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External Consultation for Self-Employed Practice Guidelines

The CRNS is currently in the process of revising the Self-Employed Practice Guidelines. The Self-Employed Practice Guidelines provide guidance for RNs and NPs who are interested in setting up their own practice. The guideline covers such topics as the legislation and regulatory requirements for self-employed practice, confidentiality, consent, considerations when treating family and friends, information management, policy and procedure development, and liability protection.

The CRNS is seeking feedback on this document from the public, partners, and member. Feedback can be provided by accessing the survey here. The document can be accessed here.

Final approval occurs through the CRNS Executive Director and CRNS Council. The guideline will take effect on the CRNS Council approval date.

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

Amendments to FDRs

In recent changes made to the Food and Drug Regulations (FDRs), Nurse Practitioners will be included as a “practitioner” to whom drug samples may be distributed.

On March 13, 2020, Bill C-4 (the Canada–United States–Mexico Agreement Implementation Act) received Royal Assent and came into effect July 1, 2020. The Canada-United States-Mexico Agreement (CUSMA) included regulatory commitments specific to products recognized as being at the interface of cosmetics and drugs. Among other things, the Act amends section 14 of the Food and Drugs Act (i.e., the prohibition on the distribution of drugs as samples).

Corresponding amendments were made to the Food and Drug Regulations (FDRs), including amendments to section C.01.048, to permit the distribution of drugs as samples to a “practitioner”. “Practitioner” is now defined in the FDRs, referring to a person who is entitled under the laws of a province or territory to treat patients with a prescription drug; therefore will include Nurse Practitioners as a “practitioner” to whom drug samples may be distributed. These changes permit distribution of drugs as samples to clients, as a matter falling within the Nurse Practitioner’s scope of practice. Other practitioners with prescribing authority under provincial and territorial law but who could not (prior to these amendments being made) receive samples of prescription drugs and NPDs include chiropodists (podiatrists), optometrists, naturopaths and midwives.

As part of the CUSMA implementation, Health Canada established a guidance document on the distribution of drugs as samples, as well as lists of the specific non-prescription drugs and natural health products that can be distributed as samples directly to consumers. Health Canada also established a list of the non-prescription drugs for which additional (i.e., identity and confirmatory) testing is not required upon importation and may be directly shipped to retailers or wholesalers.

Further to this guidance document, Health Canada wishes to advise interested stakeholders of the steps that are being undertaken to expand the lists of products described above, as follows:

1. Amend List A: List of Certain Natural Health Products for Distribution as Samples to include all currently authorized products in the product categories set out in the CUSMA and meeting the identified criteria, i.e., for topical use, localized and non-systemic effect, and meets the definition of a “cosmetic”.

2. Amend List D: List of Certain Non-prescription Drugs for Distribution as Samples to include all currently authorized products in the product categories set out in the CUSMA and meeting the identified criteria, i.e., for topical use, localized and non-systemic effect, and meets the definition of a “cosmetic”.

3. Amend the List of Non-prescription Drugs for Which the Testing Requirements Set Out in Subsections C.02.019 (1) and (2) of the Food and Drug Regulations Do Not Apply to include all currently authorized products in the product categories set out in the CUSMA and meeting the identified criteria, i.e., for topical use, localized and non-systemic effect, and meets the definition of a “cosmetic”.

If you have any questions, please contact the Natural and Non-prescription Health Products Directorate at: hc.nnhpd.consultation-dpsnso.sc@canada.ca

More information on the amendments 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

PRP ADVISORY – Drug Panel Update

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.

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).

NP Practice Update: NPs Prescribing for Opioid Use Disorder (OUD) and Methadone for Pain

On March 27, 2019, CRNS Council passed the two policies that allow NPs, who regularly see people with Opioid Use Disorder (OUD) or who require methadone for pain, to apply to the CRNS to receive approval to prescribe medications such as suboxone and methadone. These regulatory processes are in follow up to the Bylaw passed by CRNS membership at the 2018 CRNS Annual Meeting. Based on this Bylaw, the CRNS has worked with provincial and national partners, including the Saskatchewan Health Authority, the Ministry of Health, the College of Physicians and Surgeons of Saskatchewan, Interdisciplinary Advisory Committees, and NP Advisory Committee, to develop the education and clinical practicum requirements, and regulatory processes.

The CRNS has developed regulatory processes to minimize harm to the public and develop expectations for safe prescribing. In accordance with the CRNS mandate to set standards for competence and govern prescribing, NPs must meet all requirements prior to receiving approval to prescribe drug therapeutics for OUD and methadone for pain. The NP prescribing of these additional medications will be monitored through the existing Prescription Review Program.

Advancing the NP Scope of Practice by enabling NPs to prescribe drug therapeutics for OUD will increase the number of approved prescribers in Saskatchewan; thereby providing increased access for clients.

Eligible NPs can begin the application process as of April 2, 2019.

NPs Can Prescribe Medical Cannabis

With the legalization of recreational cannabis on October 17, 2018, new Cannabis Regulations have replaced the Access to Cannabis for Medical Purposes Regulations (ACMPR). Under the new regulations, a nurse practitioner is defined as an authorized health care provider and is not restricted, under the laws of the province in which they practise, from authorizing the use of cannabis.  The College of Registered Nurses of Saskatchewan (CRNS) has determined that it is within the NPs scope of practice whom have the appropriate knowledge, skills and competencies to safely authorize the use of medical cannabis for Saskatchewan clients.

It is important NPs educate clients on the risks, side effects, safe transportation and storage of medical cannabis. NPs are required to adhere to employer policy for authorizing the use of medical cannabis. Clients authorized by their health care provider are still able to access cannabis for medical purposes by:

Additional resources for NPs:

CRNS Nursing Advisors are available to discuss practice questions about cannabis. To contact the CRNS for practice advice, please call: 1-800-667-9945 or 306-359-4200 (ask to speak to a practice advisor), or you can email at practiceadvice@crns.ca

NPs Can Prescribe Mifegymiso

Mifegymiso is an antihormonal medication consisting of two medications (mifepristone and misoprostol) that work together to block the effects of progesterone for termination of early pregnancy.

Health Canada recently broadened the interpretation of Mifegymiso prescriber to include prescribing health professional, resulting in Nurse Practitioners having the legal authority to prescribe Mifegymiso within Canada. The College of Registered Nurses of Saskatchewan (CRNS) has determined that it is within the NP’s scope of practice whom have the appropriate knowledge, skills and competencies to prescribe Mifegymiso to Saskatchewan patients.

Additional resources for NPs:

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