Nursing Practice Updates

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

NP RN

Medication Management Guideline

The SRNA is pleased to announce the release of an updated nursing practice guideline, Medication Management Guideline. The guideline has been updated to reflect current, evidence-informed best practices and applies to all categories of nursing practice.

Please review this document and consider how it 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 RN

Joint Message about Ivermectin in the Prevention and Treatment of COVID-19

Ivermectin for prophylaxis or treatment of COVID-19 has been promoted on social media and is not supported by scientific evidence. In humans, ivermectin is only approved for treatment of parasitic infections and rosacea.

Based on the current scientific evidence and best-practice guidelines, the College of Physicians and Surgeons (CPSS), the Saskatchewan Registered Nurses Association, the Saskatchewan College of Pharmacy Professionals, the Saskatchewan Medical Association, and the Pharmacy Association of Saskatchewan disapprove of the use of ivermectin for either treatment or prophylaxis for COVID. This opinion is further supported by the evidence from Health Canada, the World Health Organization (WHO), Alberta Health Services Covid-19 Scientific Advisory group, and the British Columbia COVID-19 Therapeutics Committee guidance document.

The joint statement is available here.

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 RN

Ethical Considerations for Industry Sponsorship

Industry sponsorship consists of any interest: personal; business; commercial; political; academic; or financial offered by a private, for-profit, or commercial enterprise as part of its marketing and public relations efforts. When encountering industry sponsorship, Registered Nurses (RN) and Nurse Practitioners (NP) must be aware of conflicts of interest. A conflict of interest can be an actual, perceived or potential conflict between the professional duty of an RN or NP and their private interests. A conflict of interest can occur when the RN or NP is in a position to make a decision based upon what is beneficial to their individual interests (i.e., deriving personal benefit [Traversy et al., 2021]) and not in the best interest of the client.

RNs and NPs can engage in ethical considerations for industry sponsorship to ensure safe, competent and ethical care for clients in Saskatchewan by:

  • Reflecting on and practicing according to current SRNA practice documents, including:
    • The Registered Nurses Act, 1988; SRNA bylaws; CNA Code of Ethics for Registered Nurses; Registered Nurse Practice Standards; Registered Nurse Entry-Level Competencies; Registered Nurse (Nurse Practitioner) Practice Standards; Registered Nurse (Nurse Practitioner) Entry-Level Competencies; and other SRNA documents as appropriate.
  • Understanding the employer’s conflict of interest policy. If a conflict of interest policy does not exist, advocate for policy that addresses conflict of interest.
  • Identifying and seeking to avoid conflict of interest to ensure the maintenance of public trust.
    • Any conflict of interest must be resolved in favour of the interest of the client receiving care.
  • Being fully transparent and fully disclosing any actual, perceived or potential conflict of interest when engaging in industry sponsorship.

This nursing practice update replaces the former SRNA Ethics Guidelines for Industry Sponsorship, 2015.

Questions or comments are welcome and can be directed to practiceadvice@srna.org or by phone: 306.359.4200 or 1.800.667.9945 (toll-free within Canada).

Resources:
RN Practice Standards
RN Entry-Level Competencies
CNA Code of Ethics (2017)
Registered Nurse (Nurse Practitioner) Entry-level Competencies (ELC)s SRNA
Registered Nurse (Nurse Practitioner) Practice Standards SRNA
Self-Employed Practice Guideline

Reference:
Traversy, G., Barnieh, L., Akl, E. A., Allan, G. M., Brouwers, M., Ganache, I., … & Tonelli, M. (2021). Managing conflicts of interest in the development of health guidelines. CMAJ, 193(2), E49-E54.

NP RN

Triaging in Emergency Departments

Registered nurses (RN) are responsible and accountable to provide evidence-based, safe, competent and ethical nursing care in all practice settings. In the emergency department, “the process of triage is essential for safe and appropriate care of the emergency department patient” (National Emergency Nurses Association [NENA], 2019).

In 2019, NENA revised their position statement, Role of the Triage Nurse and includes the following key points:

  • Triage is a sorting process that requires rapid assessment, critical thinking and application of a standard set of guidelines with patients that can experience instability and changes to their condition.
  • The process of triage is best carried out by RNs and Nurse Practitioners (NP) with emergency nursing expertise who have completed a triage-specific educational program.

RNs and NPs work in the emergency department as part of a multidisciplinary team, where safe and appropriate care is best achieved through collaboration and respect.

This nursing practice update replaces the former Triaging in Emergency Departments SRNA and SALPN Joint Statement, 2013.

If you have questions, please contact an SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@srna.org.

 

Reference:

National Emergency Nurses Association. 2019. Role of the Triage Nurse. Retrieved from https://nena.ca/w/wp-content/uploads/2014/11/Role-of-the-Triage-Nurse-2.pdf

NP RN

Physician to RN Delegation

The College of Physicians and Surgeons of Saskatchewan (CPSS), through The Medical Professions Act, 1981 and their bylaws provide the opportunity for physicians to delegate certain activities to Registered Nurses (RN). The current CPSS Bylaw 23.3 permits delegation from a physician to an RN.

