Nursing Practice Updates

Updates focus on changes to legislation, SRNA bylaws, and the introduction of new standards and guidelines.

NP RN

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  • “Reasonable foreseeability of natural death” criterion has been repealed.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. SRNA MAID resources are being updated to reflect the changes and will be shared once complete.

If you have questions, please contact an SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@srna.org.

NP RN

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 SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@srna.org.

NP

National NP Regulation Project Update

In follow up to the December 22, 2020 Nursing Practice Update:

The CCRNR National NP Regulation Project continues to move forward with the goal of providing consistent regulation with a single category of NPs and one national examination for all NPs in Canada. The current priorities of the project are selecting an exam vendor, review of entry level competencies and establishing advisory committees.

The SRNA encourages members who are interested in staying up to date on this project to subscribe to the CCRNR NPR-FIPP newsletter to receive the Project News and to access Frequently Asked Questions.

This project will involve consultation from provincial key stakeholders. The SRNA will be setting up meetings to inform stakeholders of the project and discuss future consultation. If you are interested in attending any SRNA upcoming information sessions regarding the project, please email Donna Cooke, Nursing Advisor at dcooke@srna.org.

NP RN

Self-Employed Practice Guideline and Documentation Guideline

The SRNA 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 SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@srna.org.

NP

NPs Completing Medical Certificates of Death (MCOD) and Medical Certificates of Stillbirth (MCOS)

The Government of Saskatchewan amended vital statistics legislation effective January 1, 2016, giving NPs the legal authority to sign the MCOD and MCOS. Information for NP practice in this area has been contained in the SRNA Guidelines for NPs Completing Medical Certificate of Death & Medical Certificate of Stillbirth, 2016. The guideline has been discontinued and this update provides the most current information and resources.

Physicians, coroners, and NPs share responsibility for proper completion of MCOD and MCOS. NPs registered with the SRNA whom have the appropriate knowledge, skills and competencies are authorized to complete a MCOD and MCOS unless the death needs to be reported to a coroner. NPs need to be familiar with the current provincial legislation that will guide their clinical decisions including;

• The Vital Statistics Regulations;

• The Vital Statistics Act;

• The Coroners Regulations; and

 • The Coroners Act.

All Government of Saskatchewan documents are available on Queen’s Printer at the following web site http://www.qp.gov.sk.ca/

Additional resources for NPs:

If you have any questions, please contact an SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@srna.org.

NP

Referral-Consultation Process for Nurse Practitioners

The College of Physicians and Surgeons of Saskatchewan (CPSS) has recently released a Guideline: Referral-Consultation Process. The guideline includes guidance for physicians who are writing referrals and consultation reports. Nurse Practitioners (NP) are included as care providers within the document. Expectations for communication to/from consulting physicians are important for NPs to know, understand and implement into their practice.

NP practice standards set the expectation for NPs to understand the roles of, and collaborate with, other health care providers to support optimal client outcomes (SRNA, 2017). Section four of the guideline outlines the expectations of referring physicians. The SRNA supports the information in this section and expects NPs to follow these guidelines when referring a patient to a specialist.

If you have any questions, please contact an SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@srna.org.

Reference:

Saskatchewan Registered Nurses Association (SRNA). (2017). Registered Nurse (Nurse Practitioner) Practice Standards. Retrieved from https://www.srna.org/wp-content/uploads/2019/05/RNNPPracticeStandards2017.pdf

GN NP RN RN(AAP)

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 SRNA 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 SRNA’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 SRNA’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 SRNA 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 SRNA, and possible disciplinary proceedings. 

Additional resources

SRNA

Social Media

Saskatchewan Health Authority

Government of Saskatchewan

Government of Canada

NP

Nurse Practitioner Regulation Framework Implementation Plan Project (NPR-FIPP)

As a member of the national steering committee, the SRNA is participating in the Nurse Practitioner Regulation Framework Implementation Plan Project (NPR-FIPP). This project is a multi-year, multi-faceted initiative commissioned by the Canadian Council of Registered Nurse Regulators (CCRNR).

The goal of NPR-FIPP is to implement the recommendations endorsed by CCRNR regarding six basic elements of a model for Nurse Practitioner regulation in Canada. These six elements include entry level education programs, the creation of one national entry-level examination for all NPs across Canada, common standards of practice, continuing competence, one NP registration category based on entry-level competencies and common principles for re-entry to practice. The first-year priority will focus on beginning work on an entry level examination and entry level education programs.

For additional information about the project, visit the CCRNR website.

If you have any questions about the project and/or the SRNA’s role, please contact Donna Cooke, Nursing Advisor, Regulatory Services at dcooke@srna.org or phone 1-800-667-9945 (ext. 202) or 306-359-4202.

