Nursing Practice Updates

Updates focus on changes to legislation, CRNS bylaws, and the introduction of new standards and guidelines.

NP RN

Medical Assistance in Dying Guideline

The CRNS is pleased to announce the release of an updated nursing practice guideline, Medical Assistance in Dying Guideline, 2021. The guideline has been updated to reflect current, evidence-informed best practices, legislative changes and applies to all categories of nursing practice.

Please review this document and consider how it may relate to your practice. If you have any questions, please contact a CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.org.

NP RN

NPs Prescribing Cosmetics

Nurse Practitioners (NP) in Saskatchewan can prescribe bioactive agents and medical fillers for cosmetic purposes when:

  • the patient condition for which they are prescribing the agents fall within the individual NP common medical disorders;and,
  • the NP has the knowledge, skills and competence to safely assess, treat, prescribe and/or administer the product in accordance with bylaws, standards and competencies and federal legislation.

NPs work within a collaborative team of physicians, Registered Nurses (RN) and other health care providers to implement the nursing process including assessment, care planning, implementation and evaluation. Recognition of practice is required for NPs who practice in the most responsible practitioner role. Contact regulation@crns.ca for further information.

Providing cosmetic services and procedures has evolved over the past several years and includes unique liability risks that NPs should understand prior to engaging in this area of practice. It is strongly recommended that NPs contact the Canadian Nurses Protective Society (CNPS) to discuss liability risks associated with cosmetic nursing.

This nursing practice update replaces the former CRNS October 13, 2020, nursing practice update.

Questions? Contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227, or by email at practiceadvice@crns.ca.

NP RN

Joint Statement on the Section 56 Exemption for CDSA Drugs

The current Health Canada section 56 exemption for all drugs under the Controlled Drugs and Substances Act (CDSA) that was set to expire on September 30, 2021, has been extended to September 30, 2026. The purpose of the exemption was to reduce regulatory barriers to support the continuity of care for patients, and as the pandemic continues and Health Canada works toward modernizing federal regulations, the extension to September 30, 2026, meets these continued needs. The Saskatchewan Prescription Review Program partners – Ministry of Health, Saskatchewan College of Pharmacy Professionals, College of Registered Nurses of Saskatchewan, College of Physicians and Surgeons, and the College of Dental Surgeons of Saskatchewan – have considered the long-term implications of the exemption, with a focus on patient safety and access.

This exemption provides prescribers, including Nurse Practitioners, the authority to issue a verbal prescription for controlled substances drugs to extend or refill a prescription. The Saskatchewan Prescription Review Program partners have agreed to accept the new exemption with the following two provisions for Saskatchewan:

  • CDSA drugs may only be transferred once within Saskatchewan. While there remains risk of diversion of medications, the Patient ID Policy alleviates some risk and permitting one transfer may benefit the patient.
  • Verbal prescription orders should only be accepted after every effort has been made to receive a written or e-prescription from a provider. The rationale for accepting a verbal order must be documented by the pharmacist.

As previous, Health Canada can terminate this exemption depending on the current conditions if the Minister deems that such suspension is necessary to protect public health, safety or security. If necessary, the Minister may change the terms and conditions of this exemption. Should this be the case, you will be informed. Read the Full Statement

NP RN

Medication Management Guideline

The CRNS is pleased to announce the release of an updated nursing practice guideline, Medication Management Guideline. The guideline has been updated to reflect current, evidence-informed best practices and applies to all categories of nursing practice.

Please review this document and consider how it may relate to your practice. If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

NP RN

Joint Message about Ivermectin in the Prevention and Treatment of COVID-19

Ivermectin for prophylaxis or treatment of COVID-19 has been promoted on social media and is not supported by scientific evidence. In humans, ivermectin is only approved for treatment of parasitic infections and rosacea.

Based on the current scientific evidence and best-practice guidelines, the College of Physicians and Surgeons (CPSS), the College of Registered Nurses of Saskatchewan, the Saskatchewan College of Pharmacy Professionals, the Saskatchewan Medical Association, and the Pharmacy Association of Saskatchewan disapprove of the use of ivermectin for either treatment or prophylaxis for COVID. This opinion is further supported by the evidence from Health Canada, the World Health Organization (WHO), Alberta Health Services Covid-19 Scientific Advisory group, and the British Columbia COVID-19 Therapeutics Committee guidance document.

