Nursing Practice Updates

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

NP

Saskatchewan Biosimilars Initiative Update 

The Saskatchewan Biosimilars Initiative was announced on October 20, 2022, to improve the uptake of biosimilar drugs. The Biosimilars Initiative means that patients will be covered for a biosimilar version of their biologic medication where one is available. 

The latest update includes clarifications and resources to support health care providers and patients. Some reminders: 

  • A new Exception Drug Status (EDS) application is not required for patients to start using a biosimilar. 
  • Where applicable, EDS coverage for the listed biosimilars has been added for patients who have current EDS coverage for an affected reference biologic. EDS coverage for the reference biologic will be terminated on April 30, 2023. 
  • Biosimilars are not listed as interchangeable with the reference biologic on the Saskatchewan Formulary. They cannot be substituted at the pharmacy level. 
  • Prescriptions must clearly indicate the biosimilar brand to be dispensed by the pharmacy. 

This update from the Ministry of Health includes Insulin coverage updates, exemptions and extensions, and patient notification requirements.

Physicians, NPs and pharmacists are asked to approach patient questions with evidence-based information to help build patient confidence in the data supporting biosimilar use and transition.

Additional resources:

November 18, 2022: Letter to Health Care Providers – Patient Communications and Patient List Request Form

October 20, 2022: Letter to Health Care Providers Regarding Saskatchewan Biosimilars Initiative

Guide for Patients

Patient List Request Form

Visit the Biosimilars Initiative website for the most current and up-to-date news regarding this initiative.

NP RN RN(AAP)

Antibiotic Suspension Shortage

Health Canada has declared a Tier 3 shortage for several antibiotic suspensions. Tier 3 is the most critical level and is expected to impact the health care system significantly. Many antibiotic suspensions are unavailable or sporadically available in extremely limited supply.

There may be a current supply of certain antibiotic suspensions, but we should expect these to become depleted as prescribing shifts. Tablets and capsules are currently available. This message addresses:

  • Strategies for conserving antibiotic suspensions
  • Resources for managing this shortage
  • Resources to help your patients understand the shortage

Note: All RN(AAP)s can only prescribe and dispense the medications that are identified in a CDT. Review the appropriate CDT prior to prescribing and dispensing any medication. Due to the suspension shortage, consult with a physician or NP as needed to receive orders for medications not included in the CDT.

Read the joint statement regarding the Antibiotic Suspension Shortage

NP

UPDATE: Saskatchewan Biosimilars Initiative

The Saskatchewan Biosimilars Initiative was announced on October 20, 2022, to improve the uptake of biosimilar drugs. The Biosimilars Initiative means that patients will be covered for a biosimilar version of their biologic medication where one is available.

The Biosimilars Initiative includes ten drugs listed on the Saskatchewan Formulary: adalimumab (Humira®), enoxaparin (Lovenox®), etanercept (Enbrel®), filgrastim (Neupogen®), glatiramer (Copaxone®), infliximab (Remicade®), insulin aspart (NovoRapid®), insulin glargine (Lantus®), insulin lispro (Humalog®), and rituximab (Rituxan®). The policy will also apply to future reference biologics as new biosimilars are launched and listed on the Saskatchewan Formulary.

Established patients already receiving a reference biologic drug (or “originator” biologic) with an available biosimilar version will be required to use a biosimilar version by April 30, 2023, in order to maintain coverage under the Saskatchewan Drug Plan.

Physicians, NPs and pharmacists are asked to approach patient questions with evidence-based information to help build patient confidence in the data supporting biosimilar use and transition.

Additional resources:

November 18, 2022: Letter to Health Care Providers – Patient Communications and Patient List Request Form

October 20, 2022: Letter to Health Care Providers Regarding Saskatchewan Biosimilars Initiative

Guide for Patients

Patient List Request Form

For the most current and up-to-date news regarding this initiative, visit the Biosimilars Initiative website.

NP RN RN(AAP)

Amendment: Pharmacists Prescribing for Acetaminophen to Support Accessing Compounded Supplies During the Pediatric Analgesic Shortage

This is an update to the October 12, 2022, Nursing Practice Update. The provincial Collaborative Practice Agreement to support accessing compounded supplies during the pediatric analgesic shortage has been updated to include ibuprofen.

There is a demand surge for pediatric analgesic and antipyretic dosage forms which is creating an ongoing supply issue for patients. Pharmacists have been supporting patients by assisting with advice on alternate products, different dosage forms, repackaging bulk supplies when able, and compounding. 

To support patient access during the pediatric analgesic shortage, the College of Physicians and Surgeons of Saskatchewan, the College of Registered Nurses of Saskatchewan, and the Saskatchewan College of Pharmacy Professionals have created a short-term solution in the form of a provincial CPA which would then enable pharmacists to prescribe for pediatric acetaminophen and ibuprofen. 

Read the full statement here.

