NRSG96 - Test 1 Study Notes PDF

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NRSG96 - Test 1 Study Notes Week 1: Legislation Affecting Nurses Regulated Health Professions Act 1991 – Overview (refer to document for details)  Scope of practice for each health profession  Describes generally what the profession does and the methods that it uses  Acknowledges overlapping scope of practice of the health professions  Nursing’s scope of practice is informed by the Nursing Act, 1991  14 Controlled acts  Potentially harmful if performed by unqualified persons 14 Controlled Acts  Communicating a diagnosis identifying a disease or disorder to the individual or representative  Performing a procedure of tissue below…  the dermis,  surface of a mucous membrane  surface of the cornea  surfaces of the teeth  Setting or casting a fracture or a bone or dislocation of a joint  Moving the joints of the spine beyond the individual’s usual physiological ROM..  Administering a substance by injection or inhalation  Putting an instrument, hand or finger…  Applying or ordering the application of a form of energy  Prescribing, dispensing, selling or compounding a drug...  Prescribing or dispensing, for vision or eye problems...  Prescribing a hearing aid for a hearing-impairment  Fitting or dispensing a dental prosthesis, orthodontic or periodontic appliance or a devise inside the mouth...  Managing labour or conducting the delivery of a baby  Allergy testing of a kind in which a positive test is a significant allergic response  Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought… Nurses Act, 1991 – Overview (refer to document for details)  Establishes the mandate of CNO  Defines a scope of practice for the nursing profession  Regulations regarding  Registration  Controlled acts (4)  Quality assurance

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Professional misconduct

Scope of Practice  Promotion of health  Assessment  Provision of care  Treatment of health conditions  Supportive, preventative, therapeutic, palliative and rehabilitative means  To attain or maintain optimal function. Two Categories Six Classes of Certification of Registration Entry to Practice Requirements for Registration (RN, RPN, NP) in Ontario General Class requirements…  Successfully meet the nursing education requirement  Provide evidence of nursing practice  Successfully complete the national registration exam  Successfully complete the jurisprudence exam  Demonstrate language proficiency in either English or French  Provide proof of citizenship, permanent residency or authorization  Complete a Declaration of Registration Requirements Title Protection ONLY members of the CNO can use the title of  Nurse  Registered Nurse  Registered Practice Nurse  Nurse Practitioner (extended class) Controlled Acts RN or RPN may perform a procedure within the controlled acts authorized to nursing  IF ordered by a physician, dentist, chiropodist, midwife or NP  IF initiated by an RN or RPN in accordance with conditions identified in the regulations (knowledge, skill & judgment)  Exceptional circumstances Delegation  A formal process by which a regulated health professional  who is authorized and competent to perform a procedure under one of the controlled acts  Delegates the performance of that procedure to someone  regulated or unregulated  who is not authorized by legislation to perform it.

Controlled Acts When ordered or permitted by regulations pertaining to initiation 1. Performing an prescribed procedure 2. Administering a substance 3. Putting an instrument, hand or finger… 4. Dispensing a drug 5. Treating, by means of psychotherapy technique Initiation of Controlled Acts A nurse can initiate a procedure only when all of the following conditions are met:  the nurse has the knowledge, skill and judgment  to perform the procedure safely, effectively and ethically  to determine whether the client’s condition warrants performance of the procedure having considered…  the nurse accepts sole accountability  known risks and benefits to the individual,  predictability of outcomes of performing the procedure,  the safeguards and resources available in the circumstances to safely manage the outcomes of performing the procedure Initiation of Controlled Acts - RPN Role The following are the procedures that may be initiated (performed) by an RPN who meets the conditions…  Care of a wound below the dermis or the mucous membrane by cleansing, soaking or dressing.  For the purpose of assisting a client with health management activities  a procedure that involves putting an instrument beyond the point…  in the client’s nasal passages where they normally narrow  beyond the client’s larynx  beyond the opening of the urethra.  putting a hand or finger beyond the labia majora  For the purpose of assessing a client or assisting a client with health management activities  a procedure that requires putting an instrument or finger  beyond the anal verge.

