PAN-A test 1 study notes PDF

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PAN-A Test 1 Week 1 Legislation and Jurisprudence Regulated Health Professions Act 1991  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 1-3 1. Communicating a diagnosis identifying a disease or disorder to the individual or representative 2. Performing a procedure of tissue below…  the dermis,  surface of a mucous membrane  surface of the cornea  surfaces of the teeth 3. Setting or casting a fracture or a bone or dislocation of a joint 14 Controlled Acts 4-7 4. Moving the joints of the spine beyond the individual’s usual physiological ROM.. 5. Administering a substance by injection or inhalation 6. Putting an instrument, hand or finger…  Listed under the Nurse Act slide 7. Applying or ordering the application of a form of energy 14 Controlled Acts 8-11 8. Prescribing, dispensing, selling or compounding a drug... 9. Prescribing or dispensing, for vision or eye problems... 10. Prescribing a hearing aid for a hearing-impairment 11. Fitting or dispensing a dental prosthesis, orthodontic or periodontic appliance or a devise inside the mouth... 14 Controlled Acts 12-14 12. Managing labour or conducting the delivery of a baby 13. Allergy testing of a kind in which a positive test is a significant allergic response 14. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought… The Nurses Act 1991  Establishes the mandate of CNO

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Defines a scope of practice for the nursing profession Regulations regarding  Registration  Controlled acts (5)  Quality assurance  Professional misconduct

The Nurses Act – Scope of Practice  The practice of nursing is the promotion of health & the assessment of the provision of care for and the treatment of health conditions by supportive, preventative, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function.

The Nurses Act-Categories 1. Registered Nurses RN 2. Registered Practical Nurses RPN The Nurses Act-Classes of Certification of Registration 1. General Class (majority of RN’s and RPN’s) 2. Extended Class (nurse practitioners) 3. Temporary Class (new grads) 4. Special Assignment Class (valid 1 year) 5. Emergency Assignment Class (declared emergency by province ie; Covid) 6. Non-practicing Class (not currently practicing nurses) The Nurses Act-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 

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

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o IF ordered by a physician, dentist, chiropodist, midwife or NP o IF initiated by an RN or RPN in accordance with conditions identified in the regulations (knowledge, skill & judgment)  Assessment  Identify problem  Consider all options  Weigh risks and benefits  Decide on course of action  Accept sole responsibility for consequences Exceptional circumstances  Emergency  Supervision  Please refer to the Act for more details

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. The Nurses Act-Controlled Acts 1-2  When ordered or permitted by regulations pertaining to initiation 1. Performing a prescribed procedure below the dermis or mucous membrane 2. Administering a substance by injection or inhalation  Acupuncture is exempt from the controlled act of performing a procedure on tissue below the dermis when it is performed by a nurse in accordance with College standards. Therefore, authorization (e.g., an order) is not required for nurses to perform acupuncture. The Nurses Act-Controlled Acts 3-4 3. Putting an instrument, hand or finger… 1. Beyond the external ear canal 2. Beyond the point in the nasal passages where they normally narrow 3. Beyond the larynx 4. Beyond the opening in the urethra 5. Beyond the labia majora 6. Beyond the anal verge 7. Into an artificial opening in the body 4. Dispensing a drug

The Nurses Act-Controlled Acts 5 5. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional

regulation, perception or memory that may seriously impair the individual’s judgement, insight, behavior, communication or social functioning. The Nurses Act-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.  the nurse has the knowledge, skill and judgment to determine whether the client’s condition warrants performance of the procedure.  the nurse determines that the client’s condition warrants performance of the procedure having considered:  the known risks and benefits to the individual,  the predictability of outcomes of performing the procedure The Nurses Act-Initiation of Controlled Acts  the safeguards and resources available in the circumstances to safely manage the outcomes of performing the procedure, and  other relevant factors specific to the situation.  the nurse accepts sole accountability for determining that the client’s condition warrants performance of 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 on the previous slides… 1. Care of a wound below the dermis or the mucous membrane by cleansing, soaking or dressing. 2. 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 or beyond the opening of the urethra. 3. For the purpose of assisting a client with health management activities, a procedure that requires putting a hand or finger beyond the labia majora 4. 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 (ex. disimpaction). The Nurses Act-Professional Misconduct  An act or omission that breaches accepted ethical and professional standards of conduct

Jurisprudence Examination  These exams test your knowledge and understanding of the laws, regulations, College by-laws, and practice standards and guidelines that govern the nursing profession in Ontario.

