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Feedback Needed on Amended Guidelines and a Scope of Practice

Revisions have been made to nine nursing policy documents to align with the legislative changes required under the Health Statutes Amendment Act, 2020 (Bill 46). The College of Registered Nurses of Alberta (CRNA) is looking for your feedback on the changes.

Feedback deadline: Aug. 8, 2022, at 11:45 p.m.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Replaced the term ‘camp nurse’ with ‘RN’ throughout the document, as camp nurse is not a protected title and may be interpreted as a regulatory title used by the CRNA.
  • Added the CRNA Infection Prevention and Control Standards to the list of CRNA documents on page one, along with the statement “All CRNA documents can be found on the CRNA website at www.nurses.ab.ca”.
  • Revised the subheading ‘Is Camp Nursing Right for Me?’ to ‘Practising in the Camp Setting’.
  • Revised the placement of the guideline boxes, for consistency with other CRNA guidelines (i.e., presented before the related content rather than after).
  • Under guideline one, changed the words ‘policies and procedures’ to ‘specific camp requirements’.
  • Under the section ‘Preparing for Camp’, revised the sentence “The CRNA recommends that the RN has current knowledge in first aid and cardiopulmonary resuscitation (CPR)” to “The RN should have current knowledge in first aid and cardiopulmonary resuscitation (CPR) and discuss certification requirements with the appropriate individuals at the camp.”
  • Under guideline three, added a third bullet stating, “policies and procedures related to privacy and management of health information”.
  • Under the ‘Liability Protection’ section, broadened the direction to encourage RNs to consult with their professional liability protection provider, rather than specifying the Canadian Nurses Protective Society (CNPS).
  • Under the ‘Infection Prevention and Control’ section, added reference to the CRNA’s Infection Prevention and Control Standards.
  • Under guideline six, the sentence “There are no provincial requirements for immunization prior to attending a camp; therefore, a camp can make their own standards for vaccination” was revised to “The RN should be aware of any provincial infection prevention and control requirements for camps. A camp may also have specific infection prevention and control interventions such as vaccination requirements”.
  • Under guideline six, revised the phrase “If it is suspected that a camper has a communicable disease the camp nurse should take the necessary measures to provide assessment, isolation and care with communication to the appropriate people such as a parent, primary care provider etc.” to “If it is suspected that a camper has a communicable disease, the RN should take the necessary measures to assess the situation, implement infection prevention and control measures as appropriate, provide care, and report to the appropriate individuals and authorities” for clarity.
  • Under guideline eight, removed the last sentence that refers to information about guidelines/protocols within the CARNA Medication Guidelines as the CRNA Medication Management Standards replaced the guidelines.
  • Under guideline nine, changed the term ‘seven rights of medication administration’ to ‘rights of medication administration’ for consistency with the CRNA’s Medication Management Standards.
  • Revised guideline ten to align with criterion 3.7 of the CRNA’s Medication Management Standards, by adding ‘RNs need to have the knowledge, skills, and competence to do so’.
  • Under guideline 13, addressed privacy and confidentiality, and added reference to the CRNA’s Privacy and Management of Health Standards and the Health Information Regulation.
  • Under the ‘Glossary’ section, added definitions for the following terms: ‘evidence-informed’, ‘rights of medication administration’ and ‘over the counter medication’ for consistency with the CRNA’s Medication Management Standards.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Areas where the new HPA Restricted Activity Regulation will need to be cited are highlighted in yellow to replace reference to Schedule 7.1 of the Government Organization Act and the Registered Nurses Profession Regulation as applicable.
  • Added reference to the CRNA’s Restricted Activities Standards throughout the document to align with Bill 46 revisions made to the Restricted Activities Standards.
  • Removed wording ‘for Determining if a Restricted Activity Should be Incorporated into Practice’ from the ‘Guidelines’ heading for brevity and consistency with other CRNA guidelines documents.
  • Under the ‘Guidelines’ section additional information added on page two paragraph one to introduce the addition of the CRNA Considerations for Incorporating Restricted Activities into Practice: Infographic. Image added as figure one. Updated Infographic to remove association language and focus on client safety.
  • Under guideline three, removed policy and practice contact information as redundant.
  • Under the ‘Glossary’ terms updated the terms ‘clinical support tool’ ‘registrant’ and ‘restricted activity’ for consistency with other CRNA documents.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Removed the wording ‘for Regulated Members’ from the document title.
  • Replaced the words ‘you’ and ‘nurses’ with ‘registrant(s)’ where appropriate.
  • Minor wording changes made throughout the document for flow and accuracy.
  • Under the opening paragraphs, changed the term ‘registered nurse profession’ to ‘nursing profession’.
  • Under guideline two, first paragraph, last sentence, changed the word ‘organization’ to ‘practice setting’.
  • Revised wording under guideline five, by removing specific processes that would be determined within the practice setting and outlined the importance of following employer requirements.
  • Under the section ‘Problematic Substance Use: A Concern for Nursing Practice’ removed the sentence “For more examples of drug diversion signs and behaviours, see Appendix A: Signs and Behaviours of Problematic Substance Use.”  as reference to appendix A is made in the next section under the subheading ‘Problematic Substance Use- Signs and Behaviours’.
