Legislative and Regulatory Amendments

In December, 2009 the Government of Ontario passed Bill 179, the Regulated Health Professions Statue Law Amendment Act, 2009 for the purpose of enabling timely, efficient and effective care, thereby:

• Increasing access to care for Ontarians by enabling the scopes of practice of certain regulated health professions,
• Removing barriers to the provision of care,
• Promoting greater inter-professional collaboration among health professions and
• Optimizing the provision of services, while ensuring patient safety.

Twenty-six acts required amendment in order to fully enact Bill 179. Amendments to Regulation 965 of the Public Hospitals Act, 1990 maximize the effectiveness of Bill 179 and showcase Ontario as the first jurisdiction in Canada to legally authorize Nurse Practitioners (NPs) to admit, treat, transfer and discharge hospital inpatients. The most significant amendments to the various acts / regulations are included in Table 1.0. In particular, Regulation 965 improves patient flow and increases hospital efficiency by eliminating the need for most medical directives while enhancing and clarifying NPs’ independent accountability for their practice.

Note: Amendments to the Controlled Drugs and Substances Act, 1996 will further remove many of the restrictions for NP prescription of narcotics and other controlled substances. Final federal amendments are expected in the spring of 2012. Provincial regulations will subsequently be required to enable the legislation.

Other Relevant Legislation and Regulations

• Bill 46, ECFAA, 2010
• Bill 122, Broader Public Sector Accountability Act, 2010
• Healing Arts Radiation Protection, 1990
• Proposed Amendments to Regulations Regarding Nurse Practitioners

College of Nurses of Ontario NP Practice Resources

On October 1st, 2011, amendments to the Nursing Act, 1991 came into effect enabling NPs to broadly prescribe medications and laboratory testing. The College of Nurses of Ontario (CNO) incorporated these and other legislative changes by swiftly issuing the following documents online:

• Nurse Practitioner Practice Standards - a document outlining the practice expectations for NPs
• Nurse Practitioner Learning Module - an interactive review of the practice standard
• NP Practice Resources - practice-related information for NPs that is meant to complement the Nurse Practitioner Practice Standards
• NP Diagnostic and Prescriptive Authority - information about the tests and medications that NPs are authorized to order
• FAQs: Nurse Practitioner Practice Questions - answers from the College on common questions asked by NPs
• FAQ: Bill 179 - information about the proposed changes that will affect the legal scope of NP practice

As a result of this enabling authority, time and effort previously used to develop and seek approval for bureaucratic medical directives can now be redirected to quality improvement initiatives that streamline and optimize inter-professional practice patterns in the healthcare system. While these amendments provide legislative authority for NP practice in hospital settings, it is the responsibility of each hospital to identify how to operationalize and support NP practice concerning treatment and discharge now and admission starting July 1, 2012.

Health Professions Regulatory Advisory Council (HPRAC) Reports

According to the 2008 HPRAC report on the Review of the Scope of Practice for Registered Nurses in the Extended Class, “Nurse Practitioners will improve the availability and efficiency of patient care and lead to better and more comprehensive and coordinated services.” Two relevant HPRAC reports about NP practice are:

• HPRAC Report on Scope of Practice Review for Extended Class Nurses (Nurse Practitioners), 2008
• HPRAC Critical Links: Transforming and Support Patient Care, 2009

Professional Association Policy Documents

Given the tremendous potential for improved health and health care system outcomes, professional associations have produced numerous documents outlining the evidence supporting the implementation of Nurse Practitioners in a variety of settings. Policy documents that relate to the hospital setting include the following:

• CNA Position Statement on Nurse Practitioners, 2009
• RNAO 2011 Provincial Election Platform, 2010
• NPAO Provincial Election Platform, 2011
• NPAO Response to HFO Consultation on NP Authority to Admit, Transfer and Discharge In-patients, 2010
• NPAO Response to Bill 179
• NPAO: Nurse Practitioners are Ready for Bill 179
• OHA - Enabling Nurse Practitioners to Admit and Discharge: A Guide for Hospitals