The jurisprudence exam is an open-book online exam you can write at any time during your application. You can take the exam as many times as you need. http://www.cno.org/en/become-a-nurse/entry-to-practice-examinations/jurisprudenceexamination/ 

Jurisprudence Exam Content  Assess competencies in 5 areas 1. Self-Regulation 2. Scope of Practice 3. Professional Accountability and Responsibility 4. Ethical Practice 5. Nurse-Client Relationship http://www.cno.org/en/become-a-nurse/entry-to-practice-examinations/jurisprudenceexamination/competencies/

Week 2 CNO The RPN  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. 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, 1991, and the Nursing Act, 1991 as amended.  As of January 4, 2021, there are currently 57,335 RPNs registered in Ontario of which 53,544 are currently practicing. 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.

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 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.  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.

What is CNO?  Governing body for RNs, RPNs and NPs in Ontario  Nursing profession has been self-regulated in Ontario since 1963  The interests of the public are placed ahead of professional interests  Nurses have the knowledge & expertise to regulate themselves as individual practitioners & to regulate their profession through the college (CNO)  CNO protects the public What is CNO’s Role?  Establishes requirements for entry to practice  Articulates & promotes practice standards  Administers 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 https://www.cno.org/globalassets/docs/reg/41042_entrypracrpn-2020.pdf 9 Practice Standards  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 http://www.cno.org/en/myqa/ Quality Assurance Components  Self-assessment  myQA is an online self-assessment  Practice assessment  College assigned 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 Action Plan using myQA  update your Action 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 effect on their ability to practice nursing.  Find a Nurse  Register to confirm a nurse is eligible to practice in Ontario https://registry.cno.org/ We RPN  The registered practical nurses of Ontario, previously known as the RNAO, was changed to We RPN in 2019. this is the professional association of registered practical nurses of Ontario  We RPN supports the nurses Mission Vision Values  Mission  To engage with and advocate for RPNs to provide high-quality, evidence-informed, patient-centered care  Vision  Respected knowledge-based professionals leading health system policy and professional practice excellence  Values

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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  WeRPN strives to support the PN student in their education.  The information WeRPN provides is to further assist the RPN students and empower them to be informed in their future career. https://www.werpn.com/learn/student-resources/ https://www.werpn.com/wp-content/uploads/2020/07/WeRPN_Student_Brochure.pdf 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. CUPE is…  CUPE is Canada’s largest union, with over 700,000 members across the country.  CUPE represents workers across a broad range of sectors including health care, emergency services, primary, secondary and post-secondary education, early learning and childcare, municipalities, social services, libraries, utilities, transportation and airlines. CUPE  CUPE advocates for workers who deliver the public services people depend on.  CUPE 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.

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CUPE 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 Professional standards  The legislation requires the college to publish the results of public hearings held by its discipline committee to fill this requirement the college publishes summaries of decisions and provides links to full text neutralized versions of its decision under the members profile on fine dinners.  Using the link, it will take you to the discipline decisions page on the CNO website. www.cno.org/en/protect-public/discipline-decisions/ Factors Influencing Standard Development  nursing practice  laws and government policy  societal and health care context  public confidence  College Council and committees  College members and stakeholders This process involves many stages…  Exploration: where an ongoing environmental scan is conducted to identify actual or potential risks of nursing practice to the public interest.  Research and analysis: where there's an investigation of the risks and how they can be lessened by collecting comprehensive information.  Development: where standards are developed based on the best available evidence with input from members of the public and extensive consultation with nurse’s stakeholders an expert.  Knowledge sharing and implementation: where standards are published and communicate information to nurses and other stakeholders.  Approval: where council must approve nursing standards.  Monitoring & Evaluation: where we use different sources of information to ensure the standards achieve their intended purpose and stay relevant to public protection overtime. Guiding Principle #1 1. Nursing in Ontario is one profession with two categories  Registered Nurse (RN)  Registered Practical Nurse (RPN) Guiding Principle #2 2. The foundational knowledge for RNs and RPNs is different  Differences in education

Guiding Principle #3 3. Nurses enhance their knowledge through education, experience and reflected practice. Guiding Principle #4, 5 & 6 4. Nurses are accountable for their actions 5. Clients are the central focus of nursing care 6. 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 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 you are competent  Identify areas where you require additional education, experience and/or supervision  Outline strategies for meeting your learning needs  Share these strategies you’re your employer/ supervisor/ manager Accountability Indicators  For All Nurses  Identify yourself and explain your role  Ensure best outcome for your clients  Advocate for clients, the profession and the health care system Accountability Indicators  For All Nurses  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 behaviors  Maintain core competencies 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 Accountability - Administrator Role  Indicators  Create an environment that encourages ongoing learning  Advocate for quality practice settings

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 Accountability - Researcher R...