Canada’s New Medical Assistance in Dying (MAiD) Law

On March 17, 2021 new MAID legislation came into effect. Some of the key changes include:

Eligibility Criteria:

  • Persons requesting MAiD have a grievous and irremediable medical condition remains in the legislation.
  • “Reasonable foreseeability of natural death” criterion has been repealed.
  • Eligibility for persons suffering solely from mental illness is temporarily excluded until March 17, 2023.

Safeguards & Consent:

  • Safeguards have been separated into two tracks based on whether the person’s natural death is reasonably foreseeable.
  • Safeguards have been eased for eligible persons whose death is reasonably foreseeable. This includes the possible waiver of final consent for eligible persons under certain circumstances.
  • Safeguards have been added and/or strengthened for eligible persons whose death is not reasonably foreseeable. Final consent for this group must be provided by the person immediately before administration of MAiD.

Data Collection and Monitoring:

  • All assessments (not only referrals) for MAiD are required to be reported to better capture who is requesting MAiD across the country.

The Government of Canada website includes the updated information and other resources related to the changes to the MAiD law. CRNS MAiD resources are being updated to reflect the changes and will be shared once complete.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

Medication Management in Covid-19 Immunization Clinics

Changes to the Saskatchewan Immunization Program have been outlined in updates to the Saskatchewan Disease Control Regulations and apply to nurses across the province including those working for the Saskatchewan Health Authority (SHA), Indigenous Services Canada (ISC), Northern Inter-Tribal Health Authority (NITHA) and others. Many partners are involved in rolling out the Covid-19 Immunization Delivery Plan across Saskatchewan, utilizing licensed and unlicensed health care providers to meet the human resource demands while providing safe client outcomes. The team-based approach means there may be some exceptions to current medication management expectations for RNs in relation to Covid-19 vaccines only.

Exceptions to usual practice are approved at the provincial level and supported by provincial and employer documents. Some exceptions that may occur include multiple health care providers:

  • Being involved in the assessment, planning, implementation and evaluation of the vaccine; and
  • Preparing and administering the vaccine.

In practice this means there may be different care providers completing screening, reconstituting vials of vaccine, pre-drawing and labelling syringes, administering the vaccine, documenting, observing for anaphylaxis and responding when needed. The team-based approach supports a large number of health care providers working within their competence to complete components of the immunization process in a safe and timely manner.

Guidance for RNs working in Covid-19 immunization clinics include:

  • Each health care provider competently provides care within their scope of practice or job description and is responsible for the care they provide.
  • Agency policy provides direction to RNs and other health care providers when exceptions to practice are in place.
  • Gaps or unsafe conditions may exist, and RNs are well positioned to identify, report and offer solutions to address these situations.
  • Collaboration and communication are fundamental to effective team functioning and for delivery of safe care.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

Self-Employed Practice Guideline and Documentation Guideline

The CRNS is pleased to announce the release of two updated nursing practice guidelines, the Self-Employed Practice Guideline, and the Documentation Guideline. The guidelines have been updated to reflect the current, evidence-based best practices. These guidelines apply to all categories of nursing practice.

Please review these documents and consider how they may relate to your practice. If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

Support for Public Health Measures

Evidence shows that measures such as handwashing, masking and social distancing are effective strategies to prevent the spread of COVID-19. At this time, as COVID vaccines are being administered to the residents of Saskatchewan, the CRNS wants to remind RNs and NPs about expectations related to providing advice on public health protection and prevention measures.

RNs and NPs are leaders in the community. The public’s trust may extend to the views expressed by RNs and NPs on health matters communicated on social media and other forums. As such, statements made by RNs and NPs in public forums have the potential to impact the health and safety of the public.

RNs and NPs have a professional responsibility and are accountable to:

  • use evidenced-based information to inform their professional practice;
  • support patients and the public to make informed health care decisions, including decisions about public health prevention and protection measures; and,
  • role model and follow public health directives that keep patients and the public safe.

The CRNS’s expectations of RNs and NPs regarding public statements, are outlined in the Registered Nurse Practice Standards, Registered Nurse Entry-level Competencies, Nurse Practitioner Practice Standards, Nurse Practitioner Entry-level Competencies and the Code of Ethics for Registered Nurses.

The CRNS’s standards, entry-level competencies and code of ethics do not apply to all aspects of an RN’s or NP’s private life. However, those who choose to make public comments, while identifying themselves as an RN or NP, are accountable to the CRNS and the public it protects.

RNs and NPs are expected to adhere to the standards, entry-level competencies and code of ethics when carrying out their professional responsibilities. They have a professional responsibility to provide evidence-based information and care. Making anti-vaccination, anti-masking and anti-distancing comments may result in an investigation by the CRNS, and possible disciplinary proceedings. 

