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Relevant Provincial Legislation (15 Competencies)

The NP Jurisprudence Examination uses a multiple choice format that consists of a variety of questions that have been developed to assess the applicant’s competencies within four (4) categories: Regulatory Policies, relevant Federal Legislation, relevant Provincial Legislation and relevant Provincial Policies. Within each of these categories is a list of policies &/or legislation to be tested. To guide your study, each section includes a list of competencies, objectives, a synopsis of information and links to relevant resources.  This study guide is specific to provincial legislation.

Note for all Acts: NPs are not defined as medical practitioners under any provincial Act or Regulations. This term is use to define the physician role.


Registered Nurse Act (3 competencies)

1. Practises in a manner consistent with the act governing the practice of a nurse practitioner

Objectives

The nurse practitioner will:

  • articulate the definition ‘practice of a nurse practitioner’ as it applies in the clinical practice setting

SYNOPSIS OF INFORMATION

Having knowledge of what is included within the definition of ‘practice of a nurse practitioner’ will be useful when answering questions throughout the jurisprudence examination. The practice of a nurse practitioner is defined within the Registered Nurses Act [Section 2 (ak)] as:

The application of advanced nursing knowledge, skills and judgment in addition to the practice of nursing in which a nurse practitioner in collaborative practice may, in accordance with standards for nurse practitioners, do one or more of the following:

  • make a diagnosis identifying a disease, disorder or condition,
  • communicate the diagnosis to the client and health care professionals as appropriate,
  • perform procedures,
  • initiate, order or prescribe consultations, referrals and other acts,
  • order and interpret screening and diagnostic tests, and recommend, prescribe or reorder drugs, blood, blood products and related paraphernalia,

and also includes research, education, consultation, management, administration, regulation, policy or system development.

Collaborative practice is defined in the RN Act [section 2(d)] as:

a relationship among a nurse practitioner, a physician or group of physicians, an employing organization and other health professionals who are relevant to the nurse practitioner’s practice, that enables the health-care providers in this relationship to work together to use their separate and shared knowledge and skills to provide optimum client-centered care in accordance with standards of practice for nurse practitioners and the guidelines for collaborative practice teams and employers of nurse practitioners approved by the College.

In order to practice in Nova Scotia, nurse practitioners are required by legislation to establish a collaborative practice relationship with a physician or group of physicians. This relationship ensures that nurse practitioners have access to at least one physician who has agreed to be available for client-care consultation (in person, by telephone, in writing or electronically). This formal relationship does not prevent the nurse practitioner from collaborating with other physicians or providing care to their patients. It also does not prevent the nurse practitioner from providing services when the collaborating physician is not available— as long as alternate arrangements have been made.

RESOURCE LINKS

2. Practises as directed within Part II: Registration and Licensing

Objectives

The nurse practitioner will:

  • explain that a licensure status search is available to the public which identifies the name & registration of every person authorized to engage in the practice of a nurse practitioner

SYNOPSIS OF INFORMATION

As noted in the RN Act (Part II, Registration and Licensing, section 9) a record must be available to the public and include the name & registration number of every person authorized to engage in the practice of nursing. A licence status check found on the CRNNS website is one way of meeting this legislative requirement.

In the RN Act (Part IV, Nurse Practitioners, s. 59) a temporary licence must be issued for a specified period of time not to exceed six months in total.  CRNNS registration policy indicates however if an individual fails the NP exam; the temporary licence is no longer valid.

RESOURCE LINKS

3. Practises as directed within Part IV: Nurse Practitioners

Objectives

The nurse practitioner will:

  • articulate the specified circumstances for which a temporary license may be issued
  • articulate the specified restrictions for temporary license holder
  • identify what is required in order to engage in the practice of a nurse practitioner
  • identify CRNNS requirements when NPs change their client population and practice setting
  • identify the two statutory committees that relate to nurse practitioners and their practice
  • explain accountability for client records when nurse practitioners leave their practice

An individual must hold an active-practising RN licence with or without restrictions prior to being issued a temporary NP license.