Requisite Skills and Abilities Seven categories capture the components necessary for nursing practice. These categories represent reasonable and justifiable skill and ability requirements for entry-level nursing practice in Ontario. Please refer to document for specific skills, abilities and examples. 1. Cognitive 2. Communication

3. Interpersonal 4. Behavioral 5. Psycho-motor 6. Sensory 7. Environmental Entry to Practice Competencies for Ontario Registered Practical Nurses At the completion of their nursing educational program all student nurses must demonstrate the capacity to meet the College of Nurses of Ontario’s (CNO) Entry-to-Practice Competencies for Ontario Registered Practical Nurses and be able to practise within the context of CNO’s nursing practice standards. This document sets out the competencies organized according to a conceptual framework consisting of…  nursing process  regulatory principles Eight Assumptions Entry Level RPN Profile and Accountability

Week 2: College of Nurses of Ontario (CNO) The Registered Practical Nurse In Ontario, nursing is one profession with two categories… 1. Registered Practical Nurse (RPN) 2. Registered Nurse (RN).  RPNs are health care professionals  RPNs combine nursing skill, knowledge and judgment and are experts of nursing care in various sectors of healthcare.  There are areas of overlap between RPNs and RNs, but there are differences as well.  These differences are based on entry-level and ongoing nursing knowledge and competencies. RPN vs RN  RPNs and RNs study from the same body of nursing knowledge.  The foundational knowledge base of RNs and RPNs is different as a result of differences in basic nursing education.  RNs study for a longer period of time, allowing for greater depth and breadth of foundational knowledge in the areas of clinical practice, decision-making, critical thinking, leadership, research utilization and resource management.

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RPNs study for a shorter period of time, resulting in a more focused body of foundational knowledge in the areas identified above.

The autonomy of the RPN is influenced by the complexity of the client’s condition.  Greater autonomy when caring for a client with less-complex conditions.  As client complexity increases, there is a corresponding increase in the need for RPNs to consult with RNs.

Practical Nursing (PN) College Graduate  In Ontario, PNs are community college graduates.  After graduation, PNs write a national certification examination.  Once they successfully complete this exam, they are registered to practice as a nurse by the College of Nurses of Ontario (CNO).  All nurses must renew their CNO registration annually, maintaining up-to-date skills and knowledge of current practices, to preserve their professional standing.  RPNs are regulated by the CNO through the Regulated Health Professions Act, 1993, and the Nursing Act, 1991 as amended.  There are currently 44,195 RPNs registered in Ontario of which 39,111 are currently practicing. What is CNO?  Governing body for RNs, RPNs and NPs in Ontario  Nursing profession has been a self-regulated in Ontario since 1963  Interests of the public placed ahead of professional interests  Nurses have the knowledge & expertise to regulate themselves as individual practitioners & to regulate their profession through the college What is CNO’s Role?  Establishes requirements for entry to practice  Articulates & promotes practice standards  Administers its Quality Assurance program  Enforces standards of practice and conduct  CNO also  Participates in the legislative process  Shares statistical information about Ontario’s nurses Entry to Practice  Ontario applicants http://www.cno.org/en/become-a-nurse/  Entry to practice competencies http://www.cno.org/globalassets/docs/reg/41042_entrypracrpn.pdf 9 Practice Standards

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To support nurses in providing safe and ethical nursing care to the people of Ontario Outline the expectations for nurses that contribute to public protection. Inform nurses of their accountabilities and the public of what to expect of nurses. Apply to all nurses regardless of their role, job description or area of practice.