NP

24 Hour RN Coverage Resources

With the recent transition towards a single mandate organization, the SRNA Council has made the decision to discontinue the use of position statements. Thus, updated resources are being provided in replacement of previous position statements.

The 24 Hour RN Coverage in Special-Care Homes resource document will replace the 24 Hour Registered Nurse Coverage position statement. It is recognized that RNs are one health care provider within the larger health system, and there are many factors that lead to better outcomes for residents. This resource provides an at-a-glace connection to standards, competencies, ethical responsibilities and evidence for RNs practising in special-care homes.

Please review this document and consider how it may relate to your practice.

NP

Updated Requirements for NP Hours

As of December 1, 2020, Nurse Practitioners in Saskatchewan will no longer be required to complete 600 clinical hours to maintain eligibility for registration. According to SRNA Bylaw VI subsection 3(7), NPs are required to work in nurse practitioner activities approved by the association in one of the four specialties for at least 900 hundred hours in the three years immediately preceding application. However, there is no longer a requirement for clinical hours.

This modification was made in recognition of changes in NP practice acknowledging the increasing diversity with many NPs working in various domains of practice outside of a clinical setting.

For any questions regarding this change, please email Leah White, RN Nursing Advisor (lwhite@srna.org)

NP

Prescription Review Program (PRP): Codeine Use in Pediatrics

In response to an updated Health Canada advisory warning that patients under 18 years of age should not use non-prescription pain relief products containing codeine, the Prescription Review Program (PRP), Saskatchewan’s prescription monitoring program, has released correspondence to assist practitioners with the management of pediatric pain and provide guidance in regards to the use of codeine products. 

The update by Health Canada also included warnings regarding the use of prescription cough and cold products containing opioids in patients under 18 years of age. Research has suggested that early exposure to opioids may put young patients at risk for opioid-related adverse events throughout their life. 

Given it’s perceived safety, codeine was previously a preferred opioid drug in pediatrics, it has since been recommended that practitioners do not initiate treatment with codeine if the patient hasn’t been prescribed the drug for a chronic condition in the past. 

Correspondence shared by the Prescription Review Program, elaborates on the above topics further, outlines non-opioid and non-pharmacological options in pediatric pain management and highlights important reminders if an opioid prescription is deemed necessary in a pediatric patient. 

Review this document here

If you have any questions, please contact Susan Furman-Pelzer, NP Nursing Advisor PRP (prp@srna.org). 

RN NP

External Consultation for Self-Employed Practice Guidelines

The SRNA 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 SRNA 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 SRNA Executive Director and SRNA Council. The guideline will take effect on the SRNA Council approval date.

Questions or comments are welcome and can be directed to practiceadvice@srna.org.

NP

NPs Prescribing Cosmetics

Nurse Practitioners (NP) in Saskatchewan can prescribe bioactive agents and medical fillers for cosmetic purposes when:

  • the patient condition for which they are prescribing the agents fall within the individual NP common medical disorders and
  • the NP has the knowledge, skills and competence to safely assess, treat, prescribe and/or administer the product in accordance with bylaws, standards and competencies and federal legislation.

NPs work within a collaborative team of physicians, registered nurses (RN) and other health care providers to implement the nursing process including assessment, care planning, implementation and evaluation. Considerations for NPs when practicing in an interdisciplinary setting:

  • Recognition of practice is required for NPs who practice in the most responsible practitioner role. Contact regulation@srna.org for further information.
    • The most responsible practitioner is responsible to:
      • conduct an initial assessment of the client at each visit;
      • establish a treatment plan for the injection;
      • assess that the RN providing the injection is competent to perform the task; and,
      • be available to provide assistance in the event of an untoward event.
    • RN Clinical Protocols are required to provide guidance to RNs who are administering these products under the authority of NPs. The four essential components for RN Specialty Practices must be incorporated into the RN Clinical Protocol.

Providing cosmetic services and procedures has evolved over the past several years and includes unique liability risks that NPs should understand prior to engaging in this area of practice. It is strongly recommended that NPs contact the Canadian Nurses Protective Society (CNPS) to discuss liability risks associated with cosmetic nursing.

Questions? Contact an SRNA Practice Advisor by phone: 1-800-667-9945 or 306-359-4227 or by email: practiceadvice@srna.org.

RN

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.

RN

External Consultation for “Documentation Guidelines for Registered Nurses”

SRNA staff are reviewing the current Documentation Guidelines for Registered Nurses and are 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.

The draft Documentation Guidelines for Registered Nurses provides information about the professional expectations and requirements for documenting nursing care. Complete the survey here: Documentation Guidelines for Registered Nurses

Feedback can be provided by accessing the survey by September 18, 2020. All feedback will be reviewed and incorporated as appropriate.

