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RN Jurisprudence Study Guide: Regulatory Policies

The RN 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 three (3) categories: Regulatory Policies, relevant Federal Legislation, and relevant Provincial Legislation. Within each of these categories is a list of policies and/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 regulatory policies.


Assignment and Delegation

Competencies and Objectives (2 competencies)

1. Demonstrate leadership in the coordination of health care

Objectives – the registered nurse will:

  • Exercise professional judgment when assigning interventions to other members of the health care team (e.g. RNs, LPNs and CCAs)
  • Exercises professional judgment when delegating to unregulated healthcare providers

2. Practise in a manner consistent with assignment/delegation accountabilities

Objectives – the registered nurse will:

  • Accept accountability for own actions and decisions when assigning
  • Employ the decision-making factors specific to assignment as outlined within the decision-making framework for assignment
  • Accept accountability for own actions and decisions when delegating
  • Employ the decision-making factors specific to delegation as outlined within the decision-making framework for delegation

Synopsis of Information

RNs have responsibilities and accountabilities requiring them to know the processes involved for assignment and delegation. It is especially important as assigning and delegating to unregulated healthcare providers is becoming an increasing part of nursing practice in Nova Scotia.

Assignment means the allocation of clients or client care responsibilities or interventions that are within the care provider’s scope of practice and/or scope of employment.

Decisions about assignment are evaluated and adjusted as the healthcare team works together to meet the changing needs of clients. Registered nurses determine assignments according to the:

  • client’s condition (complexity, variability and acuity)
  • scope of practice of the health provider’s profession
  • individual scope/competence of the individual performing the intervention
  • scope of employment/agency policy
  • context of practice.

Delegation means transferring the responsibility to perform a function or intervention to a care provider who would not otherwise have the authority to perform it. Registered nurses delegate health care activities to unregulated health care providers consistent with levels of expertise, education, job description/agency policy, legislation and person needs. Unregulated healthcare providers may include continuing care assistants (CCAs), youth health workers (YHW), personal care workers (PCWs), home support workers (HSWs), care team assistants (CTAs), orderlies, and others.

RNs do not delegate to LPNs. The knowledge that differentiates an RN’s practice from an LPN’s practice cannot be delegated away. RNs are accountable for the overall development and coordination of the nursing plan of care whereas, the LPN and other care providers contribute to the nursing care plan. Knowledge and the decision-making used to determine that care (i.e., the assessment, evaluation, and judgment of the RN) cannot be delegated.

Delegation does not involve transferring accountability for the outcome of the function or intervention although the delegated provider is responsible to successfully perform the intervention or task.  Delegation is client specific, meaning that the delegation applies only to a designated client.

When delegating, the registered nurse is accountable for:

  • assessing the client’s needs to inform the appropriateness of delegation
  • the decision to delegate and to whom
  • determining if the individual is competent to perform the delegated intervention
  • supervision; and
  • evaluating the overall outcome

The unregulated healthcare professional is accountable for:

  • having sufficient knowledge, skills and judgement to accept the delegation
  • refusing to accept delegation for those acts which s/he is not competent
  • following agency policy and procedure
  • performing the intervention safely, effectively and ethically
  • documenting the care provided as per agency policy
  • reporting observations and client information to the registered nurse

The employer is accountable and responsible for:

  • providing adequate staff
  • education processes to establish competence
  • written policies and procedures related to delegation

Resource Links:

CRNNS By-Laws

Competencies and Objectives (1 competency)

1. Identify the governance process as outlined in the College By-Laws as approved by the Board

Objectives – the registered nurse will:

  • Define ‘member in good standing’
  • Identify the composition of the Board
  • Define the term voting body as it applies to the role of a registered nurse attending an AGM

Synopsis of Information

A ‘member in good standing’ means a member who has no current licensing sanctions, conditions or restrictions on their licence to practice nursing, or is not subject to any voluntary undertakings that limit their practice of nursing.

The Board consists of a minimum of eight persons where public representatives comprise not less than one-third and not more than one-half of the board composition. Vacancies on the Board will be filled as set out in the Bylaws.

Verified voting delegates (voting body) include those registrants who are not College employees, Board members or scrutineers, who hold practicing licenses and have registered to vote prior to a poll taken at the commencement of a relevant meeting.

