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Category: RN(AAP)

Extension to the Temporary Exclusion of Eligibility for MAiD 

On February 2, 2023, the Ministers of Justice and Health of the Government of Canada introduced legislation, Bill-39, to extend the temporary exclusion of eligibility for MAiD where a person’s sole medical condition is a mental illness until March 17, 2024. The one-year extension would provide the federal government with additional time to prepare for the safe and consistent assessment and provision of MAID where the person’s sole underlying medical condition is a mental illness. 

The CRNS will continue to monitor updates from the Federal government, work with Saskatchewan Health Authority MAiD program partners and provide updates as they become available.

More information is available from the Department of Justice Canada website, MAiD Media Release.

If you have any questions, please get in touch with Practice Advice at practiceadvice@crns.ca

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

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.

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.

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.

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

Government of Saskatchewan

Government of Canada

Section 56 Exemption Extension

The current Health Canada section 56 exemption that was set to expire on September 30, 2020 has been extended to September 30, 2021. This exemption provides practitioners with the authority to issue a verbal prescription for controlled substances. There are no changes to the exemption and 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. View the update here.

Professional Accountability During the Pandemic – Joint Statement

Nursing Practice Update: Joint Statement – Supporting Saskatchewan Regulated Health Care Professionals During the COVID-19 Response

The COVID-19 pandemic is difficult and challenging for our health care system. During a surge in COVID-19 cases, you may be required to adapt your usual practice. A joint statement outlining principles and practice expectations for you and other regulated health care professionals has been developed to support clarity during these challenging times. Read the Full Statement

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

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