Nursing Practice Updates

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.

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:

• Government of Saskatchewan, Vital Statistics, eHealth Saskatchewan. (2016). Guidelines for completing the medical certificate of death and medical certificate of stillbirth. Regina, SK. https://www.ehealthsask.ca/residents/deaths/Documents/HowToCmpltMCD%20v7.pdf
• CPSS 2016, Physician obligations regarding medical certification of death. https://www.cps.sk.ca/imis/CPSS/Legislation__ByLaws__Policies_and_Guidelines/Legislation_Content/Policies_and_Guidelines_Content/Physician_Obligations_Regarding_Medical_Certification_of_Death.aspx
• 2016 CRNS Webinar, edited Jan 2021 https://youtu.be/tg0EnxOPTmk
• CMPA https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2016/completing-medical-certificates-of-death-who-s-responsible

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.

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

As of December 1, 2020, Nurse Practitioners in Saskatchewan will no longer be required to complete 600 clinical hours to maintain eligibility for registration. According to CRNS Bylaw VI subsection 3(7), NPs are required to work in nurse practitioner activities approved by the association in one of the four specialties for at least 900 hundred hours in the three years immediately preceding application. However, there is no longer a requirement for clinical hours.

This modification was made in recognition of changes in NP practice acknowledging the increasing diversity with many NPs working in various domains of practice outside of a clinical setting.

For any questions regarding this change, please email Leah White, RN Nursing Advisor (lwhite@crns.ca)

Infection Prevention and Control Canada has released an updated document on the use, cleaning, disinfection, sterilization and storage of foot care devices. The document outlines the required equipment and devices for client treatment, as well as stipulations for the purchasing and reusing of foot care devices, and options for guaranteed sterilization of the devices if items are being reused.

It is your duty as the Registered Nurse administering care to ensure that the client is not placed at risk of infection when foot care devices are being used. The level of sterilization of foot care instruments and supplies must be at the level of a health professional. RNs should evaluate their current practices against the recommended infection prevention and control practices within the document and adjust, as necessary.

With the rise of instances of chronic diseases increasing the need for advanced foot care, this document is to ensure that all Registered Nurses with this added certification are up-to-date on the best practices for safe foot care treatment, and are educated on the options available to ensure infection does not occur.

Read the full document here.

RNs and NPs are working with organizations to provide continued safe, competent and ethical care to the people of Saskatchewan during the COVID-19 pandemic. Using virtual means, such as telehealth, to connect with patients and families is a necessity in today’s environment. Telehealth connects patients and health care providers who provide health services over the phone, computer or any other forms of information and communication technologies (ICT). Nursing telepractice is the delivery, management and coordination of care and services provided via ICT.

When utilizing ICT for telepractice, RNs and NPs must ensure they continue to uphold their standards, competencies and code of ethics. The importance of clinical knowledge, nursing judgment, communication and documentation skills is paramount when establishing and maintaining a nurse client relationship through telehealth. More information for nursing telehealth activities can be found in the resource section below.

To provide telehealth to a Saskatchewan resident, you must be registered and hold a practicing license with the CRNS. The Registered Nurses Act, 1988 in Saskatchewan outlines the need to be registered to engage in the practice of registered nursing and to use protected titles. Information about registration can be found here.

Each province/territory and country is governed by differing legislation/regulations/bylaws. It is important to contact the nursing regulator in that jurisdiction before providing telehealth services to their residents.

Questions about registration can be directed to Regulatory Services by email at register@crns.ca or by calling 306.359.4200 or 1.800.667.9945 (toll free within Canada).

For a confidential consultation about a practice issue, please contact a Practice Advisor by email at practiceadvice@crns.ca or call 306.359.4200 or 1.800.667.9945 (toll free within Canada).

Resources:      

Van Houwelingen, C. et al. (2016). Competencies required for nursing telehealth activities: A Delphi-study. Nurse Education Today, 39, 50-52. https://www.sciencedirect.com/science/article/pii/S0260691716000149

Canadian Nurses Protective Society, www.cnps.ca

Canadian Nurses of Ontario (CNO) (2017). Practice Guideline: Telepractice CNO Practice Guideline: Telepractice

Changes to Prescription Review Program Panel of Monitored Drugs

As a partner to the Prescription Review Program (PRP), the College of Registered Nurses of Saskatchewan (CRNS) is sharing the following update with all Nurse Practitioner members in the province.

As outlined in CRNS Bylaw (2019) VI – Categories of Practice, Section 4 The Prescription Review Program, (2) Panel of Monitored Drugs, the Prescription Review Program shall apply to all dosage forms of the drugs listed in the panel of monitored drugs contained in the bylaws of the College of Physicians and Surgeons of Saskatchewan as amended from time to time.

The College of Physicians and Surgeons (CPSS) has provided the following information to their members, which also applies to all NPs. Please be advised of the amendment to The College of Physician and Surgeons of Saskatchewan’s Regulatory Bylaw 18.1(a) Panel of Monitored Drugs.

The highlighted drugs reflect the new additions, effective immediately.

Review the full list of changes from The College of Physician and Surgeons of Saskatchewan here.

We have received a number of calls lately about telehealth and the ability to provide this service. Telehealth connects patients and health care providers who provide health services over the phone, computer or any other form of information and communication technologies (ICT).

Providing telehealth to a Saskatchewan resident

To provide telehealth to a Saskatchewan resident, you must be registered and hold a practicing license with the CRNS. The Registered Nurses Act, 1988 in Saskatchewan outlines the need to be registered to engage in the practice of registered nursing and to use protected titles. Information about registration can be found here.

Questions about registration can be directed to Regulatory Services by email at register@crns.ca or by calling 306.359.4200 or 1.800.667.9945 (toll free within Canada).

Providing telehealth to clients who are residents of another province or territory

Each province/territory and country is governed by differing legislation/regulations/bylaws. We encourage you to contact the nursing regulator in that jurisdiction before providing telehealth services to their residents.

A national discussion is currently underway to examine the delivery of telehealth services across the country. We will provide updates on this issues as further information becomes available.

For a confidential consultation about a practice issue, please contact a Practice Advisor by email at practiceadvice@crns.ca or call 306.359.4200 or 1.800.667.9945 (toll free within Canada).