 Resource Links:

Delegated Functions and Care Directives

Competencies and Objectives (2 competencies)

1. Exercise professional judgment when following agency policy on registered nursing accepting delegated functions from other regulated health professionals

Objectives – the registered nurse will:

  • Define the term delegated functions
  • Identify factors to consider when determining the appropriate provider to perform delegated functions
  • Identify RN accountabilities when performing delegated functions
  • Recognize approval processes for delegated functions

 

  1. Exercise professional judgment when following agency policy related to direct orders, preprinted orders and care directives

Objectives – the registered nurse will:

  • Define the terms direct order, pre-printed order and care directive
  • Identify authorized prescribers in Nova Scotia

Synopsis of Information

Delegation is the process of transferring a specific intervention (task, procedure, treatment or action within explicit and limited situations having clearly defined limits) that falls within the scope of practice of one healthcare profession (delegator). However, in the interest of client care, has been approved to be performed by a member(s) of another healthcare profession (delegatee) for whom the intervention is outside their scope of practice, but who has the required competence (certification/recertification).

The delegator is accountable for the decision to delegate the intervention as well as for overall client outcomes. The RN, as the delegatee, is responsible and accountable for the performance of the outcome of the intervention.

Delegated functions should be consistent and in the best interest of clients, appropriate for the practice environment, promote the optimal application of the competencies of all members of the healthcare team and cannot contravene existing laws or accepted standards of practice.

 

Agency policies should be in place to support the implementation of delegated functions including provisions for resources required by healthcare practitioners to acquire and maintain required levels of competence.

Client factors, context of practice and provider competencies are considered when determining the appropriate healthcare provider to perform a particular delegated function.

Registered nurses who perform delegated functions in their practice are accountable for:

  • assessing the client to determine the appropriateness of the delegated function
  • knowing the risks and outcomes the delegated function
  • attaining and maintaining the competence required
  • knowing who to contact for support if needed

The employer must ensure that there is an appropriate approval body and processes to approve a DF such as a Medical Advisory Committee or equivalent body. An equivalent body should consist of a representative physician delegating the function, a representative registered nurse involved in implementing the DF and other content experts – including representatives of risk management – as appropriate.

A direct order is a prescription from an authorized prescriber for RNs and other designated health care providers to perform an intervention for an individual client.

Pre-printed orders are a list of orders for a specific client for a specific health condition from which the authorized prescriber selects the applicable orders.

A care directive is an order written by an authorized prescriber for an intervention or series of interventions to be implemented by another care provider (e.g., registered nurse) for a range of clients with identified health conditions, only when specific circumstances exist. A care directive is not an intervention that is delegated, but is an intervention that is within the RN scope of practice (e.g., medication administration). An authorized prescriber must always be available when a care directive is performed.

Authorized prescribers in Nova Scotia include nurse practitioners, physicians, dentists, midwifes, optom­etrists, pharmacists, and veterinarians (Nova Scotia Pharmacare, 2010).

Resource Links:

Duty to Provide Care

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with College regulatory policies related to duty to provide care.

Objectives – the registered nurse will:

  • Define ‘Duty of Care’, ‘Duty to Provide Care’ and abandonment
  • Exercise professional judgment resulting in flexible decision-making in the provision of care during emergency situations
  • Explain the duty of the RN to provide care during Emergency Department closures
  • Explain the duty of the RN to provide care when asked to work in an unfamiliar client care environment

 Synopsis of Information

Duty of care is “a moral or legal obligation to ensure the safety or well-being of others” (Oxford Dictionary 2016).

Duty to provide care is defined as a registered nurse’s obligation to provide safe, competent and ethical care to their clients, in accordance with College Standards of Practice for Registered Nurses, regulatory policy, CNA Code of Ethics, and relevant legislation.

An unreasonable burden may occur in relation to the duty to provide care and withdrawing from providing or refusing to provide care (CNA Code of Ethics, 2017). An unreasonable burden may exist when a nurse’s ability to provide safe care and meet professional standards of practice is compromised by unreasonable expectations, lack of resources, or ongoing threats to personal wellbeing.