  • Removed the ‘Conclusion’ section for redundancy.
  • On page eight, revised the heading titled ‘Sources of Support’ to ‘Information’.
  • Under the ‘Glossary’ section, added definitions for the terms ‘fitness to practice’ and ‘Registrant’ for clarity.
  • In ‘Appendix A: Signs and Behaviours of Problematic Substance Use’ replaced the word ‘patient’ to ‘client’ for consistency with other CRNA documents.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Changed the term ‘non-professional relationship’ to ‘non- therapeutic relationship’ throughout the document for clarity.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Removed the wording ‘for Regulated Members’ from the document title.
  • Under the section ‘Legislation and Regulation’, slight wording changes made for more regulatory focus.
  • Under the section ‘Guidelines for the Pronouncement of Death’ on page four added the term ‘spiritual’ to 7a for clarity.
  • Under ‘Appendix B: Pronouncement of Death by Physical Assessment’, replaced the term ‘chest sounds’ with ‘respiratory sounds’.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Under the ‘Purpose’ section in the last paragraph, removed the reference to standard one, criterion 1.7 of the CRNA’s Restricted Activities Standards to align with Bill 46 revisions made to the Restricted Activities Standards.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replace ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta.
  • Under the ‘Glossary’ section added a definition for ‘approved nursing program’ for clarity and consistency with other CRNA documents.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta’.
  • Replaced ‘registered nursing practice’ with ‘RN practice’ throughout the document for consistency.
  • Replaced ‘continuing education’ with ‘continuing professional development’ throughout the document for consistency with other CRNA documents.
  • Under the ‘Purpose’ heading in paragraph one, replaced the term ‘defines’ with ‘identify and describe’ for clarity.
  • Revised the third paragraph under the ‘Purpose’ heading to focus the language on the public/client.
  • Under ‘Scope of Practice Principles’ revised principle one to state “The focus in scope of practice decisions is safe, competent and ethical care to clients” for clarity.
  • Under ‘Scope of Practice Principles’ in number two, replaced the term ‘health profession’s’ with ‘registered nurse profession’s’, added ‘to’ before ‘optimize’, replaced ‘health professional’ with ‘RN’ for clarity.
  • Under ‘Scope of Practice Principles’ in number five, added ‘that are performed’ before ‘as the complexity’ for clarity.
  • Under ‘Scope of Practice Principles’ in number six, replaced the term ‘individual RN competence’ with ‘the competence of an individual RN’ for clarity.
  • Under the section ‘For the Registered Nurse Profession’, moved ‘sets the outer limits of practice for all RNs in Alberta’ to the second sentence. The second sentence now states ‘These set the outer limits of practice for all RNs in Alberta and is illustrated in Figure 1.’
  • Under the section ‘For Individual Registered Nurses’ (paragraph one), replaced the sentence ‘which continues to progress with professional experience, continuing education, competence, and client needs’ with ‘RN practice is dynamic and evolving and continues to progress with emerging evidence and technologies that may change, enhance, or support health care. Through an RN’s professional experience, continuing professional development, and individual competence, the scope of practice is shaped by specific experiences in response to client needs.’.
  • Under the section ‘For Individual Registered Nurses’, moved the content related to the CRNA’s entry-level competencies for RNs to the second paragraph. Added the term ‘generally’ before ‘narrower’ for clarity.
  • Revised the first paragraph under the ‘Restricted Activities’ section to align with the Bill 46 revisions to the CRNA’s Restricted Activities Standards.
  • Removed the first paragraph under ‘Clinical Practice’ as the content is addressed under the section ‘For Individual Registered Nurses’.
  • Under ‘Education’, paragraph one, replaced the term ‘focuses’ with ‘may focus’, replaced ‘regulated health-care professionals’ with ‘regulated professionals and/or’, replaced the term ‘unregulated health-care workers’ with ‘unregulated health-care providers’.
  • Under the ‘Glossary’, defined the term ‘health service’ and revised the definition of ‘standards’ to align with other CRNA documents.
  • Removed the section ‘Appendix A: Restricted Activities Authorized for Registered Nurses’ as it quoted large portions of legislation which are already referenced in the body of the document.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed

 

  • Replaced ‘CARNA’ with ‘CRNA’ and ‘College and Association of Registered Nurses of Alberta’ with ‘College of Registered Nurses of Alberta’.
  • Revised the ’Purpose’ section to remove the association focused content such as, statistics Canada data, the Canadian Nurses Association (CNA) information and literature review content that was redundant.
  • Added the heading ‘Legislation’ to the legislation section and updated this section to align with Bill 46, added an authority statement from the Health Professions Act (HPA), and referenced the new HPA regulations and Registered Nurse Profession Regulations. Where the new HPA regulation will need to be cited, it is highlighted in yellow.
  • Under guideline one removed guidance around scheduling practices as it is outside the scope of the regulator role.
  • Under guideline four removed Canadian Nurses Protective Society (CNPS) information.
  • Removed guideline five from the current version as it discussed the role of the union.
  • Reworded guideline six to focus on public safety and removed association language.
  • Under the ‘Glossary’ section updated the definition of ‘fitness to practise’ to align with other CRNA documents.
  • The citations and references were reviewed for currency and accuracy and updated as needed. All reference links/digital object identifiers (DOIs) were updated as needed.