SYNOPSIS OF INFORMATION

In the RN Act (Part IV, Nurse Practitioners, section 59) a temporary licence may be issued for a specified period of time not to exceed six months in total. Another temporary licence may be issued after the expiry date of the recent temporary licence as long as the applicant has not failed the NP licensure exam or 12 months have not passed since they completed the requirements of their program.

A temporary licence may be issued to applicants who are eligible to write the NP exam or have written the NP examination and are awaiting the results. CRNNS registration policy indicates however if an individual fails the NP exam, the temporary licence is no longer valid. There are no conditions and restrictions on NP temporary licenses, however, the CEO/Registrar may impose conditions or restrictions on an NP license if they are necessary in the interest of the public.

In accordance with the CRNNS By-Laws, candidates shall have a maximum of three (3) opportunities to pass the nurse practitioner (NP) examination. The first writing of the exam shall be at the earliest reasonable opportunity following eligibility to write. In the event the candidates do not pass the first write, candidates shall have a maximum of two (2) further opportunities to pass the examination in the twenty-four (24) month period immediately following their first writing of the applicable examination.

In accordance with the RN Act [Part IV, Nurse Practitioners, section 60 (2) and (3)], no person shall engage in the practice of a nurse practitioner in the Province unless the person holds a nurse practitioner licence or a temporary NP licence (with or without conditions or restrictions).  In addition, no person can engage in the practice of a nurse practitioner, unless such practice is consistent with the standards for nurse practitioners; and is within that nurse practitioner’s individual scope of practice.

A student enrolled in a nurse practitioner program may engage in the practice of a nurse practitioner if such practice is authorized to be performed by the administrators of the program. Students cannot hold a temporary NP license until they have successfully completed their NP program.

Temporary licence holders receive liability coverage through the Canadian Nurses Protective Society (CNPS).

NP temporary licence holders may use the designation Nurse Practitioner, N.P. or NP, or any derivations thereof.

The temporary licence is rescinded or cancelled by Registration Services on the date the:

  • temporary licence expires;
  • College receives notification the temporary licence holder has failed the NP examination for the first time;
  • temporary licence holder becomes licensed as an NP with CRNNS; or
  • temporary licence is suspended or revoked under the professional conduct process.

In accordance with Standard 1 – Responsibility and Accountability in the Nurse Practitioner Standards of Practice, nurse practitioners are responsible and accountable for providing competent, safe and ethical care within their legislated scope of practice. They perform these functions in accordance with their educational preparation, competence and focus of practice.

In accordance with the RN Act [Part IV, Nurse Practitioners, section 60 (6), (7) and (8)] and Section 50 (1) and (2) of the RN Regulations, where a nurse practitioner is changing practice settings to practise with a different client population, the Nurse Practitioner Committee shall ensure that the person has the appropriate competencies to meet the standards of practice for nurse practitioners in the different practice setting. The nurse practitioner and employers are accountable to advise the Nurse Practitioner Committee of the change in practice settings.

According to the Registered Nurses Act, CRNNS is required to establish statutory committees to carry out the essential functions related to its regulatory mandate. The statutory committees specifically related to Nurse Practitioners are the Nurse Practitioner committee and the Interdisciplinary NP Practice Review Committee.

According to RN Act (Section 63), “client records includes all documents charts, laboratory specimens, x-rays, photographic film or any other form of record relating to the clients of a nurse practitioner or a self-employed registered nurse”.   In the event of inadequate provision for the protection of client records (e.g. abandonment of a clinic practice), CRNNS may, with or without notice as the court directs, request the court to appoint a custodian of the client records.

RESOURCE LINKS 

Registered Nurse Regulations (3 competencies)

1. Practises as directed within Part II: Registration, Licensing and Membership 

Objectives

The nurse practitioner will:

  • list the criteria required in order to enter the nurse practitioner roster

SYNOPSIS OF INFORMATION

In addition to the criteria in Sections 10 & 11 of the RN Regulations, nurse practitioners are bound by the criteria in Section 19 of the RN regulations; which requires a number of regulatory criteria for licensure as an NP in Nova Scotia.  These include, but are not limited to, holding an active practicing RN licence, successful completion of the appropriate NP examination and 600 hours of practice as an NP in the 2 years immediately before their application for entry in the nurse practitioner roster.