The joint statement is available here.

If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

NP RN

Ethical Considerations for Industry Sponsorship

Industry sponsorship consists of any interest: personal; business; commercial; political; academic; or financial offered by a private, for-profit, or commercial enterprise as part of its marketing and public relations efforts. When encountering industry sponsorship, Registered Nurses (RN) and Nurse Practitioners (NP) must be aware of conflicts of interest. A conflict of interest can be an actual, perceived or potential conflict between the professional duty of an RN or NP and their private interests. A conflict of interest can occur when the RN or NP is in a position to make a decision based upon what is beneficial to their individual interests (i.e., deriving personal benefit [Traversy et al., 2021]) and not in the best interest of the client.

RNs and NPs can engage in ethical considerations for industry sponsorship to ensure safe, competent and ethical care for clients in Saskatchewan by:

  • Reflecting on and practicing according to current CRNS practice documents, including:
    • The Registered Nurses Act, 1988; CRNS bylaws; CNA Code of Ethics for Registered Nurses; Registered Nurse Practice Standards; Registered Nurse Entry-Level Competencies; Registered Nurse (Nurse Practitioner) Practice Standards; Registered Nurse (Nurse Practitioner) Entry-Level Competencies; and other CRNS documents as appropriate.
  • Understanding the employer’s conflict of interest policy. If a conflict of interest policy does not exist, advocate for policy that addresses conflict of interest.
  • Identifying and seeking to avoid conflict of interest to ensure the maintenance of public trust.
    • Any conflict of interest must be resolved in favour of the interest of the client receiving care.
  • Being fully transparent and fully disclosing any actual, perceived or potential conflict of interest when engaging in industry sponsorship.

This nursing practice update replaces the former CRNS Ethics Guidelines for Industry Sponsorship, 2015.

Questions or comments are welcome and can be directed to practiceadvice@crns.ca or by phone: 306.359.4200 or 1.800.667.9945 (toll-free within Canada).

Resources:
RN Practice Standards
RN Entry-Level Competencies
CNA Code of Ethics (2017)
Registered Nurse (Nurse Practitioner) Entry-level Competencies (ELC)s CRNS
Registered Nurse (Nurse Practitioner) Practice Standards CRNS
Self-Employed Practice Guideline

Reference:
Traversy, G., Barnieh, L., Akl, E. A., Allan, G. M., Brouwers, M., Ganache, I., … & Tonelli, M. (2021). Managing conflicts of interest in the development of health guidelines. CMAJ, 193(2), E49-E54.

NP RN

Triaging in Emergency Departments

Registered nurses (RN) are responsible and accountable to provide evidence-based, safe, competent and ethical nursing care in all practice settings. In the emergency department, “the process of triage is essential for safe and appropriate care of the emergency department patient” (National Emergency Nurses Association [NENA], 2019).

In 2019, NENA revised their position statement, Role of the Triage Nurse and includes the following key points:

  • Triage is a sorting process that requires rapid assessment, critical thinking and application of a standard set of guidelines with patients that can experience instability and changes to their condition.
  • The process of triage is best carried out by RNs and Nurse Practitioners (NP) with emergency nursing expertise who have completed a triage-specific educational program.

RNs and NPs work in the emergency department as part of a multidisciplinary team, where safe and appropriate care is best achieved through collaboration and respect.

This nursing practice update replaces the former Triaging in Emergency Departments CRNS and SALPN Joint Statement, 2013.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@crns.ca.

 

Reference:

National Emergency Nurses Association. 2019. Role of the Triage Nurse. Retrieved from https://nena.ca/w/wp-content/uploads/2014/11/Role-of-the-Triage-Nurse-2.pdf

NP RN

Physician to RN Delegation

The College of Physicians and Surgeons of Saskatchewan (CPSS), through The Medical Professions Act, 1981 and their bylaws provide the opportunity for physicians to delegate certain activities to Registered Nurses (RN). The current CPSS Bylaw 23.3 permits delegation from a physician to an RN.