RN RN(AAP)

Update to Pharyngitis: Adult and Pediatric Clinical Decision Tool (CDT)

There is an updated dose of Azithromycin as a third-line oral antibiotic agent within the Pharyngitis: Adult and Pediatric CDT. This change takes effect immediately and is posted on the CRNS website along with all of the CDTs for RN(AAP) practice. 

The change in Adult and Pediatric dosing and duration of Azithromycin is consistent with the RxFiles: Drug comparison charts (13th ed.), and is as follows: 

If you have any questions, CRNS Practice Advisors are available by emailing practiceadvice@crns.ca.

Reference

RxFiles Academic Detailing Program. (2021). RxFiles: Drug comparison charts (13th ed.). Saskatoon Health Region.

NP RN RN(AAP)

CRNS Bylaws Update

The 2022 Bylaws package was presented to registrants for their approval at the annual meeting on May 5, 2022. All proposed bylaw amendments were approved which allowed CRNS to follow the established government processes for finalizing the bylaws. Administrative bylaws were filed with the Information Services Corporation (ISC) following the annual meeting and we received written approval from them on May 31, 2022. Regulatory bylaws were submitted to the Ministry of Health for Ministerial approval in June. These bylaws were approved and published in the September 9, 2022, Saskatchewan Gazette which brings them into force and effect. 

What this means for registrants is that the 2022 Bylaws are being updated and are now posted on the CRNS website for review. On November 1, 2022, all registrants will be required to comply with these bylaws. Some of the key regulatory bylaw amendments are listed below:

  • Continuing Competence Program (CCP) requirements for the revised program will be implemented for the upcoming 2023 registration year which begins on December 1, 2022. The new requirements have been outlined in Bylaw V.1 Continuing Competence. 
  • To fulfill the CRNS mandate of protection of the public, all practicing members in every category must report to the Registrar by email or phone, as soon as is reasonably practical, a charge under the Criminal Code (Canada), the Controlled Drugs and Substances Act (Canada) or any similar legislation in any province, territory, state, or country, or any charge concerning the practice of nursing or another profession in any jurisdiction. This amendment can be found in Bylaw VI Membership.
  • Bylaw VI Categories of Practice, Section 3 Nurse Practitioner Category contains a change for NP practice. It enables NPs to order or request medical imaging involving the application or detection of forms of energy for diagnostic and screening purposes and to receive and interpret reports, or to perform ultrasound imaging for the sole purpose of point of care diagnostic assistance when it is in the best interest of the client, in accordance with their practice standards and code of ethics, when they have the competence and judgment to safely do so, when it is in alignment with best practice evidence and when agency policy permits. This is an important amendment that facilitates increased access to timely care for the residents of Saskatchewan. 
  • Another bylaw that impacts NPs directly is Bylaw VI Categories of Practice, Section 4 Prescription Review Program as the language has been updated to reflect current best practices on providing prescriptions directly to a pharmacy. 
  • A new section was added to Bylaw VI Categories of Practice, Section 5 Resignation on Medical or Other Grounds. This bylaw essentially allows a CRNS registrant who identifies that their fitness to practice is significantly impacted by the effects of a physical or mental disability and choose to resign from practice to protect the safety of patients. The bylaw outlines the conditions of this process. 
  • Bylaw XV adopts the recently published RN with Additional Authorized [RN(AAP)] Practice Standards as the standards required of registered nurses practicing with Additional Authorized Practice, so this will be of special interest to RN(AAP)s and managers or interdisciplinary colleagues of RN(AAPs). The 2022 RN(AAP) Practice Standards will be posted online in the upcoming weeks.

Some of the key administrative bylaw amendments are listed below:

  • The Canadian Nurses Association (CNA) officially changed their membership structure at their 2021 annual meeting and this was implemented on January 1, 2022. Jurisdictional Membership will not exist going forward. Instead of organizations representing nurses as members, individual nurses will obtain their own memberships. Therefore, Bylaw I, Section 6 and Bylaw VII Fees, Sections 3 and 4 have all been updated to reflect this. This is important for registrants to be aware of because CRNS will no longer be collecting CNA fees during license renewal. Should registrants wish to be CNA members, they can do so independently by following this link.
  • Bylaw VII Fees also contains wording regarding fees for practicing registrants currently licensed in a jurisdiction whose nursing regulatory body has signed a multijurisdictional agreement with the council to provide virtual care in Saskatchewan. 

Should you have questions regarding the 2022 Bylaws, contact a Nursing Practice Advisor by email at practiceadvice@crns.ca or by phone at 1.800.667.9945.

NP

NPs Authorizing RNs to Administer Bioactive Agents

Registered Nurses (RN) may be authorized by a Nurse Practitioner (NP) to administer bioactive agents such as Botox. The CRNS has collaborated with the College of Physicians and Surgeons of Saskatchewan (CPSS) over the past several months to obtain written clarification on this matter and is able to share this update. 