RESOURCE LINKS

2. Practises as directed within Part III: Records and Audit of Records

Objectives

The nurse practitioner will:

  • state why a valid record of hours must be kept for previous 2 years

SYNOPSIS OF INFORMATION

According to the RN Act (2006, Section 8) and RN Regulations (Section 39), CRNNS may at any time conduct an audit of members’ records to ensure validity of the data that is recorded on applications to CRNNS. One measure of competency is a determination of the number of hours of worked as a nurse practitioner in the immediate two years prior to licensure. In compliance with the RN Regulations (Section 19), a nurse practitioner must obtain 600 hours in this time frame.

RESOURCE LINKS

3. Practices as directed within Part IV: Committees (Educational Advisory Committee, Interdisciplinary NP Practice Review Committee and Nurse Practitioner Committee)

Objectives

The nurse practitioner will:

  • define the role of Educational Advisory Committee in nursing education program approval
  • define the role of Interdisciplinary NP Practice Review Committee in nursing education program approval
  • define the role of Nurse Practitioner Committee in nursing education program approval

SYNOPSIS OF INFORMATION

In accordance with RN Regulations (Section 41), the Education Advisory Committee ensures all of the following for nurse practitioner programs:

  • the curriculum provides the necessary learning experiences for students to achieve professional practice and ethical standards and entry-level competencies for beginning nurse practitioners;
  • program activities and resources support the achievement of program goals and expected outcomes;
  • the program provides students with opportunities to demonstrate progress toward achieving professional practice and ethical standards and entry-level competencies for beginning nurse practitioners;
  • the program provides appropriate clinical experience and assessment of that experience to demonstrate that graduates of the program are competent to practise as beginning nurse practitioners;
  • the program prepares graduates to practise according to practice and ethical standards and entry-level competencies for beginning nurse practitioners.

Interdisciplinary NP Practice Review Committee

In accordance with RN Regulations (Section 46), the Interdisciplinary NP Practice Review Committee reviews the practice of nurse practitioners through the Nurse Practitioner – Quality Monitoring and Improvement Program (NP-QMP)™. The program consists of a primary practice review which includes multi-source survey feedback and an exception review process. When required a secondary practice review is also conducted.  The NP-QMP™ provides NPs with detailed, multi-source performance feedback from a comprehensive self-assessment, NP and physician colleagues, other health professionals and co-workers, and patients/residents and/or parents/guardians. This feedback is presented to NPs in a confidential report and provides the information they need to set goals to improve their practice.

Nurse Practitioner (NP) Committee

In accordance with RN Regulations (Section 50) and CRNNS Policy, the NP Committee conducts competence assessments for nurse practitioners, applicants for entry in the NP’s roster or NP with conditions or restrictions roster in any of the following circumstances:

  • a NP has changed practice settings or is working with a different client population;
  • a NP has not maintained their 600 hours of practice in the 2 years immediately before his/her application for entry in the nurse practitioner roster;
  • an applicant’s NP program completed outside of Nova Scotia is not equivalent to a Nova Scotia NP Program;
  • where documents cannot be obtained by an applicant for reasons beyond the applicant’s control; or
  • a competence assessment is otherwise required by the Act or these regulations.

