Transcript Scope of Practice Update

CRPNBC Scope of Practice
Update
Education Day 2015
Agenda
 Poll Q&As applying the following
concepts:
 Scope of Practice and Regulation
 Controls on RPN practice
 CRPNBC Standards, Limits and
Conditions
 SOP education
SOP Poll question #1
On a scale of 1-10 (0 being nothing and 10 being almost
everything), how much do you know about RPN scope of
practice?
a.
b.
c.
d.
0-2
3-5
6-8
9-10
SOP Poll question #2
Identify the first level of control on
RPN Scope of Practice:
a. The Health Professions Act (HPA)
b. The HPA and Nurses (Registered Psychiatric)
Regulation
c. CRPNBC Standards, Limits and Conditions
d. Employer Policies
RPN Scope of Practice
Health Professions Act (Umbrella)
Health Professions Act (1996)
LPN
Regulation
OT
Regulation
Pharmacy
Regulation
PT
Regulation
RN & NP
Regulation
RPN
Regulation
(2008)
SOP Poll question #3
Complete the sentence. RPN Scope of Practice
(SOP), based on the proposed 2015 SOP statement:
a. Does not overlap with other health professionals
b. Are activities that RPNs are educated and
authorized to perform
c. Includes only restricted activities
d. Includes restricted activities that all RPNs must be
competent to perform in order to be registered as
an RPN
e. Includes all of the above
Level 1 – HPA and Regulation
 Scope of practice of regulated professions
may overlap, or be shared, with other
regulated professions
 Supports interprofessional practice,
consumer choice, and maintains patient
safety and public protection
Level 1: Proposed Nurses (Registered
Psychiatric) Regulation
 Reserved titles
 Registered psychiatric nurse
 Psychiatric nurse
 Nurse
 Scope of practice
 Restricted activities
Proposed Nurses (Registered Psychiatric) Regulation:
http://www2.gov.bc.ca/assets/gov/health/practitionerpro/professional-regulation/redline_proposed-new-rpn-regmarch-23-2015.pdf
Proposed Scope of Practice Statement
Psychiatric nursing is the profession in which a person provides:
a) Health care for the promotion, maintenance, and restoration of
health, with a focus on psychosocial, mental or emotional
health;
b) Prevention, treatment and palliation of illness and injury, with a
focus on psychosocial, mental or emotional disorders or
conditions and associated or comorbid physiological conditions,
by
i)
Assessing health status
ii) Planning, implementing and evaluating interventions, and
iii) Coordinating health services
SOP Poll question #4
The 2015 Proposed Nurses (Registered
Psychiatric) Regulation:
a.
Authorizes RPNs to prescribe some
Schedule I and II medications
b. Authorizes RPNs to perform
Section 8 Certified Practice
c. Is presently in effect
d. Authorizes RPNs to order a chest xray for the purpose of TB screening
e. a, d
f. a, c, d
0%
0%
0%
0%
0%
a.
b.
c.
d.
e.
0%
f.15
Nurses (Registered Psychiatric) Regulation
Restricted Activities
• List of invasive, higher risk activities
• performed by members of a regulated
profession
– that has been granted specific authority to do
so in their regulations
– based on their education and competence.
RPN Scope of Practice
Self- Regulation and Protecting the Public
CRPNBC Mission
To protect the public by regulating RPNs to be safe, competent and
ethical as mandated by the Health Professions Act
Regulatory Functions
Entry to
Practice
Standards
Quality
Assurance
Patient
Relations
Enforcement
Level 2: Self-Regulation
CRPNBC has the authority, under the Health
Professions Act, to:
 Determine which activities are considered
the practice of psychiatric nursing within the
scope of practice set out in the Regulation.
 Establish, monitor and enforce any
standards, limits and conditions (SLC) that
apply to RPN practice.
SOP Poll question #5
CRPNBC has the authority under the HPA to establish, monitor
and enforce any Standards, Limits and Conditions (SLC) that apply
to RPN practice. Choose the most accurate statement below:
a.
b.
c.
d.
e.
A standard is the achievable level of
performance against which the highest
standard in practice is compared.
A limit is what an RPN can do with
additional education.
A condition is the circumstance under
which RPNs may carry out an activity;
education, competencies, decision
support tools.
None of the above
All of the above
0%
0%
0%
a.
b.
c.
0%
d.
0%
e.15
CRPNBC Standards, Limits and Conditions
Standard: A desired and achievable level of
performance against which actual performance
can be compared. It provides a benchmark
below which performance is unacceptable.
 Practice Standards
 Professional Standards
 Scope of Practice Standards
CRPNBC Standards, Limits and Conditions
Limit: specifies what an RPN is not permitted to do
related to a nursing activity.
Condition: the circumstances under which RPNs may
carry out an activity. There are three types of
conditions; education, competencies, and decision
support tools.
Limits and conditions often focus on:
 Autonomous practice
 Areas beyond entry to practice competencies
CRPNBC Limits and Conditions
https://www.crpnbc.ca/nursing-standards/
SOP Poll question #6
Which of the following CRPNBC Practice standards best informs
RPNs on activities related to Section 6 of the Proposed Nurses
(Registered Psychiatric) Regulation?
a.
b.
c.
d.
e.
Consent
Documentation
Duty to Report
Acting Without an Order
None of the above
0%
0%
0%
a.
b.
c.
0%
d.
0%
e.15
CRPNBC Practice Standards





