Quality Practice - A resource for nurses and nurse leaders

  February 2019 | Volume 18, issue 1
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Introducing the Nurses’ Health Program

Ontario’s 175,000 nurses have a new voluntary program that focuses on early identification and referral for treatment of mental health and/or substance use disorders.

The Nurses’ Health Program (NHP) recognizes these disorders as illnesses and takes a non-punitive approach that reduces stigma and focuses on recovery. It embraces the philosophy that nurses experiencing these disorders should have an opportunity for education, treatment and recovery. It recognizes their unique needs as health care professionals and the importance of protecting the public.

NHP offers a proven approach, and is modelled on similar programs used by other regulated health professions. The new bilingual program offers nurses access to resources, a dedicated case manager, comprehensive assessment, an individualized support and treatment plan, and monitoring.

“There is significant research showing that voluntary and confidential professional health programs are highly effective both in supporting recovery and protecting the public,” says Anne Coghlan, CNO’s Executive Director and CEO.

NHP was developed by the College of Nurses of Ontario (CNO), Ontario Nurses’ Association (ONA), Registered Nurses’ Association of Ontario (RNAO), and Registered Practical Nurses Association of Ontario (RPNAO). It is an incorporated not-for-profit organization overseen by a board of directors with equal representation from the four nursing organizations and administered by Lifemark Health Group.

You can find out more about the program at nurseshealth.ca.

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New Code of Conduct clarifies patients’ rights and nurses’ accountabilities

CNO has developed a new Code of Conduct for nurses that reflects the expectations of both CNO as a regulator with a mandate to protect the public, and the public’s feedback about what they need from nurses.

This new practice standard came into effect on Feb. 4, 2019. Nurses are now accountable to this standard.

The Code tells the public what to expect from nurses when receiving care. It is also an overarching standard that sets out the behaviours and conduct that nurses are expected to follow.

The Code is more than a practice standard; it is a reflection of what the public expects of nurses. When we created the Code, it was important for us to include the public’s perspective. Through our comprehensive consultation with members of the public, nurses, educators, nurse employers, nursing associations, nursing unions and government, we listened and integrated their feedback and expectations into the Code.

To ensure Ontario’s culturally diverse population can read and use the Code, it will be translated into the top six languages (French, Mandarin, Cantonese, Punjabi, Spanish and Tagalog) spoken in this province.

While most of the accountabilities in the Code come from current practice standards, we have added a few new ones to reflect current evidence, legislation, technology and situations that nurses may encounter in different practice settings. For example, expectations related to social media, providing timely nursing care, and gaps impacting patient care and health outcomes in different communities.

The code is divided into six principles:

  1. Nurses respect the dignity of patients and treat them as individuals
  2. Nurses work together to promote patient well-being
  3. Nurses maintain patients’ trust by providing safe and competent care
  4. Nurses work respectfully with colleagues to best meet patients’ needs
  5. Nurses act with integrity to maintain patients’ trust
  6. Nurses maintain public confidence in the nursing profession

To help nurses understand how to apply the Code, we have developed FAQs and a document showing how the Code’s accountabilities link to other CNO practice standards and guidelines. We will also host teleconferences to review case studies that support the Code’s application.

Visit www.cno.org/codeofconduct to learn more about the Code and access the new resources. If you have specific questions related to the Code, contact Practice Support.

Use Nurse Renewal Check to verify a nurse’s registration status

Nurses who have not yet renewed their membership with CNO for 2019 must renew by Tuesday, Feb. 19, 2019 or their membership will be suspended.

If a nurse’s membership is suspended, they will not be able to practice nursing in Ontario until they renew and pay all outstanding fees. This includes a late renewal fee of $113 and an additional fee of $56.50 to lift the suspension.

If they do not renew or resign their membership by Thursday, March 21, 2019, their membership will expire. If a person’s membership with the College has expired, they will need to meet the requirements for reinstatement and pay additional fees in order to resume practicing in Ontario.

Practicing in Ontario while your membership is suspended, revoked or expired is a serious offence. To confirm if nurses at your facility are registered to practice, use Nurse Renewal Check.

Nurse Renewal Check is a service the College provides to nursing employers, facility operators and others. It quickly and efficiently checks the membership status of nurses you employ on a full-time, part-time, casual or contractual basis.

The service is an efficient alternative to manually reviewing each nurse’s membership status by phone or using Find a Nurse. This makes it ideal for organizations that employ a large number of nurses.