RESOURCE LINKS

Adoption Information Act (1 competency)

1. Practises in a manner consistent with the Adoption Information Act that directly governs nursing practice.

Objectives

The nurse practitioner will:

  • define the purpose of the Adoption Information Act
  • identify the compelling circumstances that would allow disclosure under the Act

SYNOPSIS OF INFORMATION

The purpose of the Adoption Information Act as stated in Section 2 is to:

(a) establish the criteria by which

(i) persons who are adopted and of the age of majority may have access to information concerning their birth families,

(ii) birth parents and adoptive parents of adopted persons may have access to information concerning their children, and

(iii) relatives and other persons may, in special circumstances, have access to information concerning the birth family of adopted persons;

(b) establish controls for adoptive parents over access by adopted persons under the age of majority to information concerning their birth families;

(c) provide for the circumstances under which reunions of persons separated as a consequence of adoption will be facilitated; and

(d) establish an appeal procedure for applications made pursuant to this Act.

Sections 13 through 16 of the Act, noted below, outline the disclosure of specific information available to the adopted person, birth parent, birth sibling or relatives through application to the Director.

Application by adopted person

13 An adopted person may apply to the Director for disclosure of

(a) the adopted person’s birth name;

(b) the name of the adopted person’s birth mother;

(c) the name of the adopted person’s birth father;

(d) where there are adopted birth siblings of an adopted person, the birth names of those persons;

(e) where there are adopted birth siblings of an adopted person, the adoptive names of those persons.

Application by birth parent

14 A birth parent may apply to the Director for disclosure of the adoptive name of an adopted person of whom the birth parent is a birth parent.

Application by birth sibling

15 (1) A birth sibling, with the written consent of a birth parent, may apply to the Director for disclosure of the adoptive name of an adopted person of whom the birth sibling is a birth sibling.

      (2) Where

(a) the birth parent whose consent is required pursuant to subsection (1) is deceased;

(b) the birth sibling provides evidence to the Director that the birth sibling has conducted a reasonable search to locate the birth parent whose consent is required pursuant to subsection (1), and has failed to locate the birth parent; or

(c) the regulations prescribe that the consent required pursuant to subsection (1) may be dispensed with,

the Director may dispense with such consent.

Application by relative

16 (1) Where an adopted person has died, a relative of the adopted person may apply to the Director for disclosure of

(a) the adopted person’s birth name;

(b) the name of the adopted person’s birth mother;

(c) the name of the adopted person’s birth father;

(d) where there are adopted birth siblings of an adopted person, the birth names of those persons; or

(e) where there are adopted birth siblings of an adopted person, the adoptive names of those persons.

      (2) Where a birth parent of an adopted person has died, a relative of the birth parent may apply to the Director for disclosure of the adoptive name of the adopted person whose birth parent is deceased.

(3) A relative who applies pursuant to subsection (1) or (2) shall submit, with the application, proof of death of the adopted person or birth parent, as the case may be.

RESOURCE LINKS

Health Protection Act, Reporting of Notifiable Diseases and Condition Regulations (1 competency)

1. Practises in a manner consistent with the Reporting of Notifiable Diseases and Condition Regulations that directly governs nursing practice 

Objectives

The nurse practitioner will:

  • identify diseases that must be reported to Public Health

SYNOPSIS OF INFORMATION

In the Health Protection Act, Section 31 under Notifiable Diseases or Conditions, a registered nurse who has reasonable grounds to believe that a person has or may have a notifiable disease or condition must report that belief to a medical officer of health.

31 (1) A physician, a registered nurse licensed pursuant to the Registered Nurses Act or a medical laboratory technologist licensed pursuant to the Medical Laboratory Technology Act who has reasonable and probable grounds to believe that a person

(a) has or may have a notifiable disease or condition; or

(b) has had a notifiable disease or condition,

shall forthwith report that belief to a medical officer

31 (5) A physician, registered nurse licensed pursuant to the Registered Nurses Act or an administrator of an institution who believes that an illness is serious and is occurring at a higher rate than is normal, shall forthwith report that belief to a medical officer. 

Diseases that must be reported can be found in A Guide to the Health Protection Act & Regulations in Appendix A.  The list of guidance documents related to the Health Protection Act and Regulations can be found in Appendix B.