Abandonment

Abandonment occurs when a registered nurse discontinues the nurse-client relationship without taking at least one of the following three actions:

  • arranging for suitable alternative or replacement services and ensuring their arrival, where the failure to do so would place the patient at risk; or
  • allowing the employer (who may be the client) a reasonable opportunity to arrange alternative or replacement services to be provided; or
  • if self-employed, obtaining the consent of the client, except where the client is unable to appreciate the consequences of their decision and remains at risk.

In addition, the registered nurse must provide an appropriate report and/or ensure that necessary documents are completed and communicated when care is transferred to another provider.

If registered nurses determine they do not have the necessary competencies or physical, psychological or emo­tional well-being to provide safe and competent care, they may withdraw from the provision of care or refuse to provide care if they have given reasonable notice to their employer and appropriate action has been taken to replace them or resolve the issue.

A nurse who is considering refusing to provide care on the basis of a risk to their own health should be aware of the provisions of the Occupational Health and Safety Act that govern refusals to work and should consider seeking assistance from a union representative or the Canadian Nurses Protective Society.

Emergency Situations

While there is an expectation that registered nurses will provide care to the sick and absorb a certain amount of risk in doing so, there is not an expectation that registered nurses will place themselves at unnecessary risk during an emergency. There are situations in which it may be acceptable for registered nurses to withdraw or refuse care.

Emergency Department Closure

RNs have a duty to provide care when a client arrives at an emergency department that is closed due to lack of physician coverage.  If a more skilled individual is not available to provide the client with care, and if not providing care would lead to worse consequences than providing it, the RN must assist the client.  The RN must complete a triage assessment (also known as a rapid patient assessment) to determine the client’s emergent needs, assign a Canadian Triage and Acuity Scale (CTAS) score, call 911 and provide life sustaining care until EHS arrives. The RN is expected to act in accordance with their competence, standards and organizational policies to ensure that the client receives safe, competent care until they can be transferred to another health care professional or facility.

Working in an Unfamiliar Client Care Environment

While it is true that RNs are not obligated to provide care independently beyond their level of competence, every registered nurse has basic entry-level competencies that are to be applied in any practice setting. Rather than refusing an assignment related to perceived lack of competence, an RN should negotiate the work assignment with her/his manager as well as the staff on the unit to which they are floating. The assignment should be based on the registered nurse’s individual scope of practice and competencies.

Registered nurses have an obligation to inform employers when they are asked to deliver care beyond their level of competence or individual scope of nursing practice, and nurses must recognize when they have passed the limits of their knowledge, skills and/or judgment and to know when and where to request assistance or additional education or training.

The refusal of an assignment in an unfamiliar practice setting is only justified when the risk of harm to a client is greater by accepting the assignment than by refusing it. If an RN refuses an assignment for any reason, they must inform the employer of the reason for refusal, document why the assignment was refused, and provide the employer with enough time to find a suitable replacement.

Resource Links:

Interprofessional Practice

Competencies and Objectives (1 competency)

1. Practise in a manner consistent with the principles of interprofessional collaborative practice

Objectives – the registered nurse will:

  • Identify the principles of interprofessional practice
  • Describe what is meant by a Collaborative Emergency Centre in Nova Scotia
  • Describe the shared accountability of the healthcare team within a Collaborative Emergency Centre
  • Identify scope of practice of the nurse practitioners in Nova Scotia
  • Define the role of the RN when working in triage with LPNs

Synopsis of Information

Interprofessional collaboration is “the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/ families and communities to enable optimal health outcomes. Elements of collaboration include respect, trust, shared decision making, and partnerships” (see link below to A National Interprofessional Competency Framework, page 8).

The CIHC National Interprofessional Competency Framework “describes the competencies required for effective interprofessional collaboration. Six competency domains highlight the knowledge, skills, attitudes and values that together shape the judgments that are essential for interprofessional collaborative practice” (see link below to A National Interprofessional Competency Framework, page 17).

The six competency domains are:

1) interprofessional communication

2) patient/client/family /community-centred care

3) role clarification

4) team functioning

5) collaborative leadership

6) interprofessional conflict resolution

The Canadian Nurses Association (CNA) (2011) “believes that interprofessional collaborative models for health service delivery are critical for improving access to client-centred health care in Canada. The responsiveness of the health system can be strengthened through effective collaboration among health professionals, regulators, educators and professional associations” (p. 1).