Quality Assurance  CNO assesses knowledge, skill & judgment of its members  All nurses, in every setting, demonstrate commitment to continually improving their nursing practice  How?  Engaging in practice reflection  Setting & achieving nursing goals Quality Assurance Components  Self assessment  myQA is an online self-assessment http://www.cno.org/en/myqa/  Practice assessment & peer assessment Annual Self-Assessment  Reflect on your practice and obtain peer input to help you determine your strengths and areas for improvement and learning needs  Develop your learning goals (2), based on your learning needs, and the learning activities necessary to achieve your goals  Select the practice document that aligns with each goal  Complete your Learning Plan using myQA  Update your Learning Plan on a continual basis and keep it for two years  Participate in Practice Assessment, if selected. Protect the Public  CNO assesses concerns about the conduct & competence of nurses  Resolved through remediation & resolution processes  CNO responds to concerns regarding a nurse’s physical & mental health and its potential or actual affect on their ability to practice nursing.  Find a Nurse  Register to confirm a nurse is eligible to practice in Ontario https://flo.cno.org/Register/Default.aspx

Registered Practical Nurses of Ontario (WeRPN) Mission

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To engage with and advocate for RPNs to provide high-quality, evidence-informed, patient-centred care

Vision  Respected knowledge-based professionals leading health system policy and professional practice excellence Values  We will embrace changes needed to sustain the health care system. We will lead with respect and care for Ontarians providing excellent care Student Resources  RPNAO strives to support the PN student in their education.  The information RPNAO provides is to further assist the RPN students and empower them to be informed in their future career.

Ontario Public Employees Union OPSEU RPN Occupational Division  OPSEU members who work as RPNs are represented across sectors including  community health care  mental health  hospitals and health care support  long-term care  developmental services  OPS workplaces. OPSEU's RPN Occupational Division will…      

bring together members with common occupational interests and coordinate division activities; identify, coordinate, and promote the scope of practice and professional responsibilities of RPNs within OPSEU and provincially; develop and promote demands for bargaining, health and safety, and workload issues; promote and advocate for RPNs through policy, resolutions and constitutional amendments; develop and build communication links and networks for RPNs; and promote common themes, activities and mandates as they pertain to the sectors and the union.

Canadian Union of Public Employees CUPE Health Care Sector CUPE …  is Canada’s largest union, with over 680,000 members across the country.

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represents workers across a broad range of sectors including health care, emergency services, primary, secondary and post-secondary education, early learning and child care, municipalities, social services, libraries, utilities, transportation and airlines. advocates for workers who deliver the public services people depend on. helps its members provide the highest level of service by ensuring they are safe and healthy at work, and that they get fair pay and benefits for the services they provide. also advocate for better public services, like improvements to public health care and to the Canada Pension Plan, that would improve our communities and the lives all Canadians.

Week 3: Professional Standards Guiding Principle #1  Nursing in Ontario is one profession with two categories  Registered Nurse (RN)  Registered Practical Nurse (RPN) Guiding Principle #2  The foundational knowledge for RNs and RPNs is different  Differences in education Guiding Principle #3  Nurses enhance their knowledge through education, experience and reflection Guiding Principle #4, 5 & 6  Nurses are accountable for their actions  Clients are the central focus of nursing care  The overall goal is best possible client outcome Practice Standards & Guidelines  To ensure public protection  To support nursing practice in Ontario.  Are broad in nature.  Apply to both RNs and RPNs working in different roles and practice settings. Practice Standards  Authoritative statements that set out the professional basis of nursing practice.  Guide to knowledge, skill, judgment & attitude  Nurses are held accountable to the standard of practice. i.e.  Documentation  Medication Guidelines

Documents developed to assist nurses in understanding their responsibilities and in making safe and effective decisions  i.e.  Consent  Utilization of RNs and RPNs Resources  Standards and guidelines and fact sheets  College of Nurses of Ontario website  Compendium of Standards of Practice for Nurses  Speak to a practice consultant 1.800.387.5526  Email a question 