RESOURCE LINKS 

 

Health Protection Act

Hospital Act (1 competency)

 1. Practises in a manner consistent with the Hospital Act that directly governs NP practice 

Objectives

The nurse practitioner will:

  • Identify who has admitting and discharge privileges

SYNOPSIS OF INFORMATION

To improve efficiencies in client flow through the health care system, revisions to the regulations under the Nova Scotia Hospitals Act authorizes nurse practitioners (NPs) to discharge clients from any hospital setting. These settings may include but are not limited to inpatient units, day surgery and/or interventional radiology units, emergency departments and collaborative emergency centers (CECs). The revised regulations do not change the Hospitals Act in relation to admission, which only authorizes physicians, midwives and dentists to admit clients to health care facilities.

According to the Hospitals Act, NPs are not authorized to admit clients to hospitals.

RESOURCE LINKS 

Homes for Special Care Act (1 competency)

1. Practises in a manner that is consistent with the Homes for Special Care Act

Objectives

The nurse practitioner will:

  • Identify the role of NPs when residents are admitted to long term care facilities and homes for special care

SYNOPSIS OF INFORMATION

Admission to long term care facilities or homes for special care is not defined in the same manner as under the Hospital Act.

Nursing homes are intended for medically-stable individuals who required more nursing care than can be provided in their home. Residential care facilities provide individuals with personal care, supervision and accommodation in a safe and supportive environment when nursing home care is not required.

Long term care facilities are not considered hospitals under the Hospitals Act and are fall under the jurisdiction of the Homes for Special Care Act.  NPs may participate in any phase of the process required as part of the application to long term care, including the completion of Medical Status Reports. Decisions regarding placement into a long term care facility are made based on an assessment carried out by Continuing Care assessors and are approved by the administrator or medical director of the facility.

Nurse practitioners may complete the initial assessment and orders for care (e.g. diet, medication, activities, treatments, etc.) when a new resident arrives at a long term care facility. Nurse practitioners are also able to provide ongoing primary care to residents.  In addition, the Homes for Special Care Regulations states that each resident must be seen once every 6 months by a physician.

Long term care beds may be located in an acute care hospital. NPs need to be aware whether these beds are “licensed” (meaning designated) as acute care or long term care beds. NPs must not be involved with the admission process for individuals being placed in acute care beds, because in doing so, they will violate section 8 of the Hospitals Act.

RESOURCE LINKS:

Motor Vehicles Act (1 competency)

1. Practises in a manner that is consistent with the Motor Vehicles Act 

Objectives

The nurse practitioner will:

  • State the health care professional who can complete a driver’s medical examination report for the registry of motor vehicles.
  • State the health care professionals who can inform the registry of motor vehicles that a person is unsafe to drive a motor vehicle.

SYNOPSIS OF INFORMATION

In accordance with Section 279 (6), (7) and (8) of the Motor Vehicles Act only a qualified medical practitioner or a qualified registered psychologist may complete a driver’s medical examination report or inform the registry of motor vehicles that a driver is incompetent to operate a motor vehicle.

Note for all Acts: NPs are not considered to be medical practitioners under any Act.  A “qualified medical practitioner” means a member under the Medical Act.

In accordance with Section 279 (7) (b), only a qualified medical practitioner can determine if a person can be exempt from wearing a seat belt or child restraint for medical reasons.

RESOURCE LINKS 

Personal Health Information Act (1 competency)

1. Practises in a manner consistent with the Personal Health Information Act that directly governs NP practice

 Objectives

The nurse practitioner will be able to:

  • Explain when a custodian may collect, use or disclose information without the consent of the individual
  • Explain when a custodian may not collect, use or disclose personal health information about an individual
  • Identify that an agent of the custodian must notify the custodian if personal health information is stolen, lost or accessed by unauthorized persons
  • State when a custodian may disclose personal health information about an individual collected in the province to a person outside the province
  • Identify when a person may request access to a record of information

SYNOPSIS OF INFORMATION

Agent and custodian are terms defined in Section 3 of the Personal Health Information Act.  Essentially, an agent is the person who “acts for or on behalf of the custodian in respect of personal health information for the purposes of the custodian”; for example, an NP (agent) acting on behalf of the health authority (custodian) by whom they are employed.