Additional resources

CRNS

Social Media

Saskatchewan Health Authority

Government of Saskatchewan

Government of Canada

External Consultation for Self-Employed Practice Guidelines

The CRNS is currently in the process of revising the Self-Employed Practice Guidelines. The Self-Employed Practice Guidelines provide guidance for RNs and NPs who are interested in setting up their own practice. The guideline covers such topics as the legislation and regulatory requirements for self-employed practice, confidentiality, consent, considerations when treating family and friends, information management, policy and procedure development, and liability protection.

The CRNS is seeking feedback on this document from the public, partners, and member. Feedback can be provided by accessing the survey here. The document can be accessed here.

Final approval occurs through the CRNS Executive Director and CRNS Council. The guideline will take effect on the CRNS Council approval date.

Questions or comments are welcome and can be directed to practiceadvice@crns.ca.

Advanced Foot Care for Registered Nurses

Infection Prevention and Control Canada has released an updated document on the use, cleaning, disinfection, sterilization and storage of foot care devices. The document outlines the required equipment and devices for client treatment, as well as stipulations for the purchasing and reusing of foot care devices, and options for guaranteed sterilization of the devices if items are being reused.

It is your duty as the Registered Nurse administering care to ensure that the client is not placed at risk of infection when foot care devices are being used. The level of sterilization of foot care instruments and supplies must be at the level of a health professional. RNs should evaluate their current practices against the recommended infection prevention and control practices within the document and adjust, as necessary.

With the rise of instances of chronic diseases increasing the need for advanced foot care, this document is to ensure that all Registered Nurses with this added certification are up-to-date on the best practices for safe foot care treatment, and are educated on the options available to ensure infection does not occur.

Read the full document here.

External Consultation Graduate Nurse Practice Guideline

The CRNS is currently reviewing the Graduate Nurse Practice Guideline and is seeking feedback on the content. This guideline provides information about topics such as the professional expectations, scope of practice and supervision requirements for Graduate Nurses (GN).

CRNS staff have reviewed and revised the existing document and are now seeking feedback from the public, partners and members as part of the external consultation process. This process is in place to ensure relevant information is clearly presented. Feedback can be provided by accessing this survey by August 7, 2020. All feedback will be reviewed and incorporated as appropriate.

Final approval occurs through the CRNS Executive Director and CRNS Council. The guideline will take effect on the CRNS Council approval date.

Questions or comments are welcome and can be directed to practiceadvice@crns.ca.

Professional Accountability During the Pandemic – Joint Statement

Nursing Practice Update: Joint Statement – Supporting Saskatchewan Regulated Health Care Professionals During the COVID-19 Response

The COVID-19 pandemic is difficult and challenging for our health care system. During a surge in COVID-19 cases, you may be required to adapt your usual practice. A joint statement outlining principles and practice expectations for you and other regulated health care professionals has been developed to support clarity during these challenging times. Read the Full Statement

Nursing Use of Information and Communication Technologies

RNs and NPs are working with organizations to provide continued safe, competent and ethical care to the people of Saskatchewan during the COVID-19 pandemic. Using virtual means, such as telehealth, to connect with patients and families is a necessity in today’s environment. Telehealth connects patients and health care providers who provide health services over the phone, computer or any other forms of information and communication technologies (ICT). Nursing telepractice is the delivery, management and coordination of care and services provided via ICT.

When utilizing ICT for telepractice, RNs and NPs must ensure they continue to uphold their standards, competencies and code of ethics. The importance of clinical knowledge, nursing judgment, communication and documentation skills is paramount when establishing and maintaining a nurse client relationship through telehealth. More information for nursing telehealth activities can be found in the resource section below.

To provide telehealth to a Saskatchewan resident, you must be registered and hold a practicing license with the CRNS. The Registered Nurses Act, 1988 in Saskatchewan outlines the need to be registered to engage in the practice of registered nursing and to use protected titles. Information about registration can be found here.

Each province/territory and country is governed by differing legislation/regulations/bylaws. It is important to contact the nursing regulator in that jurisdiction before providing telehealth services to their residents.

Questions about registration can be directed to Regulatory Services by email at register@crns.ca or by calling 306.359.4200 or 1.800.667.9945 (toll free within Canada).

For a confidential consultation about a practice issue, please contact a Practice Advisor by email at practiceadvice@crns.ca or call 306.359.4200 or 1.800.667.9945 (toll free within Canada).

Resources:      

Van Houwelingen, C. et al. (2016). Competencies required for nursing telehealth activities: A Delphi-study. Nurse Education Today, 39, 50-52. https://www.sciencedirect.com/science/article/pii/S0260691716000149

Canadian Nurses Protective Society, www.cnps.ca

Canadian Nurses of Ontario (CNO) (2017). Practice Guideline: Telepractice CNO Practice Guideline: Telepractice

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