Professional Standards Revised 2002  Overall framework for nursing practice and links with the College’s other practice standards and guidelines and competencies  Seven broad statements 1. Accountability 2. Continuing Competence 3. Ethics 4. Knowledge 5. Knowledge application 6. Leadership 7. Relationships  7a Therapeutic nurse client relationships  7b Professional relationships Accountability - Standard and Indicators  Accountability-Standard Statement  Each nurse is accountable to the public and must meet legislative requirements and standards of the profession  Accountability Indicators  For All Nurses  Seek help and share knowledge  Refrain from performing activities for which she/he is not competent  Accountability of One’s Actions  Assess your ability  Identify areas where your are competent  Identify areas where you require additional education, experience and/or supervision  Outline strategies for meeting your learning needs  Share these strategies with your employer/supervisor/manager  Accountability Indicators  For All Nurses  Identify yourself and explain your role

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Ensure best outcome for your clients Advocate for clients, the profession and the health care system Take responsibility for your errors Practice according to the practice standards, guidelines and legislation Take action when a client is at risk Report unsafe or unprofessional behaviours Maintain core competencies

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Accountability for Administrator Role  Indicators  Ensure staffing is in the best interest of clients and professional practice  Ensure appropriate utilization, education and supervision of staff

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Accountability - Administrator Role  Indicators  Create an environment that encourages ongoing learning  Advocate for quality practice settings

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Accountability - Educator Role  Indicators  Communicate level of preparation and objectives for learning  Ensure appropriate supervision of students  Use standards of practice and evidence-based knowledge

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Accountability - Researcher Role  Ensuring the safety and well-being of clients

Continuing Competence – Standard Statement  Each nurse maintains and improves competence in the Quality Assurance (QA) Program Continuing Competence- Indicators  For All Nurses  Invest time, effort and resources to improve your knowledge, skills and judgment  Be responsible for professional development and the sharing of knowledge  Participate in the QA Program  Reflective practice  Practice review  Advocate for improvements  Advocate for resources to promote continuing competence 

Continuing Competence - Administrator Role  Indicators  Support reflective practice  Encourage and seek opportunities for continuous learning

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Incorporate Reflective Practice into agency professional development systems Advocate for quality practice settings

Continuing Competence- Educator Role  Indicators  Support students and nurses in becoming reflective practitioners  Develop, implement and facilitate learning activities  Support nurses in engaging in ongoing learning

Continuing Competence - Researcher Role  Indicators  Encourage evaluation of practice through research  Communicate best practice research results

Ethics -Standard Statement  Each nurse understands and upholds the values and beliefs described in the College’s Ethics practice standard. Ethics-Indicators  For All Nurses  Practice according to ethical values, act with integrity, honesty and professionalism  Identify personal values and ensure lack of conflict  Take action to resolve ethical issues Ethical Care Is…  Promoting the values of client well-being  Respecting client choice  Assuring privacy and confidentiality  Respecting quality of life  Maintaining commitments  Respecting truthfulness  Ensuring fairness in the use of resources Ethical Values  Fairness  Client well-being  Privacy and confidentiality  Respect for life  Truthfulness  Maintaining commitments Ethics-Administrator Role

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Indicators  Create an environment that promotes safe, effective and ethical practice  Value time taken to resolve ethical issues  Advocate for resources and establish mechanisms to assist with ethical issues  Support nurses in developing skills to manage ethical issues  Advocate for nurses on ethics committees

Ethics-Educator Role  Indicators  Encourage and support critical thinking and dialogue about ethical issues  Obtain resources to improve recognition and resolution Ethics-Researcher Role  Indicators  Ensure the client has information to make decisions  Participate in a ethical review of research  Ensure ethical guidelines are followed Knowledge – Standard Statement  Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice.  Entry to Practice Competencies for RPNs (2014) http://www.cno.org/globalassets/docs/reg/ 41042_entrypracrpn.pdf Knowledge - Indicators  For All Nurses  Use theory and evidence to make decisions;  Seek, review and apply research in practice; and  Understand the legislation and standards relevant to nursing.  Know how practice environments affect practice;  Know how and where to access learning resources; and  Understand how bio-psychosocial needs and cultural background relate to health needs. 

In Addition, RNs Must  Contribute to the generation of new professional knowledge through research; and  Seek, critique and use philosophical, theoretical and research-based literature in practice.

Knowledge - Administrator Role  Understand how ...