A custodian is an individual or organization that has custody of personal health information as part of their powers or duties.  Custodians can include:

  • a regulated health professional or a person who operates a group practice of regulated health professionals,
  • the Minister,
  • the Minister of Health Promotion and Protection,
  • a district health authority under the Health Authorities Act,
  • the Izaak Walton Killam Health Centre,
  • the Review Board under the Involuntary Psychiatric Treatment Act,
  • a pharmacy licensed under the Pharmacy Act,
  • a continuing-care facility licensed by the Minister under the Homes for Special Care Act or a continuing-care facility approved by the Minister,
  • Canadian Blood Services,
  • any other individual or organization or class of individual or class of organization as prescribed by regulation as a custodian;

In accordance with Section 10(2) of the Act, a custodian can disclose personal health information about an individual without the consent of the individual when it does not:

  • require the custodian to disclose it unless required to do so by law;
  • relieve the custodian from a legal requirement to disclose the information; and
  • prevent the custodian from obtaining the individual’s consent for the disclosure or giving notice to the individual of the disclosure.

In accordance with Section 11 of the Act, a custodian cannot collect, use or disclose personal health information about an individual unless:

  • the custodian has the individual’s consent under this Act and the collection, use or disclosure is reasonably necessary for a lawful purpose; or
  • the collection, use or disclosure is permitted or required by this Act.

In accordance with Section 28 (3) of the Act, an agent (e.g. NP) of a custodian (e.g. health facility) must notify the health facility at the first reasonable opportunity if a client’s personal health information in their custody is stolen, lost or accessed by unauthorized persons.

In accordance with Section 35 of the Act, a custodian may use personal health information about an individual without the individual’s consent for a number of purposes, including but not limited to:

  • planning or delivering programs or services;
  • ensuring quality or standards of care;
  • when the information is limited to the individual’s name and contact information;
  • processing, monitoring, verifying or reimbursing claims for payment for the provision of health care;
  • research conducted by the custodian, in accordance with Sections 52 to 60 of the Act

In accordance with Section 36 of the Act, a custodian may disclose personal health information about an individual to another custodian involved in that individual’s health care if it is deemed reasonably necessary for the provision of health care to the individual.

In accordance with Section 44 (1) of the Act, a custodian may disclose personal health information about an individual collected in Nova Scotia to a person outside Nova Scotia for a number of reasons, including disclosure to a regulated health professional to meet the functions of another jurisdiction’s prescription monitoring program.

In accordance with Section 75 of the Act, a person can ask to examine or obtain a copy of their personal health record by:

  • making a request in writing to the custodian;
  • specifying the subject-matter of the requested record; and
  • paying any required fees.

In accordance with Section 72 of the Act, a custodian may refuse to grant access to an individual’s personal health information if:

  • the record is subject to a legal privilege;
  • another Act of the Province or of the Parliament of Canada or a court order prohibits disclosure;
  • the information in the record was collected or created primarily for the purpose of ensuring quality or standards of care;
  • the information in the record was collected or created in anticipation of or for use in a proceeding, and the proceeding, together with all appeals or processes resulting from it, have not been concluded;
  • the information was collected as the result of an investigation of an individual receiving or attempting to receive a service or benefit for which he/she was not entitled, and the investigation has not been concluded;
  • granting the access could result in a risk of serious harm to the treatment or recovery of the individual or their mental or physical health;
  • granting the access could result in a risk of serious harm to the mental or physical health of another individual;
  • granting the access could lead to the identification of a person who provided information in the record to the custodian in circumstances in which confidentiality was reasonably expected; or
  • granting access could result in the release of another individual’s personal health information.