RNs who are considering accepting a delegation from a physician must understand the conditions for this to occur. RNs accepting a delegation from a physician should ensure that they:

  • are certain that the practice is in the best interest of the client in their surrounding environment, including assessment of the risks and all possible outcomes;
  • are willing to only accept a delegation from a physician if the activity is specified in the current CPSS Bylaw 23.3 and for which they are competent;
  • confirm appropriate education, supervision, support and communication avenues are in place with the delegating physician before performing a delegated medical activity;
  • possess the competencies required to manage any outcomes of that activity, including intended and unintended consequences;
  • do not delegate any activity delegated by a physician, to another RN or any other health care provider;
  • are practicing within the legislated scope of registered nursing practice and are upholding the current standards, competencies and code of ethics;
  • have a written agreement with the physician who is delegating to the RN;
  • verify that employer policies and processes are in place to enable acceptance of a delegation from a physician; and,
  • adhere to the employer policy and procedure for a delegated medical activity. That said, no employer policy can relieve RNs of their professional accountability and responsibility. The RN must ensure that:
    • roles, responsibilities and authority, specific for the physician and RN, are clearly outlined in the policies and procedures, including clear lines of reporting and communication;
    • a collaborative process with representation from appropriate professionals, guides the development of these policies and procedures, to ensure professional roles are accurate, professional accountabilities and standards can be met, and that the documents are based upon evidence-informed best practice; and that
    • there is ongoing monitoring and evaluation of the physician to RN delegation process.

The information contained within this nursing practice update replaces the former SRNA document, Guidelines for Physician to RN Delegation.

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

External Consultation MAiD Guideline

Following feedback from Canadians, experts, practitioners, stakeholders, Indigenous groups, provinces and territories, changes were made to Medical Assistance in Dying legislation which took effect on March 17, 2021.

In response, the SRNA has revised and updated the Guidelines for RN Involvement in Medical Assistance in Dying and the Guidelines for NP Involvement in Medical Assistance in Dying.

The new document Medical Assistance in Dying identifies the changes to the legislation as well as combines the two previous documents into one document. The SRNA is seeking feedback from members, stakeholders and the public related to the new document. Please access the document here. Please access the survey questions here. The SRNA would appreciate any feedback by July 13, 2021, at 4:30 pm.

Final approval of the document is through the SRNA Executive Director and SRNA Council. The document will take effect on the day of SRNA Council approval.

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

NP

Changes to The Coroners Amendment Act, 2019

On June 1, 2021, The Coroners Amendment Act, 2019 and The Coroners Amendment Regulations, 2021 came into force making several changes to The Coroners Act, 1999 and The Coroners Regulations, 2000. There are a couple of changes that may be important for Nurse Practitioners (NP) to be aware of with respect to the reporting of deaths resulting from medical assistance in dying (MAiD). The changes include:

1. The definition of “medical assistance in dying” as defined in section 241.1 of the Criminal Code has been moved from The Coroners Regulations, 2000 to Section 2 of The Coroners Act, 1999.

2. Subsection 7(4) has been added to The Coroners Act, 1999 which clarifies that the reporting requirements under section 7 do not apply with respect to a person who died as a result of medical assistance in dying where the underlying cause leading to death is natural, i.e. from a natural disease process.

3. Subsection 7(5) has been added which requires an NP to report a death resulting from medical assistance in dying to a coroner if the underlying cause leading to the death is unnatural, i.e. from injury rather than disease.

If you have questions, please contact an SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@srna.org.

NP RN

Drug Recall and Pharmacist Approved Substitutes

As per the safety alert from Health Canada, there is a significant recall of Angiotensin II Receptor Blockers (ARBs) including irbesartan, losartan and valsartan due to an azido impurity. To ensure the continuity of care for patients using ARBs, the Registrar for the Saskatchewan College of Pharmacy Professionals (SCPP) has passed emergency exemptions that allow pharmacists to prescribe therapeutic substitutions, in collaboration with the College of Physicians and Surgeons of Saskatchewan, the Saskatchewan Registered Nurses Association and the Ministry of Health. See the joint recall notification

If you have questions, please contact an SRNA Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@srna.org.

NP RN

SRNA Social Media Resource

The SRNA is pleased to announce the release of a new Social Media resource. This resource has been created using current information and feedback from SRNA members and the public. The resource provides guidance and recommendations to SRNA members who utilize social media both inside and outside the workplace. The resource offers strategies to balance advocacy and engagement while also adhering to the practice standards and the code of ethics.

Please review this document and consider how it 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 RN

Medication Management Guideline

The SRNA is currently reviewing the Medication Management Guideline and is seeking feedback on the content. Medication management is one of the most important responsibilities Registered Nurses (RN) have. This document is applicable to all designations and outlines the responsibilities of both the RN and the employer, as well as the importance of providing safe and competent client care.

The SRNA is seeking feedback on this document from members and stakeholders, including the public, 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 the document here and the survey here. Feedback will be accepted until Tuesday, May 18, 2021 at 4:30 pm.

Final approval of the document is through the SRNA Executive Director and SRNA Council. The document will take effect on the day of SRNA Council approval.

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

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)

Scroll to top
X