RNs who are considering accepting a delegation from a physician must understand the conditions for this to occur. RNs accepting a delegation from a physician should ensure that they:

  • are certain that the practice is in the best interest of the client in their surrounding environment, including assessment of the risks and all possible outcomes;
  • are willing to only accept a delegation from a physician if the activity is specified in the current CPSS Bylaw 23.3 and for which they are competent;
  • confirm appropriate education, supervision, support and communication avenues are in place with the delegating physician before performing a delegated medical activity;
  • possess the competencies required to manage any outcomes of that activity, including intended and unintended consequences;
  • do not delegate any activity delegated by a physician, to another RN or any other health care provider;
  • are practicing within the legislated scope of registered nursing practice and are upholding the current standards, competencies and code of ethics;
  • have a written agreement with the physician who is delegating to the RN;
  • verify that employer policies and processes are in place to enable acceptance of a delegation from a physician; and,
  • adhere to the employer policy and procedure for a delegated medical activity. That said, no employer policy can relieve RNs of their professional accountability and responsibility. The RN must ensure that:
    • roles, responsibilities and authority, specific for the physician and RN, are clearly outlined in the policies and procedures, including clear lines of reporting and communication;
    • a collaborative process with representation from appropriate professionals, guides the development of these policies and procedures, to ensure professional roles are accurate, professional accountabilities and standards can be met, and that the documents are based upon evidence-informed best practice; and that
    • there is ongoing monitoring and evaluation of the physician to RN delegation process.

The information contained within this nursing practice update replaces the former CRNS document, Guidelines for Physician to RN Delegation.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

NP RN

External Consultation MAiD Guideline

Following feedback from Canadians, experts, practitioners, stakeholders, Indigenous groups, provinces and territories, changes were made to Medical Assistance in Dying legislation which took effect on March 17, 2021.

In response, the CRNS has revised and updated the Guidelines for RN Involvement in Medical Assistance in Dying and the Guidelines for NP Involvement in Medical Assistance in Dying.

The new document Medical Assistance in Dying identifies the changes to the legislation as well as combines the two previous documents into one document. The CRNS is seeking feedback from members, stakeholders and the public related to the new document. Please access the document here. Please access the survey questions here. The CRNS would appreciate any feedback by July 13, 2021, at 4:30 pm.

Final approval of the document is through the CRNS Executive Director and CRNS Council. The document will take effect on the day of CRNS Council approval.

Questions or comments are welcome and can be directed to creece@crns.ca.

NP

Changes to The Coroners Amendment Act, 2019

On June 1, 2021, The Coroners Amendment Act, 2019 and The Coroners Amendment Regulations, 2021 came into force making several changes to The Coroners Act, 1999 and The Coroners Regulations, 2000. There are a couple of changes that may be important for Nurse Practitioners (NP) to be aware of with respect to the reporting of deaths resulting from medical assistance in dying (MAiD). The changes include:

1. The definition of “medical assistance in dying” as defined in section 241.1 of the Criminal Code has been moved from The Coroners Regulations, 2000 to Section 2 of The Coroners Act, 1999.

2. Subsection 7(4) has been added to The Coroners Act, 1999 which clarifies that the reporting requirements under section 7 do not apply with respect to a person who died as a result of medical assistance in dying where the underlying cause leading to death is natural, i.e. from a natural disease process.

3. Subsection 7(5) has been added which requires an NP to report a death resulting from medical assistance in dying to a coroner if the underlying cause leading to the death is unnatural, i.e. from injury rather than disease.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@crns.ca.

NP RN

Drug Recall and Pharmacist Approved Substitutes

As per the safety alert from Health Canada, there is a significant recall of Angiotensin II Receptor Blockers (ARBs) including irbesartan, losartan and valsartan due to an azido impurity. To ensure the continuity of care for patients using ARBs, the Registrar for the Saskatchewan College of Pharmacy Professionals (SCPP) has passed emergency exemptions that allow pharmacists to prescribe therapeutic substitutions, in collaboration with the College of Physicians and Surgeons of Saskatchewan, the College of Registered Nurses of Saskatchewan and the Ministry of Health. See the joint recall notification

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4200 or by email practiceadvice@crns.ca.