CNA believes that the following seven principles facilitate collaboration among professions and professionals: client-centred care, evidence-informed decision-making for quality care, access, epidemiology, social justice and equity, ethics, and communication (CNA, 2011).

In Nova Scotia, the Regulated Health Professions Network, established in 2006, is a forum for all the health professions’ regulatory bodies in Nova Scotia to discuss and address common regulatory issues.  The Regulated Health Professions Network Act builds on the regulatory systems already in practice and authorizes regulated health professions in Nova Scotia to collaborate, on a voluntary basis, in regulatory processes related to the investigation of complaints, interpretation and/or modification of scopes of practice, and review of registration appeals. This network also believes that health professionals working to their full scope of practice will further enhance access and health outcomes.

A Collaborative Emergency Center (CEC) is a model of care in Nova Scotia that makes access to emergency care a seamless part of primary health care by enhancing access to a comprehensive interprofessional primary health care team. This team deals with client’s primary care needs and is capable of dealing with unexpected illness or injury. Most CECs are located within or are in very close proximity to a rural health care facility.

The responsibility for client or patient assessment is the collaborative responsibility shared between registered nurse and the paramedic in consultation with the medical oversight EHS on-call physician. Every client contact will result in a mandatory three-way conversation among the registered nurse, the paramedic, and the online physician. Communication may take place at any point in the client journey and can occur several times over the client contact. Every decision for the client is based on the collective assessment, clinical judgment and decision-making authority of the registered nurse, paramedic, and online physician. The final decision is the responsibility of the medical oversight physician. Client care disposition could include treat and release, treat and follow- up or treat and transfer. If a client requires a level of care that exceeds the capabilities of the site, they will be transferred to the closest, most appropriate facility if there is capacity to safely do so. The care of the client will then be transferred to the accepting ER physician.

Since nurse practitioners were introduced as healthcare providers in Nova Scotia, it is not uncommon for RNs to work with NPs as part of their interprofessional team; therefore, it is important for registered nurses to be aware of and understand that the advanced practice of nurse practitioners. Nurse practitioners work in collaboration with their clients and other healthcare providers to provide high quality, person-centered care. They work with diverse client populations in a variety of contexts and practice settings. For example, some nurse practitioners provide primary care in family practice settings, while others work in specialized fields in hospitals and clinics. Regardless of where they practise or with whom, nurse practitioners are accountable for their own practice and for providing leadership to enhance client care and care-delivery systems within their focus of practice.

Nurse practitioners are authorized them to autonomously conduct comprehensive health assessments and to diagnose, treat and manage acute and chronic physical and mental conditions. They identify health risks, order and interpret screening and diagnostic tests, perform procedures, prescribe medications, monitor treatment results, and provide written consultations/referrals to other healthcare providers when required.

The Canadian Triage & Acuity Scale (CTAS) is a tool that enables healthcare providers working in Emergency Departments (ED) to triage clients according the type and severity of their presenting signs and symptoms.  It is used to ensure that the sickest patients are seen first when ED capacity has been exceeded due to visit rates or reduced access to other services and also ensures client care is reassessed periodically while in the ED.

LPNs may participate in the triage process in emergency rooms or Collaborative Emergency Centers. Only LPNs who have completed a formal Canadian Triage and Acuity Scale (CTAS) course are able to complete a triage assessment and health history, which will determine a preliminary CTAS score. The RN who also completed a recognized CTAS course must review the data provided by the LPN, validate the assessment findings and confirm that the CTAS score is consistent with the presentation of the client. A final CTAS score is assigned once the LPN has consulted with the RN for interpretation of the findings.

When working with LPNs in triage, the RN is responsible to determine the overall predictability and/or complexity of the client based upon determination of the final CTAS score. The LPN is accountable for her/his own practice and is expected to consult with the RN, immediately for CTAS scores of 1, 2, or 3. For a CTAS score of 4 or 5, the LPN is required to consult with the RN within 30 minutes.

If, after consultation, the RN does not change the CTAS score assigned by the LPN, the agreed upon score is recorded. If there is a difference between the CTAS scores assigned by the LPN and RN, the RN’s CTAS score is considered final, documented and used for client care planning. If the RN has concerns regarding the preliminary assessment of the client and feels conditions may have changed or further consideration may be required, the RN must do a more in-depth assessment to ensure the assessment is accurate.