Nurses should also remember to update their employment information if it’s changed. CNO’s by-laws require nurses to report any change in their employment information to us within 30 days. It is their responsibility to update this information any time their employment changes, not just during renewal.

New Reporting and Complaint forms easier to use

CNO is enhancing our professional conduct procedures. We’ve heard the issues raised in the Long-Term Care Homes Public Inquiry and we are improving our processes to help protect the public. As part of this ongoing strategy, we have updated our resources for making a complaint and a report.

Changes to our Reporting Form

We have updated the reporting form that is used when making a report about a nurse’s conduct or capacity. The form can be used by a nurse, a nurse employer, or facility operator to report any information to CNO, not just incidents that employers are required to report.

The updated Reporting Form, formerly called the Report Form for Facility Operators and Employers, has new features to make it easier to complete and submit.

First, instructions have been added to the form. This allows the user to understand the process without having to go back and forth between the form and the instructions on www.cno.org.

Second, we have clarified employer’s reporting responsibilities and requirements. We have also added an option for “Non-mandatory reports.” This is for information that an employer isn’t required under regulation to report, yet the employer feels it is in the public’s best interest to make CNO aware of the incident.

Third, we have added more sections to the form for describing the incidents that led to the report. We want to ensure that users are aware there is no limit to the amount of information they can provide.

You can learn more about CNO’s reporting process online.

Changes to our Complaints Form

An essential part of how we protect the public is making sure someone who has concerns about a nurse’s conduct can easily access and understand our complaints process. As part of this, we have updated our resources for making a complaint.

The updated Make a Complaint form has three new features that make it easier to complete.

First, the form can now be completed online. Previously, a user had to print a paper copy and fill it out by hand.

Second, we have added instructions to the form. This allows the user to understand the process without having to go back and forth between the form and the instructions on the web page.

Third, there are more sections to the form for members of the public to include details about the complaint. We want users to be aware there is no limit to the amount of information they can provide.

We’ve also updated the Make a Complaint web page, so it is easier to understand when and how to make a complaint. Read more about CNO’s complaints process online.

New resources for employers

Are you a nurse employer or health care administrator needing to know more about CNO’s investigation, prosecutions and monitoring processes? Then our new employer resources can be helpful to you.

As a nurse employer, you have an important role in nursing regulation. You work with us to protect the public. You are accountable for overseeing nurses’ conduct and behaviour, and are involved in reporting processes and other professional conduct matters.

We created the Employer Resources web page to help you understand what happens when we receive a report or complaint about a nurse. It also explains your accountabilities during an investigation and its potential outcomes, including how we monitor nurses with restricted, suspended or revoked certificates of registration.

Please check back often, as this important tool is updated regularly to keep you informed of the most up-to-date information. 

To learn about other ways CNO and nurse employers work together, visit Employer Reference Group.

New Adverse Event Decision Pathway could help employers decide what and when to report

To help employers decide whether to report a nurse to CNO, we are participating in a pilot study of the Adverse Event Decision Pathway with the National Council of State Boards of Nursing (NCSBN). NCSBN is a not-for-profit organization advancing nursing regulatory excellence worldwide.

The Adverse Event Decision Pathway is a decision-making tool designed to help protect the public. It assists employers in deciding how to respond to adverse events involving nurses, including whether to report the nurse.

The tool was developed by NCSBN in early 2018. It stems from research conducted by NCSBN that indicated many employers want additional guidance from their regulators about reporting nurses.

In early 2019, we are sending emails to senior nurse managers working in all sectors inviting them to participate in the pilot. Those who do participate will be asked to complete two surveys: one before using the pathway and one after using the pathway for six months. The quantitative and qualitative study results will be used to refine the tool. Once the tool is considered effective, it will be launched. The results will also be used to identify barriers to employer reporting so additional resources can be developed.

This tool is also being piloted by the British Columbia College of Nursing Professionals.

Website to submit 2018 health privacy breach statistics is open

Protecting the privacy and confidentiality of patients’ personal health information is fundamental to the nursing profession. If you are a health information custodian, you are responsible for ensuring that systems are in place to meet the legislated requirements of the collection, use and disclosure of personal health information. According to new rules under the Personal Health Information Protection Act, 2004, you are also required to provide the Information and Privacy Commissioner of Ontario (IPC) with an annual report of statistics relating to health privacy breaches.