Prior to initiating practice, RNs administering and NPs administering and/or authorizing bioactive agents require recognition of practice through the CRNS Regulatory Services team. 

RNs and NPs must have the ongoing knowledge, skill and judgement to safely perform the injection of bioactive agents. NPs authorizing this practice must also supervise the RN to reasonably assure safety for clients. The administration of bioactive agents is beyond entry-level practice and requires an RN Clinical Protocol that includes the essential components of an RN Specialty Practice

Further guidance on including alternative and complementary therapies into RN and NP practice can be found in thisNursing Practice Update.

CRNS Nursing Advisors are available by emailing Regulatory Services at regulation@crns.ca or Nursing Practice at practiceadvice@crns.ca.

NP RN

National NP Regulation Project Update, as of March 2, 2022

The Canadian Council for Registered Nurse Regulators (CCRNR) Nurse Practitioner Regulation Framework Implementation Plan Project (NPR-FIPP) continues to move forward. All project updates can be found on the CCRNR website. 

If you’d like to stay up-to-date on this project, you can subscribe to the CCRNR NPR-FIPP newsletter when you visit CCRNR website. The CRNS will be setting up meetings to inform partners of the project and involve key stakeholders in consultation. 

If you are interested in learning more about this project, email Donna Cooke, Nursing Advisor, at dcooke@crns.ca.

GN NP RN

Amendments to the Criminal Code to Protect Health Care Workers and People Seeking Access to Health Services

Nursing Practice Update: Amendments to the Criminal Code to protect health care workers and people seeking access to health services

Changes to the Criminal Code came into effect on January 16, 2022, and serve to enhance protection for health care workers and people seeking access to health services. Violence and threats of violence towards Registered Nurses and other health care workers is a long-standing issue that has worsened during the COVID-19 pandemic and has extended to the public who are seeking health services. A backgrounder from the Government of Canada is available here.

The Canadian Nurses Protective Society (CNPS) has written an article further describing the changes to the Criminal Code and how they may intersect with Registered Nurses as health care professionals.

CRNS members are encouraged to read the linked articles in this update to become familiar with the legislation changes.

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

External Consultation – Assignment of Tasks to Unregulated Care Providers

The CRNS is updating direction to its members who assign tasks to unregulated care providers. The CRNS is seeking feedback on this resource from members and external 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 this survey and will be accepted until Monday, January 31, 2022 at 4:30pm.

Final approval of the resource is through the CRNS Executive Director. Questions or comments are welcome and can be directed to tbelcourt@crns.ca.

NP

Amendment to the Controlled Drugs and Substances Act & the Narcotic Control Regulations

Effective March 31, 2022, tramadol will be removed from the Prescription Drug List (PDL) and listed in Schedule 1 of the Controlled Drugs and Substances Act (CDSA). Tramadol will also be listed as item 19 in the Schedule of the Narcotic Control Regulations (NCR). This means that tramadol will be subject to all the regulatory requirements set out in the CDSA and NCR. The rational to change the listing is to reduce risks to human health, and to facilitate the detection and prevention of diversion of tramadol.

For a full explanation, including impact to practice, please visit:

https://gazette.gc.ca/rp-pr/p2/2021/2021-03-31/html/sor-dors43-eng.html

If you have any question about your NP practice, please contact practicadvice@crns.ca.  If you have any questions about prescribing controlled drugs and substances or the CRNS

Prescription Review Program, please contact prp@crns.ca

NP RN

Alternative and Complementary Therapies

The number of RNs and NPs engaging in alternative or complementary therapies, such as aesthetics, through non-traditional employers or self-employed practice, has increased in recent times.  These practices require assessment by the College of Registered Nurses of Saskatchewan (CRNS) to determine if the activity is recognized as registered nursing practice. Being engaged in self-employed practice brings certain opportunities as well as inherent risks, therefore it is important for RNs and NPs interested in and/or practicing in these areas to:

  • Consult with a Nursing Practice Advisor to discuss your practice situation and receive guidance on next steps;
  • Consult with a Regulatory Services Nursing Advisor to discuss the Recognition of Practice process;
  • Refrain from using the RN or NP title until the activity has been recognized as nursing practice by the CRNS;
  • Ensure that the necessary resources, including but not limited to, supplies to manage untoward events, policy/procedure manual, are in place for safe patient care;
  • Ensure that you have the appropriate authority to conduct the activities; and,
  • Refrain from including hours worked in these areas in self-reported RN or NP practice hours until the activity has been recognized as nursing practice by the CRNS.

As the landscape of alternative and complementary therapies grows and changes, the CRNS applies principles of right touch regulation when working with members to reasonably assure accountable professional practice. The CRNS lives this by applying consistent and transparent processes, providing decisions that are proportionate to the risk posed and by showing agility to adapt to change while keeping the focus on public safety.

CRNS Nursing Advisors are available by emailing:

Regulatory Services at regulation@crns.ca or

Practice at practiceadvice@crns.ca.

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.

Scroll to top
X