Resource Links:

Professional Conduct/Registration Services

Competencies and Objectives (1 competency)

Practise in a manner consistent with the process and policies for professional conduct and Registration Services

Objectives – the registered nurse will:

  • Define the terms professional misconduct, conduct unbecoming the profession, incompetence and incapacity
  • Identify the information an RN has a duty to report prior to registration
  • Determine when there is a duty to report a member of the profession to the regulatory body
  • Determine when there is a duty to report another health professional to the regulator of that health profession
  • Explain who may use the designation registered nurse in Nova Scotia
  • State under what circumstance a temporary licence expires or is not re-issued

Synopsis of Information

Definitions of Terms

There are several terms related to professional conduct with which you should be familiar: professional misconduct, incapacity, incompetence, and conduct unbecoming.

Professional misconduct means actions that would reasonably be regarded as disgraceful, dishonourable or unprofessional that may include but not limited to:

  • failing to maintain the standards of practice,
  • failing to uphold the Code of Ethics,
  • abuse,
  • misappropriating drugs or property,
  • inappropriately influencing a client to make or change a will or power of attorney,
  • client abandonment or neglect,
  • disclosure of confidential information,
  • falsifying records,
  • inappropriately using professional nursing status for personal gain,
  • promoting for personal gain any drug, device, treatment, procedure, product or service that is unnecessary,
  • ineffective or unsafe, publishing, or causing to be published, any advertisement that is false, fraudulent, deceptive or misleading,
  • engaging or assisting in fraud,
  • misrepresentation, falsifying or concealing facts when applying for registration or licensure, or
  • inappropriately using the designation “registered nurse or any derivation thereof.

Incapacity means a registered nurse is unable to practice with reasonable skill or judgment or may have endangered the health or safety of clients due to a medical, physical, mental or emotional condition, disorder or addiction.

Incompetence means the display of a lack of knowledge, skill or judgment in the registered nurse’s care of a client or delivery of nursing services that, having regard to all the circumstances, rendered the registered nurse unsafe to practise at the time of such care of the client or delivery of nursing services or that renders the registered nurse unsafe to continue in practice without remedial assistance;

Conduct unbecoming means conduct in a registered nurse’s personal or private capacity that tends to bring discredit upon the nursing profession.

Duty to Report

RNs have a legal and ethical obligation to report incompetent, unethical or impaired practice of an RN, or unethical conduct by any regulated health professional, to or appropriate regulatory body.

If a registered nurse has reasonable grounds to believe another RN or regulated health professional has engaged in professional misconduct, incompetence or conduct unbecoming the profession, is incapacitated or is practicing in a manner that otherwise constitutes a danger to the public; the informed RN must file a written report to the College or the health professional’s appropriate regulatory body. RNs who fail to report these situations could be subject to discipline by their employer and by the College.

Prior to registering in Nova Scotia, RNs must report if they have been found guilty of a disciplinary finding in another jurisdiction or if they have had a licensing sanction imposed by another jurisdiction.

Temporary Licence

A temporary licences will expire on the earliest of the dates listed below:

  1. the expiry date of the temporary licence;
  2. immediately following the third failure of the NCLEX-RN;
  3. when a licence, other than a temporary licence, is issued to the temporary licence holder; or
  4. when the temporary licence is suspended or revoked under the professional conduct process.

Considerations that could disqualify an individual from meeting the requirements necessary for re-issuing a temporary licence:

  • Failure of the NCLEX-RN for the third time;
  • A suspended or revoked temporary licence by a Professional Conduct Committee;
  • Being issued an active practising licence;
  • More than 12 months have passed since the applicant completed their program.

Temporary Engagement of Nursing in Nova Scotia

An RN registered but not currently licensed with the College or RNs currently licensed in another Canadian jurisdiction who wish to temporarily engage in the practice of nursing in NS for a special, time-limited event may be issued a temporary licence with or without conditions and restrictions. These events may include but not be limited to:

  1. temporary employment as a camp RNs;
  2. completion of a nursing course in Nova Scotia which includes a clinical practicum; or
  3. an emergency or disaster event (e.g. pandemic).

All applicants must maintain a current active-practising licence (RN) in another Canadian jurisdiction while they hold a temporary licence in Nova Scotia. If their licence in the other Canadian jurisdiction lapses, their temporary licence with the College expires.