The IPC has opened the online statistics submission website for custodians to submit their statistics for the 2018 reporting year. Custodians that have experienced at least one health privacy breach from January to December 2018 are required by law to complete the online questionnaire. The deadline to submit is Friday, March 1, 2019.

You do not have to submit a report if there were no health privacy breaches to report for 2018.

To learn more about reporting health privacy breaches, including access to guidance documents and responses to frequently asked questions, refer to the IPC’s 2018 Mandatory Statistics Reporting blog post. 

If you have any questions about the reporting process, contact the IPC directly.

New resources replace the Infection Prevention and Control and Restraints practice standards

We have recently replaced two practice standards and six guidelines with up-to-date resources that will be more relevant to practicing nurses.

The standards that have been replaced are the Infection Prevention and Control and Restraints practice standards. The guidelines no longer in use include:

  • Complementary Therapies
  • Culturally Sensitive Care
  • Disagreeing with the Plan of Care
  • Influenza Vaccinations
  • Preparing for Influenza Pandemic
  • Supporting Learners.

Read the December issue of The Standard to learn more about why these standards and guidelines have been replaced, and the resources we have developed to help guide nurses’ decision making in these areas.

Proposed by-law changes puts more employment information on the Register

To make it easier for members of the public and employers to find current and past employment information about a nurse, CNO’s Council is proposing two changes to our Register and Fees By-Laws. These changes would increase the amount of employment information on the public Register, and would allow CNO to charge a fee if a nurse fails to notify us about changes in their employment status within 30 days.

Council is proposing these changes because including more employment information on the register would increase transparency, lead to increased confidence in the nursing profession and give the public the information they need to make informed decisions about who is providing their care. It would also provide employers with another consistent, efficient and reliable way to obtain information about nurses when making hiring decisions.

Recommendations to publish employment history on the register were made by several participants, including victims’ groups and the Ontario Long-Term Care Association during the public hearings of the Long-Term Care Homes Public Inquiry. Although the Inquiry will deliver its final report and recommendations by July 31, 2019, we have reviewed and reflected on the publicly available material as well as evidence in literature and have proactively identified improvements that can be made now. Posting more employment information on our public Register is one such change in the public interest.

Review the proposed changes and send us your feedback. The deadline to comment is Monday, Feb. 18, 2019.

At their March 2019 meeting, Council will review your feedback before deciding whether to implement the by-law changes.

Proposed changes to the Register By-Law
Currently, Find a Nurse only lists each practicing nurse’s “primary” employer. We are proposing that this be expanded to include all “current” employers and employers from the last three years. We know that many nurses have more than one employer, and providing a broader listing of employers will provide a clearer and more accurate portrayal of the information nurses declare.

The College already collects this information and nurses are already required to report this. The proposed change is only to make this information available on the public Register.

Proposed changes to the Fees By-Law
Currently, nurses are required to update their employment information with CNO within 30 days of any change in their employment. This has been a reporting requirement for all practicing nurses for some time. The proposed by-law change is to allow us to charge a fee if a nurse fails to meet their self-reporting requirements. It is important that the information on Find a Nurse be up-to-date and accurate. Money collected from this fee would help CNO to partially recoup costs associated with tracking down and changing out-of-date information. 

Comment on the changes
If you would like to submit feedback about any of the proposed changes, comment on the specific proposed by-law change using its corresponding feedback box. The deadline to comment is Monday, Feb. 18, 2019.

Have your say about RN prescribing regulations

In December, we started seeking feedback on proposed regulation changes related to RN prescribing. The deadline to comment is Monday, Feb. 18, 2019.

We value your feedback. To comment, read the details on the consultation page and complete the included online survey or send an email to regulations@cnomail.org.

In March 2019, Council will review your feedback before it makes a final decision about submitting the new regulation to the government for consideration.

Should nurses initiate psychotherapy without an order? Comment on the proposed changes to the Controlled Acts Regulation

We are seeking your feedback on a proposed regulation related to the controlled act of psychotherapy.

The changes would allow RNs and RPNs to independently initiate the controlled act of psychotherapy without an order following the end of the exemption period (Monday, Dec. 31, 2019).

To provide your feedback, and submit your feedback in the comment section of the webpage.This consultation is now over.

In March 2019, Council will review your feedback before making a final decision about submitting the regulation to the Ministry of Health and Long-Term Care for its consideration.

To learn more about the controlled act of psychotherapy, read our article in the January issue of The Standard or read our psychotherapy FAQs.