BSN 2057: REGULATION OF THE NURSING PROFESSION AND PROFESSIONAL ACCOUNTABILITY Ends-In-View To explore the laws, procedures, and

structures regulating the nursing profession across Canada The nursing profession in Canada has been self-regulated, since World War 1; each province was regulated at different times. In Ontario, nursing has been self-regulated since 1963. The Nursing Practice is to describe the nature and scope of nursing practice by defining acts and procedures that constitute nursing practice. This provides a framework to determine whether certain actions include the nursing practice and allows distinction between nursing and other professions. Ontario s definition of Nursing as the promotion of health and assessments of the provision of care for and the treatment of health conditions by supportive preventative, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function. (See pg 125 in text, you can also review all the other provinces definitions). Legal and Organizational Structure of Nursing Bodies y Ensure an orderly and well-regulated process for entry into the nursing profession y Ensure maintenance of nursing skills and standards of practice amongst all practicing nurses y Ensure fair and thorough complaints procedure and disciplinary process to protect the public from professional misconduct and poor-quality nursing care. There are two categories of nurses: y RN- registered nurses, extended-class RN s are call nurse practioners (NP). y RPN- registered practical nurse or licensed practical nurses (LPN). The difference between RN s and practical nurses, is that RN s have more in-depth education with strong on critical thinking, and evidence-based practice. RN s are educated at university level and RPN s usually attend a community college. RPNs have less complex and more predictable client populations. RN s have the opportunity to specialize. Regulatory Systems governing nursing in Canada: Single-tiered Systems y Found in all three territories and most provinces y A provincially created regulatory body y Has a complete legislative mandate to regulate entry of candidates into the nursing profession and to perform other functions. Two-Tiered System y In place in Ontario and Quebec y First tier is the nursing regulatory body

Health Professions Appeal and Review Board make up the second tier Functions and duties are hearing appeals from complaints, registration, and accreditation committees of the lower-tier health professions colleges. Regulatory Bodies y Separate classes of nurses are regulated by different regulatory bodies. y Each college or association is governed by a board composed of members of the profession and registered with the college or association. y May also include laypersons appointed by the government. y The board of a nursing college is usually granted powers and responsibilities to govern the nursing profession in the interest of the public and to protect the public from incompetent, unethical, or unprofessional conduct by it members. y Must ensure members are properly educated and meet the standards required to practice nursing. y In some provinces, regulatory bodies are formerly and legally called colleges . y y y To explore the role, function, and responsibility of nursing governing bodies (i.e., the College of Nurses of Ontario) Nursing Governing bodies y Introduce and maintain processes to evaluate the competence of nurses. y In Ontario, the CNO Quality Assurance Program is in place; all the nurses registered are encouraged to participate in it. y The program has 3 parts, each nurse must participate in one of these components: -Reflective practice- intended to identify strengths and improvement opportunities. Involves a self-assessment, feedback from peers, development of learning plan, implementation of learning plan, and evaluation. -Competence assessment- exams, observation in clinical settings. -Practice setting consultation

To explore some of the rules and standards regulating the nursing profession -standards for admission to nursing schools -curricula and teaching standards of such schools -student membership -continuing education -reinstatement and renewal of membership -licensing, membership and other fees -rules governing types of duties -appeals

To examine the processes and procedures used by governing bodies with regards to (a) registration / licensing, and entry to practice, (b) complaints, discipline, and matters relative to incompetence, and (c) quality assurance

Registration, Licensing and Entry to Practice y Applicants for membership must have graduated from an approved school of nursing and passed the nursing registration examination before they are admitted as members of the regulatory body. y Registration refers to a prospective registered nurse enrolling as a member of a nursing college or association. The member is then recognized as a person who is authorized to practice nursing in the particular province or territory. It also allows the regulatory body to record the nurse s contact information, educational background and qualifications. The qualifications for an applicant are reviewed to ensure that all requirements related to education and hours of practice are met. y Licensing refers to a nurse who has successfully passed the Canadian Registered Nurse Examination and met any other requirements imposed by the regulatory body. Complaints, discipline, and matters relative to incompetence y Complaints- must be in writing, must be signed and dated by the person making the complaint, should name the health care professional involved, most outline the facts and particulars for the alleged misconduct. A complaint not made in writing is not considered. y Discipline-for those who have been found guilty of professional misconduct or been found incompetent: o Reprimand before the committee or in writing o Conditions placed on the nurse s right to practice, including that she take additional courses or education to pass further examination o Suspension for a specified period of time o Revocation of the nurse s right to practice and expulsion from the nursing association Quality Assurance y To review and examine individual members practices to identify incompetence, incapacity, review and examine individual members practices to identify incompetence, incapacity, professional misconduct, sexual abuse of patients by health professionals. y The quality assurance committee will conduct an investigation to identify incompetence or incapacity and identify inadequacies. If the committee believes misconduct, incompetence or inadequacies has occurred, it may disclose the accused name and the allegations against them to the executive committee. Then the committee would refer the matter to the disciplinary committee. y To examine the role of regulatory bodies in defining standards of professional practice y y y regulate nursing roles education entry into the profession

y y y y y

scope of practice standards of practice complaints processes discipline members not in compliance protect the public

1. What are some of the advantages and disadvantages of having a self-governing nurse regulatory body? Advantage -accountability -competent and safe nursing standards for practice -education, research, and leadership -flexibility -responsibility -adaptability -safety and well-being of the public -protect the public from incompetent, unqualified, and unethical health care providers. Disadvantage 2. How does CNO handle complaints against nurses? y Alternative Dispute Resolution: The Resolution Process  Used to protect the public  Not place blame  Develop acceptable resolution  Promote quality of care  Provide opportunity for learning and self-reflection  Come with a mutual agreement with the nurse  Once an agreement is made the nurse must adhere to the agreement  College staff ensure the agreement has been fulfilled  All information between the complainant and nurse must remain confidential and no further involvement from the college is required.

3. What are the steps of the CNO disciplinary process? y Investigation  Very serious matters such as abuse  No resolution could be agreed on  The investigator will gather relevant information  The nurse s history will be reviewedto decide if remedial action is required  Information will be provided to the complainant regarding decisions made  The CNO has influence on the panel s decision. Public hearing

Depending on the severity of the case, the Panel can order the nurse to do one or more of the following: y pay a fine to the Ontario government (not the College or the complainant) y appear in person for a reprimand delivered by the Panel y complete remedial education y place conditions a nurse s practice y suspend the nurse from working for a set period of time; and/or y in the most serious cases (especially sexual abuse) y revoke the nurse s ability to practise nursing If your complaint results in a hearing before the Discipline Committee, you will receive a copy of the Panel s decisions and reasons after the matter is concluded. In addition, the results of all disciplinary hearings are published in the College s membership magazine, The Standard, and are made public on the College s web site at www.cno.org/decisions.

4. What is the CNO Quality Assurance Program? The Quality Assurance (QA) Program is based on the principle that lifelong learning is essential to continuing competence. Nurses demonstrate their commitment to continually improving their nursing practice, in every setting, by engaging in practice reflection, and by setting and achieving goals. It is mandatory for every nurse registered in the General, Transitional and Extended Classes in Ontario to participate in the College's QA Program. The QA Program measures a member's knowledge and application of the College's practice standards, guidelines and related competencies. Each year, the College will select two practice documents as the focus of the year's QA Program. You must review the specified practice documents and apply them in your Learning Plan.