 Resource Links:

Scope of Practice

Competencies and Objectives (1 competency)

1. Practise within scope of practice

Objectives – the registered nurse will:

  • Define the terms scope of practice of the nursing profession, scope of practice of the RN designation, individual scope of practice, modification of scope of practice, and scope of employment.
  • Describe the decision-making framework for adding a new intervention to the RN scope of practice

Synopsis of Information

Scope of practice forms the foundation on which competencies and practice standards are developed, informs curriculum content, assists with staffing decisions and health care workforce planning. No single health profession has a completely unique scope of practice and many professions share competencies. One task or activity does not define a profession; rather, it is the entire scope of competencies that make a profession unique.

 

The determinants of nursing practice, which enable changes to scopes of practice include legislated authority, regulatory standards, evidence informed practice, individual registered nurse competencies and the organizational/employer policies and support for practice. Periodic review of scopes of practice is therefore essential to ensure consistency with current health needs and to support improved health outcomes. Health care professions need to remain flexible regarding scope of practice issues and, at the same time, make careful, informed decisions regarding changes to the scope of practice.

Definition of Terms

Scope of practice of the nursing profession: means the combined scopes of practice of the nursing designations.

Scope of practice of the RN designation: means the nursing services authorized for practice by RNs under the Act, the Regulations and the bylaws.

Nursing services: means the application of specialized and evidence-based knowledge of nursing theory, health and human sciences inclusive of principles of primary health care, in a variety of roles including clinical services to clients, research, education, consultation, management, administration, regulation, policy or system development relevant to such application, and such other services, roles, functions, competencies and activities for each nursing designation that are related to and consistent with the foregoing, including those set out in the regulations taught in approved education programs, authorized for practice under federal or provincial legislation, and generally accepted as constituting nursing practice.

Individual scope of practice: means the nursing services for which a registrant is educated, authorized and competent to perform. The scope of practice of an individual may be narrower than the scope of practice of the profession. However, while the scope of an individual registered nurse may be narrower than that of the profession, an individual may have more specialized and in-depth knowledge and competence in one area of practice.

Modification of scope of practice: major proposed change in competencies or profession’s scope of practice requiring actual changes in the current legislation or initiating a modification of scope of practice through the process outlined in the Nova Scotia Regulated Health Profession Network Act. A modification to the scope of practice may be required when 1) the role, function or accountability is not currently within the scope of practice of nursing 2) the new addition is restricted by a statute regulating the practice of another health profession. A modification also might be required when the role, function or accountability may be considered within the scope of practice of nursing but the risk is significant enough to consider a legislative change to the scope of practice for the profession. Example: Registered Nurse taking on broad prescriptive authority or conducting minor surgery, administering general anesthesia.

Scope of employment: the range of roles that are defined by the employer through legislation, job descriptions, policies and procedures, guidelines, orientation processes and education. Individual RNs may have competencies to perform an intervention, which they are not authorized to implement in their current employment setting.

Adding an Intervention to the RN Scope of Practice

The decision-making framework for adding a new intervention to the RN scope of practice is designed to assist RNs, employers and other stakeholders to collaboratively determine if interventions are consistent within the current RN scope of practice and whether the intervention will enhance client care. The framework consists of a series of questions, which are organized into a variety of categories. If all of the decision points in the framework can be answered with a ‘yes’, the RN and employer have the necessary information to make an informed decision regarding incorporating a new intervention in the RN scope of practice. Answering negatively to any of the questions in the framework does not necessarily mean that the intervention cannot be added to the RN scope of practice; rather it is an indicator that additional analysis is required before proceeding.

When to Consult with the College

  1. When it is not clear whether the intervention is actually within the RN scope of practice
  2. When there is a question about whether the potential risk to the client is acceptable
  3. When the RN is self-employed or does not have the available resources at their place of work to assess the appropriateness of an interpretation to scope
  4. Any time there are questions when applying the decision-making framework

 Resource Links:

Self-Regulation

Competencies and Objectives (2 competencies)

1. Identify how nursing is a self-regulating and autonomous profession mandated by provincial legislation to protect the public

Objectives – the registered nurse will:

      • Define self-regulation
      • State the primary purpose for the regulation of a profession by its members
      • Describe how legislation directs the College to carry out the mandate of self-regulation
  • Identify the three principles of self-regulation
  • Explain self-regulation as it applies to the individual registered nurse and the profession

2. Identify the difference in mandate between regulatory bodies, unions and professional associations

Objectives – the registered nurse will:

  • Explain the difference between a regulatory body, a professional association and a union

Synopsis of Information

Self-regulation is the relative autonomy by which a profession is practiced within the context of accountability to serve and protect the public interest.

