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 nursing. We are pleased to respond to the HPRAC consultation on issues related to the ministerial referral on interprofessional collaboration among health colleges and professionals. This submission by the Board of Directors of the Registered Nurses’ Association of Ontario was informed by the perspectives of our members, including two of our expert interest groups, the Community Health Nurses' Initiatives Group (CHNIG) and the Nurse Practitioners' Association of Ontario (NPAO).
Changes to HPRAC’s Definition of Interprofessional Collaboration
• HPRAC proposes that any initiatives should be directed to finding ways to: “assist health regulatory colleges and their members to work collaboratively, rather than competitively, and to learn from and about each other through a process of mutual respect and shared knowledge” (p. 26). RNAO suggests that “rather than competitively” be removed, as it reinforces organized medicine’s preoccupation with shared scopes of practice as inherently competitive.
• RNAO suggests that “patient” be replaced by “client” and defined as being “inclusive of individuals, families/significant others, groups, communities, and populations.”
• RNAO suggests replacing “improve patient care” to “improve client-centred care”. Changes to the Regulated Health Professions Act
• RNAO recommends access to the following additional controlled acts for the profession of nursing:
o 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; o setting or casting a fracture of a bone or a dislocation of a joint;
o 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
• Supporting interprofessional practice requires the government to act on CNO’s recommendation to remove limitations on the following controlled acts currently authorized to RN(EC)s:
o communicating a diagnosis;
o and administering a substance by injection or inhalation.
As well, it requires providing access to the following additional acts for RN(EC)s:
o setting or casting a fracture of a bone or a dislocation of a joint; o dispensing, selling or compounding a drug;
o and, applying a form of energy prescribed in regulations under this Act (i.e. RHPA).
Changes to the Public Hospitals Act and its regulations
• Allow RNs to work to their full scope of practice in hospitals settings.
• Allow RN(EC)s to work to their full scope of practice in an inpatient setting.
• Replace Medical Advisory Committees with Interprofessional Advisory Committees.
Changes to the Healing Arts Radiation and Protection Act
• To provide RNs with the authority to order X-Rays Changes to the Vital Statistics Act
• To provide RNs with the authority to sign the Medical Certificate of Death in situations when death is expected.
• The critical issue that must be addressed is the adequacy of professional liability protection carried by all employers of health-care professionals.
• Those professionals, including the relatively few NPs and RNs who practice as independent contractors or are self-employed, should be fully informed about their professional obligation to clients. Requirements should be in place to ensure that these professionals maintain adequate liability protection reflective of their risk profile.
• The current coverage of $5M that is available through CNPS should be deemed sufficient for NPs practicing as independent contractors. Further, the $1M coverage for RNs is also an acceptable minimum requirement when practicing as an independent contractor.
• It is essential that interprofessional education begins within basic health science education curriculum and that it models interprofessional delivery of educational services.
• In order to fully realize the objectives of interprofessional care, funding for teams and compensation for all providers must recognize the unique contributions of each profession consistent with this team based approach to care.
(For the full text of the submission, please download the file below [PDF - 100 KB])