice standard.
When providing patient care, consider:
- do I have the appropriate supports (for example, infection control guidelines or policies) and resources, such as protective gear such as gloves and masks, to minimize the risk of infection?
- do I have the knowledge, skill and judgment to perform the assignment?
- have I shared my concerns with my employer and broader health care team?
You should make sure you understand your accountabilities related to infection prevention and control. Our Infection Prevention and Control page is a curated collection of best practice resources and applicable standards and legislation.
If you have questions about your accountabilities when caring for patients affected with the new coronavirus, email us: email@example.com.
CNO’s mandate is to protect the public—but patient safety is a responsibility we all share. Our role during the novel coronavirus outbreak is to support your ability to provide safe and competent care and help you understand your accountabilities.
If you have questions about your accountabilities when caring for patients affected with the new coronavirus, please contact us. One of our Advanced Practice Consultants can help identify the appropriate practice standards and guidelines to guide your decision-making and help you understand your accountabilities.
Guidance and best practices
- Ministry of Health and Long-Term Care - Guidance for Health Care Workers and Health Sector Employers on novel coronavirus associated with Wuhan, China (COVID-19)
What are my accountabilities as a nurse manager during an outbreak on our unit?
Proper planning is key to determining how well a facility and its nursing staff will manage coronavirus. Employers are responsible for establishing a working environment that supports safe and effective patient care. This includes arranging appropriate staffing coverage and Personal Protective Equipment (PPE) for all nurses who require it. Your practice setting must also provide proper PPE training and fitting.
CNO’s Professional Standards specifies that nursing managers need to access and share up-to-date, evidence-based information and guidelines with staff. Nurse managers must also provide staff with clear policies on screening and managing the outbreak.
All nurses are accountable to take action when patient care may be compromised. This includes identifying strategies to prepare for, reduce and resolve situations that may leave patients without the nursing services they need. This accountability is found in CNO’s practice guideline, Refusing Assignments and Discontinuing Nursing Services.
To ensure a safe practice environment, nurse managers should consider:
- are there strategies in place for prioritizing patient care needs?
- have you explored concerns with your staff and clearly communicated your organization’s plan to address these concerns?
- have you included front line staff in the creation and implementation of these strategies?
- is there a readily available system for replacement staff?
- are strategies in place to facilitate the reorganization of workload, if needed?
- are there clear policies and lines of communication for nurses to follow when staffing is short?
Nurse managers can show leadership by working through dilemmas that nurses may have regarding assignments by following the decision-making process framework found on page 6 of the Refusing Assignments and Discontinuing Nursing Services practice guidelines.
Members of the public looking for more information, including how to protect yourself from the virus, what to do if you’re sick and how to recognize possible symptoms should visit the Ministry of Health and Long-Term Care’s public website.