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

Questions or comments are welcome and can be directed to practiceadvice@srna.org.

RN

External Consultation for “Guideline for Prescribing Medication” and “RNs Recommending and Administering Over-the-Counter Medications”

SRNA staff have drafted two new documents and are seeking feedback on the content of both 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.

The SRNA Guideline for Prescribing Medication provides information about the professional expectations and requirements for authorized nursing prescribers in Saskatchewan. Complete the survey here: Guideline for Prescribing Medication 

RNs Recommending and Administering Over-the-Counter Medications outlines the professional responsibilities and considerations for RNs who are enabled to guide client decision-making regarding over-the-counter (OTC) medications in a variety of clinical settings. Complete the survey here: RNs Recommending and Administering Over-the-Counter Medications

Feedback can be provided by accessing the related survey by September 15, 2020. All feedback will be reviewed and incorporated as appropriate.

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

Questions or comments are welcome and can be directed to practiceadvice@srna.org.

RN(AAP)

Section 56 Exemption Extension

The current Health Canada section 56 exemption that was set to expire on September 30, 2020 has been extended to September 30, 2021. This exemption provides practitioners with the authority to issue a verbal prescription for controlled substances. There are no changes to the exemption and as previous, Health Canada can terminate this exemption depending on the current conditions if the Minister deems that such suspension is necessary to protect public health, safety or security. If necessary, the Minister may change the terms and conditions of this exemption. Should this be the case, you will be informed. View the update here.

NP

Amendments to FDRs

In recent changes made to the Food and Drug Regulations (FDRs), Nurse Practitioners will be included as a “practitioner” to whom drug samples may be distributed.

On March 13, 2020, Bill C-4 (the Canada–United States–Mexico Agreement Implementation Act) received Royal Assent and came into effect July 1, 2020. The Canada-United States-Mexico Agreement (CUSMA) included regulatory commitments specific to products recognized as being at the interface of cosmetics and drugs. Among other things, the Act amends section 14 of the Food and Drugs Act (i.e., the prohibition on the distribution of drugs as samples).

Corresponding amendments were made to the Food and Drug Regulations (FDRs), including amendments to section C.01.048, to permit the distribution of drugs as samples to a “practitioner”. “Practitioner” is now defined in the FDRs, referring to a person who is entitled under the laws of a province or territory to treat patients with a prescription drug; therefore will include Nurse Practitioners as a “practitioner” to whom drug samples may be distributed. These changes permit distribution of drugs as samples to clients, as a matter falling within the Nurse Practitioner’s scope of practice. Other practitioners with prescribing authority under provincial and territorial law but who could not (prior to these amendments being made) receive samples of prescription drugs and NPDs include chiropodists (podiatrists), optometrists, naturopaths and midwives.

As part of the CUSMA implementation, Health Canada established a guidance document on the distribution of drugs as samples, as well as lists of the specific non-prescription drugs and natural health products that can be distributed as samples directly to consumers. Health Canada also established a list of the non-prescription drugs for which additional (i.e., identity and confirmatory) testing is not required upon importation and may be directly shipped to retailers or wholesalers.

Further to this guidance document, Health Canada wishes to advise interested stakeholders of the steps that are being undertaken to expand the lists of products described above, as follows:

1. Amend List A: List of Certain Natural Health Products for Distribution as Samples to include all currently authorized products in the product categories set out in the CUSMA and meeting the identified criteria, i.e., for topical use, localized and non-systemic effect, and meets the definition of a “cosmetic”.

2. Amend List D: List of Certain Non-prescription Drugs for Distribution as Samples to include all currently authorized products in the product categories set out in the CUSMA and meeting the identified criteria, i.e., for topical use, localized and non-systemic effect, and meets the definition of a “cosmetic”.

3. Amend the List of Non-prescription Drugs for Which the Testing Requirements Set Out in Subsections C.02.019 (1) and (2) of the Food and Drug Regulations Do Not Apply to include all currently authorized products in the product categories set out in the CUSMA and meeting the identified criteria, i.e., for topical use, localized and non-systemic effect, and meets the definition of a “cosmetic”.

If you have any questions, please contact the Natural and Non-prescription Health Products Directorate at: hc.nnhpd.consultation-dpsnso.sc@canada.ca.

Review CUSMA’s “Information Session on the Notice of Proposal to expand lists of certain products for distribution as samples” from July 23, 2020. More information on the amendments here.

GN

External Consultation Graduate Nurse Practice Guideline

The SRNA 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).

SRNA 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 SRNA Executive Director and SRNA Council. The guideline will take effect on the SRNA Council approval date.

Questions or comments are welcome and can be directed to practiceadvice@srna.org.

RN RN(AAP) NP

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

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