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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.

Advanced Foot Care for Registered Nurses

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.

Nursing Use of Information and Communication Technologies

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

Telehealth Nursing Practice

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).

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