RESOURCE LINKS

 

Prescription Monitoring Act (1 competency)

 

1. Prescribes drugs according to the Prescription Monitoring Act and its regulations 

Objectives

The nurse practitioner will be able to:

  • Identify drugs that fall under the designation of monitored drugs
  • Identifies that a prescriber must be registered with the Prescription Monitoring Program in order to prescribe monitored drugs
  • State the objects of the prescription monitoring program
  • State when the Administrator of the Prescription Monitoring Program may file a complaint with a licensing body
  • Identify situations when a prescription form does not have to be used when prescribing a monitored drug

SYNOPSIS OF INFORMATION

According to the Prescription Monitoring Regulations, a “registrant” is a prescriber, pharmacist or pharmacy who is registered with the Program.  In order to prescribe controlled drugs and substances in Nova Scotia, the NP must be registered with the Presciption Monitoring Program (PMP).

Section 2 (i) of the Prescription Monitoring Act defines “monitored drugs” as those drugs designated by the regulations as being subject to the Program.

A list of controlled drugs and substances can be found in the Controlled Drugs and Substances Act or any successor legislation and are designated as being subject to the Nova Scotia Prescription Monitoring Program, except testosterone, when dispensed as a compound for topical application for local effect.

The mandate of the Nova Scotia Prescription Monitoring Program is to promote the appropriate use of monitored drugs and the reduction of the abuse or misuse of monitored drugs.  The Nova Scotia Prescription Monitoring Board, which is responsible for operating the Prescription Monitoring Program, interprets this legislative mandate as including a mission to:

  • educate prescribers, dispensers and the general public on the appropriate use of monitored drugs;
  • collaborate and develop working partnerships with other key organizations in order to achieve the Program’s objectives; and
  • proactively share information in a timely and responsive manner to allow others to do their part in achieving the Program’s objectives.

In accordance with Section 23(1) of the Prescription Monitoring Act, the administrator may communicate or file a complaint with authorities when the administrator has reason to believe that:

  • an offence has been committed contrary to the Controlled Drugs and Substances Act or the Criminal Code (Canada) or successor legislation, or
  • a member of that licensing authority may be practising in a manner that is inconsistent with the objects of the Program.

In accordance with Section 13(1) of the Prescription Monitoring Regulations, a prescriber must only prescribe a monitored drug in the manner approved by the Board and by using a prescription form. However, a prescriber does not have to use a prescription form if the prescription is for one of the following:

  • a person in a nursing home, as defined in the Homes for Special Care Act;
  • a person in a home for the aged that is subject to the Homes for Special Care Act;
  • a person who is prescribed a monitored drug while an in-patient, as defined in the Hospital Insurance Regulations made under the Health Services and Insurance Act;
  • an inmate in a federal correctional centre or penitentiary.

Nurse practitioners should become familiar with the Nova Scotia Prescription Monitoring Program policies and resources (see links below).

 

RESOURCES

Timely Medical Certificate Act (1 competency)

1. Practices in a manner consistent with the Vital Statistics and Chapter 494: Timely Medical Certificate Act and its regulations that directly governs NP practice 

Objectives

The nurse practitioner will:

  • sign death certificates as outlined in the Vital Statistics Act
  • cite the circumstances under which a NP can complete the certificate of death

SYNOPSIS OF INFORMATION

In Nova Scotia, nurse practitioners can enact their authority to complete a Medical Certificate of Death when they:

  • Hold an active practice license with the College of Registered Nurses of Nova Scotia
  • Have a collaborative relationship with a physician(s)
  • Completed the approved Medial Certificate of Death education
  • Received a registration number from vital statistics.

In accordance with Section 3 of the Medical Certificate of Death Regulations, attending nurse practitioners working in all practice settings (hospitals, community, long term care) have the authority to complete Medical Certificates of Death in the following circumstances:

  • The death of a person was expected as the result of a diagnosed chronic or acute illness or conditions; and
  • There is no reason to believe that the death was a result of any of the circumstances referred to in sections 9-12 of the Nova Scotia Fatality Investigations Act.

Nurse practitioners are accountable for accurate completion the Registration of Death Form for Nova Scotia including the medical certification of death outlining the date of death, immediate cause of death, antecedent causes of death and other significant conditions contributing to the death to uphold the accuracy of mortality statistics in Nova Scotia and Canada.