NP RN

CRNS Social Media Resource

The CRNS is pleased to announce the release of a new Social Media resource. This resource has been created using current information and feedback from CRNS members and the public. The resource provides guidance and recommendations to CRNS members who utilize social media both inside and outside the workplace. The resource offers strategies to balance advocacy and engagement while also adhering to the practice standards and the code of ethics.

Please review this document and consider how it may relate to your practice. If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

NP RN

Medication Management Guideline

The CRNS is currently reviewing the Medication Management Guideline and is seeking feedback on the content. Medication management is one of the most important responsibilities Registered Nurses (RN) have. This document is applicable to all designations and outlines the responsibilities of both the RN and the employer, as well as the importance of providing safe and competent client care.

The CRNS is seeking feedback on this document from members and stakeholders, including the public, as part of the external consultation process. This process is in place to ensure relevant information is clearly presented. Feedback can be provided by accessing the document here and the survey here. Feedback will be accepted until Tuesday, May 18, 2021 at 4:30 pm.

Final approval of the document is through the CRNS Executive Director and CRNS Council. The document will take effect on the day of CRNS Council approval.

Questions or comments are welcome and can be directed to creece@crns.ca.

NP RN

Canada’s New Medical Assistance in Dying (MAiD) Law

On March 17, 2021 new MAID legislation came into effect. Some of the key changes include:

Eligibility Criteria:

  • Persons requesting MAiD have a grievous and irremediable medical condition remains in the legislation.
  • “Reasonable foreseeability of natural death” criterion has been repealed.
  • Eligibility for persons suffering solely from mental illness is temporarily excluded until March 17, 2023.

Safeguards & Consent:

  • Safeguards have been separated into two tracks based on whether the person’s natural death is reasonably foreseeable.
  • Safeguards have been eased for eligible persons whose death is reasonably foreseeable. This includes the possible waiver of final consent for eligible persons under certain circumstances.
  • Safeguards have been added and/or strengthened for eligible persons whose death is not reasonably foreseeable. Final consent for this group must be provided by the person immediately before administration of MAiD.

Data Collection and Monitoring:

  • All assessments (not only referrals) for MAiD are required to be reported to better capture who is requesting MAiD across the country.

The Government of Canada website includes the updated information and other resources related to the changes to the MAiD law. CRNS MAiD resources are being updated to reflect the changes and will be shared once complete.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

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Medication Management in Covid-19 Immunization Clinics

Changes to the Saskatchewan Immunization Program have been outlined in updates to the Saskatchewan Disease Control Regulations and apply to nurses across the province including those working for the Saskatchewan Health Authority (SHA), Indigenous Services Canada (ISC), Northern Inter-Tribal Health Authority (NITHA) and others. Many partners are involved in rolling out the Covid-19 Immunization Delivery Plan across Saskatchewan, utilizing licensed and unlicensed health care providers to meet the human resource demands while providing safe client outcomes. The team-based approach means there may be some exceptions to current medication management expectations for RNs in relation to Covid-19 vaccines only.

Exceptions to usual practice are approved at the provincial level and supported by provincial and employer documents. Some exceptions that may occur include multiple health care providers:

  • Being involved in the assessment, planning, implementation and evaluation of the vaccine; and
  • Preparing and administering the vaccine.

In practice this means there may be different care providers completing screening, reconstituting vials of vaccine, pre-drawing and labelling syringes, administering the vaccine, documenting, observing for anaphylaxis and responding when needed. The team-based approach supports a large number of health care providers working within their competence to complete components of the immunization process in a safe and timely manner.

Guidance for RNs working in Covid-19 immunization clinics include:

  • Each health care provider competently provides care within their scope of practice or job description and is responsible for the care they provide.
  • Agency policy provides direction to RNs and other health care providers when exceptions to practice are in place.
  • Gaps or unsafe conditions may exist, and RNs are well positioned to identify, report and offer solutions to address these situations.
  • Collaboration and communication are fundamental to effective team functioning and for delivery of safe care.

If you have questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

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National NP Regulation Project Update

In follow up to the December 22, 2020 Nursing Practice Update:

The CCRNR National NP Regulation Project continues to move forward with the goal of providing consistent regulation with a single category of NPs and one national examination for all NPs in Canada. The current priorities of the project are selecting an exam vendor, review of entry level competencies and establishing advisory committees.

