Response to HPRAC's New Directions Report
The Registered Nurses’ Association of Ontario (RNAO) is the professional organization for registered nurses who practice in all roles and sectors across Ontario. Our mandate is to advocate for healthy public policy and for the role of registered nurses in serving the public. It is in the context of this mandate that RNAO is pleased to provide feedback to the Ministry on HPRAC’s New Directions Report.
Registered nurses are the single largest group of health-care professionals in the province. The legislative environment in which we work has an impact on our practice, and our relationships with other health-care professionals.
RNAO and its members are very supportive of the Registered Health Professionals Act (RHPA) and the fundamental concepts that underlie the legislation – protection of the public and self-regulation. This legislative context has accommodated many advances in nursing over the last 14 years. While the structure of the legislation with overlapping scope of practice, self-regulation, and protection of the public remains current, the legislation does require some changes to keep up with the changing practice environment.
We have attached comments in the form that the Ministry requested. This letter provides an overview of our responses to the report. While we are supportive of the overall direction of the report, we have serious concerns about the regulation of personal support workers (PSWs). In particular, we believe that a move to regulate this group of workers will negatively impact health outcomes and compromise patient safety.
We are concerned that HPRAC’s recommendations in some areas are not specific enough, and in others that proposed consultations should not delay necessary changes in regulation or legislation. The attached feedback forms present our views on regulation of personal support workers, definition of psychotherapy and educational requirements, prescriptive authority for nurse practitioners, alternative dispute resolution, and mandatory reporting.
We strongly support the following recommendations in the report:
Chapter 7, Recommendation 1 and Chapter 2, Recommendations 49 and 50
- That psychotherapy and psychotherapists be regulated under the RHPA.
- Recommendation 49 adds the following definition to section 1 of the RHPA:
- “bodily harm means any harm, hurt, or injury, whether physical, psychological or emotional, that interferes in a substantial way with the integrity, health or well-being of an individual”.
- Recommendation 50 amends the “harm clause” to include a reference to serious bodily harm.
RNAO supports the regulation of psychotherapy because of the risk of harm associated with it. RNAO supports HPRAC’s approach to regulation. It accomplishes a number of important objectives: protection of the public from harm; ensuring access to psychotherapeutic services for the population; providing for existing professional colleges to set standards and educational requirements for psychotherapy; and, not requiring dual registration for professionals with the college of psychotherapy and their own colleges.
Chapter 2, Recommendations 52 and 53
These recommendations provide title protection for nurse practitioners.
In Ontario, the title Nurse Practitioner is widely used. Other jurisdictions have already protected the Nurse Practitioner title.
Chapter 2, Recommendation 56
This recommendation requires the Ministry to set accountability standards for its performance in the regulation process.
Nursing practice has been unduly constrained by delays in the regulatory process. The most obvious example is the constraints on RN(EC)s’ practice both by the process for determining diagnostic and prescriptive authority, but also by delays in the regulatory process. Delays in the current regulatory system of approval hamper RN(EC)s’ practice and Ontarians’ access to timely health care from the appropriate provider.
While we support the following recommendation, we are disappointed that it is not more specific and does not have timelines attached to it.
Chapter 2, Recommendation 62
HPRAC recommends the development of a consultation program that will enable each profession to assess the validity and currency of its scope and authorized acts and to report to the Minister with its recommendations.
RNAO had hoped for more progress on expanding RNs’ scope of practice in HPRAC’s report. We had consulted with our membership, and made the following recommendations on expanding RNs’ scope of practice:
- Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis;
- Setting or casting a fracture of a bone or a dislocation of a joint;
- Applying a form of energy prescribed by the regulations under this Act (i.e. RHPA); and,
- Dispensing a drug as defined in subsection 117 (1) of the Drug and Pharmacies Regulation Act.
RNs should have the authority to perform these acts within nursing scope of practice based on knowledge, skill, and experience. This will ensure timely access to care; reduce the need for delegation; and, support progression of care management in a timely way.
We believe that the report should have recommended mandatory liability coverage. RNAO believes very strongly that mandatory liability coverage serves the interests of nurses and is an important component of the self-regulatory environment. The mandatory nature of the coverage will ensure equality of access to legal assistance for all registrants, regardless of where they practice and what financial resources are available to them. Universal access to legal assistance for nurses will also enhance the fairness and transparency of the discipline process.
We thank the Ministry for the opportunity to provide feedback on these important measures, and look forward to working with you on legislative amendments that will protect the public and improve the health of Ontarians.