Purpose of Self-Regulation

Self-regulation recognizes that members of a profession have the specialized knowledge needed to govern themselves with public input. Through self-regulatory mechanisms, the profession registers, licenses, monitors and when necessary, disciplines its members appropriately with the overall goal of ensuring public protection (Schiller, 2014).

The Board, consisting of elected individuals with representation from our membership and the public, oversees College services. The Board receives its authority from the Act and Regulations. It sets policy directions impacting the programs and services we provide, and determines how the practice of nursing will be regulated and advanced in the public interest.

There are two levels of self-regulation:

  1. The individual level – RNs are accountable for their own practice, adhering to the standards of practice for RNs and NPs and Code of Ethics in all practice settings; and
  2. The College level – We are accountable for supporting RNs to help ensure that the nursing profession acts in the best interest of the public and fulfills the role that has been entrusted to them by government and society.

Three Principles of Self-Regulation

College programs and services are grounded in self-regulation principles, which include but are not limited to promoting good nursing practice, preventing poor nursing practice and intervening when practice is unacceptable.

The College promotes good practice by setting standards for nursing education programs, defining entry-level competencies, setting licensure requirements, promoting evidence based nursing, recognizing nursing role models, establishing professional practice standards and adopting a code of ethics.

The College prevents poor practice by identifying potential risks to client and public safety and offering programs and services to assist RNs to manage or mitigate these risks. This includes providing practice consultations, implementing a continuing competence program, developing resources to support practice and influencing administrative and government policy development that affects the practice of RNs.

The College intervenes when practice is unacceptable through the professional conduct process. Concerns of unsafe practice can be reported by a colleague, manager, employer, or the public. Concerns received are reviewed, and if required, investigated and action is taken to address complaints about the conduct, competence, health or behavior of RNs licensed to practice in our province.

The Difference between a Regulatory Body, an Association and a Union

A regulatory body’s mandate is to protect the interest of the public and an association is a body that promotes the interest of its members and advocates for the profession. The role of the association is supported by organizations external to the College. For example, the Canadian Nurse Association (CNA) exists to advance the practice and profession of nursing nationally and unions represent the interest of RNs in the workplace within Nova Scotia.

Resource Links:

Standards of Practice for Registered Nurses

Competencies and Objectives (1 competency)

1. Practice in accordance with the standards of practice as determined by the College

Objectives – the registered nurse will:

  • Define the terms standard and standards for nursing practice
  • Identify the principles that are the basis for the standards of practice

Synopsis of Information

Standards are defined as authoritative statements that promote, guide, direct and regulate professional nursing practice: describe the desirable and achievable level of performance expected of all registered nurses, including nurse practitioners, against which actual performance can be measured.

Standards of practice means the minimal professional practice expectations for a registrant of a particular designation in any setting or role, approved by the Board.

The Standards of Practice for Registered Nurses are the benchmark for assessing the professional practice of all registered nurses in Nova Scotia, regardless of specialty or practice setting. Nurse practitioners are required to meet these standards, as well as the Nurse Practitioner Standards of Practice.

Principles Related to the Standards

The standards statements are broad in nature, capturing the diverse practice settings and areas in which nurses practise. The standards:

  • apply at all times to all registered nurses in RN practice roles, including nurse practitioners
  • provide guidance to assist registered nurses in decision-making and self-assessment as part of continuing competence
  • are the foundation for the development of standards specific to various contexts of practice.
  • may be used in conjunction with other resources to guide nursing practice (e.g., agency mission statements, models of care delivery)
  • may be used to develop position descriptions, and performance appraisal and quality improvement tools
  • support registered nurses by outlining practice expectations of the profession
  • inform the public and others about what they can expect from practising registered nurses
  • are used as a legal reference for reasonable and prudent practice (e.g., professional conduct processes).

 Resource Links:

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