RESOURCES

Workers Compensation Board Act (1 competency)

1. Practises in a manner consistent with the Workers Compensation Board Act that directly governs NP practice

Objectives

The nurse practitioner will be able to:

  • recognize accountability related to completion of the Workers Compensation Board Act

SYNOPSIS OF INFORMATION

An NP can complete the Physician’s Report 8/10. Please see the Physician’s Report Guide for additional guidance for completion of this form.  To become a WCB service provider, an NP will need to complete the Service Provision Proposal Application form and fax it to the WCB Health Service Department for processing.

In accordance with Section 195 of the Worker’s Compensation Act, medical records completed as part of a WCB claim are privileged. This means that every report submitted to the Board or the Appeals Tribunal by a physician, surgeon, hospital official or other health care professional:

  • is a privileged communication of the person submitting the report; and
  • is not admissible as evidence in any action against the physician, surgeon, hospital official or health care professional.

RESOURCES

Adult Capacity and Decision Making Act (1 competency)

1. Practises in a manner consistent with the Adult Capacity and Decision Making Act that directly governs NP practice.

Objectives

The nurse practitioner will be able to:

  • recognize accountability under the Adult Capacity and Decision Making Act

SYNOPSIS OF INFORMATION

The Adult Capacity and Decision-making Act and Regulations applies to adults who may not be able to make some decisions for themselves because of learning disabilities, mental health problems, brain injuries, etc. and allows another person to make some important decisions for the individual.

The Act and Regulations came into effect on December 28, 2017 and replaced the Incompetent Persons Act. This legislation extends the authority to complete capacity assessments to healthcare professionals other than physicians including nurse practitioners (NPs) and registered nurses (RNs) who have completed education mandated by the Public Trustee’s Office.

The purpose of the Adult Capacity and Decision Making Act is to:

(a) recognize that adults may experience an impairment of their capacity;

(b) provide a fair and respectful legal framework for protecting the safety and security of adults whose capacity is impaired and who may be made vulnerable thereby;

(c) promote the dignity, autonomy, independence, social inclusion and freedom of decision-making of adults who are the subject of this legislation; and

(d) ensure that the least restrictive and least intrusive supports and interventions are considered before an application is made or a representation order is granted under this Act.

Under this Act, “capacity” is defined as an individual’s ability, with or without support, to understand information relevant to making a decision, appreciate the reasonably foreseeable consequences of making or not making a decision including, for greater certainty, the reasonably foreseeable consequences of the decision to be made.  For healthcare professionals, capacity refers to an individual’s ability to make decisions about their personal care, including but not limited to, health care, nutrition and hydration, shelter or residence, hygiene, safety, comfort, recreation, social activities, support services and finances.

There is additional legislation that addresses assessment of capacity:

  • Hospitals Act addresses the assessment of capacity in a hospital setting.
  • Involuntary Psychiatric Treatment Act addresses issues of capacity assessment in psychiatric settings.
  • Personal Directives Act allows an individual with capacity to make a personal directive outlining instructions about future personal care decisions to be made on their behalf. Personal directives take effect when an individual lacks the capacity to make a personal care decision but has no effect when the individual still has such capacity.

An individual may need different levels of capacity depending on the decision required. Decisions that are associated with greater risk require a higher level of capacity. At the most basic level, capacity in relation to day-to-day services refers to the ability of a client to consent to specific activities or treatments. This basic capacity assessment falls within the scope of practice of many healthcare professionals including licensed practical nurses, nurse practitioners and registered nurses. However, when an individual is unable to make decisions beyond day-to-day personal care services, a more formal capacity assessment may be required. A delegate or statutory decision-maker may also make a request to have a capacity assessment completed.

When a nurse is unable to determine the client’s day-to-day capacity and determine that further assessment is needed, they should consult an authorized healthcare professional who have completed the required education.  Nurses are accountable to be familiar with the legislation that is applicable to their practice setting and to follow agency policies when initiating capacity assessments.

RESOURCES

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