The CRNS encourages members who are interested in staying up to date on this project to subscribe to the CCRNR NPR-FIPP newsletter to receive the Project News and to access Frequently Asked Questions.

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

NP RN

Self-Employed Practice Guideline and Documentation Guideline

The CRNS is pleased to announce the release of two updated nursing practice guidelines, the Self-Employed Practice Guideline, and the Documentation Guideline. The guidelines have been updated to reflect the current, evidence-based best practices. These guidelines apply to all categories of nursing practice.

Please review these documents and consider how they may relate to your practice. If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

NP

NPs Completing Medical Certificates of Death (MCOD) and Medical Certificates of Stillbirth (MCOS)

The Government of Saskatchewan amended vital statistics legislation effective January 1, 2016, giving NPs the legal authority to sign the MCOD and MCOS. Information for NP practice in this area has been contained in the CRNS Guidelines for NPs Completing Medical Certificate of Death & Medical Certificate of Stillbirth, 2016. The guideline has been discontinued and this update provides the most current information and resources.

Physicians, coroners, and NPs share responsibility for proper completion of MCOD and MCOS. NPs registered with the CRNS whom have the appropriate knowledge, skills and competencies are authorized to complete a MCOD and MCOS unless the death needs to be reported to a coroner. NPs need to be familiar with the current provincial legislation that will guide their clinical decisions including;

• The Vital Statistics Regulations;

• The Vital Statistics Act;

• The Coroners Regulations; and

 • The Coroners Act.

All Government of Saskatchewan documents are available on Queen’s Printer at the following web site http://www.qp.gov.sk.ca/

Additional resources for NPs:

If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

NP

Referral-Consultation Process for Nurse Practitioners

The College of Physicians and Surgeons of Saskatchewan (CPSS) has recently released a Guideline: Referral-Consultation Process. The guideline includes guidance for physicians who are writing referrals and consultation reports. Nurse Practitioners (NP) are included as care providers within the document. Expectations for communication to/from consulting physicians are important for NPs to know, understand and implement into their practice.

NP practice standards set the expectation for NPs to understand the roles of, and collaborate with, other health care providers to support optimal client outcomes (CRNS, 2017). Section four of the guideline outlines the expectations of referring physicians. The CRNS supports the information in this section and expects NPs to follow these guidelines when referring a patient to a specialist.

If you have any questions, please contact an CRNS Practice Advisor by phone at 1.800.667.9945 or 306.359.4227 or by email practiceadvice@crns.ca.

Reference:

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

GN NP RN RN(AAP)

Support for Public Health Measures

Evidence shows that measures such as handwashing, masking and social distancing are effective strategies to prevent the spread of COVID-19. At this time, as COVID vaccines are being administered to the residents of Saskatchewan, the CRNS wants to remind RNs and NPs about expectations related to providing advice on public health protection and prevention measures.

RNs and NPs are leaders in the community. The public’s trust may extend to the views expressed by RNs and NPs on health matters communicated on social media and other forums. As such, statements made by RNs and NPs in public forums have the potential to impact the health and safety of the public.

RNs and NPs have a professional responsibility and are accountable to:

  • use evidenced-based information to inform their professional practice;
  • support patients and the public to make informed health care decisions, including decisions about public health prevention and protection measures; and,
  • role model and follow public health directives that keep patients and the public safe.

The CRNS’s expectations of RNs and NPs regarding public statements, are outlined in the Registered Nurse Practice Standards, Registered Nurse Entry-level Competencies, Nurse Practitioner Practice Standards, Nurse Practitioner Entry-level Competencies and the Code of Ethics for Registered Nurses.

The CRNS’s standards, entry-level competencies and code of ethics do not apply to all aspects of an RN’s or NP’s private life. However, those who choose to make public comments, while identifying themselves as an RN or NP, are accountable to the CRNS and the public it protects.

RNs and NPs are expected to adhere to the standards, entry-level competencies and code of ethics when carrying out their professional responsibilities. They have a professional responsibility to provide evidence-based information and care. Making anti-vaccination, anti-masking and anti-distancing comments may result in an investigation by the CRNS, and possible disciplinary proceedings. 

Additional resources

CRNS

Social Media

Saskatchewan Health Authority

Government of Saskatchewan

Government of Canada

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