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  • “Reasonable foreseeability of natural death” criterion has been repealed.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.

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 CRNS 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 CRNS will be setting up meetings to inform stakeholders of the project and discuss future consultation. If you are interested in attending any CRNS upcoming information sessions regarding the project, please email Donna Cooke, Nursing Advisor at dcooke@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.

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 CRNS 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 CRNS 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 CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

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 (CRNS, 2017). Section four of the guideline outlines the expectations of referring physicians. The CRNS 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 CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

Reference:

College of Registered Nurses of Saskatchewan (CRNS). (2017). Registered Nurse (Nurse Practitioner) Practice Standards. Retrieved from https://www.crns.ca/wp-content/uploads/2019/05/RNNPPracticeStandards2017.pdf

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

As a member of the national steering committee, the CRNS 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 CRNS’s role, please contact Donna Cooke, Nursing Advisor, Regulatory Services at dcooke@crns.ca or phone 1-800-667-9945 (ext. 202) or 306-359-4202.

24 Hour RN Coverage Resources

With the recent transition towards a single mandate organization, the CRNS 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.

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 CRNS 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@crns.ca)

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@crns.ca). 

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