Acting with an Order
Acting without an Order
Appropriate Use of Title
Boundaries in Nurse-Client Relationships
Consent
CRPNBC Practice Standards





Dispensing Medication
Documentation
Duty to report under the HPA
Medication Administration
Privacy and Confidentiality
Acting With an Order
Ensure order is
 Client specific
 Given by authorized HP
Ensure activity is:
 Within SOP (Regulation)
 Congruent with CRPNBC Limits and
Conditions
 Consistent with employer policy
Acting With an Order (cont.)
Have competence to
 carry out the activity safely and ethically
 manage the intended outcomes
 recognize and implement the plan
related to unintended outcomes
Take appropriate action if the order is not
evidence-based
Obtain client consent
Practice Standard found at http://www.crpnbc.ca/wpcontent/uploads/2014/04/acting-with-an-order.pdf
Acting Without an Order
Acting With an Order plus:
 Accept sole accountability.
 Assess client status and make a
psychiatric nursing diagnosis
 Interpret and use current evidence
Have competence to determine client’s
condition warrants the activity by considering:
 Known risks and benefits
 Predictability of outcomes
 Other factors specific to situation
Have competence to Manage outcomes
Practice Standard found at http://www.crpnbc.ca/wpcontent/uploads/2014/04/acting-without-an-order.pdf
RPN Scope of Practice
SOP Poll question #7
As per the controls on RPN practice, if an activity is permitted by
the Nurses (Registered Psychiatric) Regulation and CRPNBC, RPNs
are authorized to perform that activity in the workplace setting.
a. True
b. False
0%
a.
0%
b.
15
SOP Poll question #8
Employer policies can increase the scope of practice of an RPN.
a. True
b. False
0%
a.
0%
b.
15
Level 3 - Employer Policies
Employers develops policies to guide their
workforce. This may include:
 If and in what setting a service is provided
 Who carries out a service and how
Employer policies may place further
restrictions on a health professionals practice.
Employer policies can never increase the scope
of practice of a health professional.
RPN Scope of Practice
SOP Poll question #9
Which of the following scenarios describes an RPN that is
competent to carry out venipuncture?
a.
b.
c.
d.
e.
An RPN who has completed additional
education and performed venipuncture
over 10 years ago
An RPN who has recently attended the
required additional education but has
not yet carried out the activity
An RPN who feels competent with the
technical skill, but not with the ability to
manage unintended outcomes in their
present work setting
All of the above
None of the above
0%
0%
0%
a.
b.
c.
0%
d.
0%
e.15
Level 4 - Individual Competence
The integration and application of




Knowledge
Skills
Attitudes
Judgment
That are required to perform nursing activities
 Safely
 Ethically
 Appropriately
SOP Poll question #10
There will be a number of webinars and in-person education sessions
that will be offered when the Proposed Nurses (Registered Psychiatric)
Regulation comes into effect. What is your preferred method of
receiving education related to scope of practice?
a. Webinars
b. In-person education in the
workplace setting
c. On-line modules
d. Receiving reading material or
information via email
e. You prefer not to receive formal
education regarding scope of
practice
0%
0%
0%
a.
b.
c.
0%
d.
0%
e.15
SOP Poll question #11
If offered at different times and days, how likely are you to participate
in a one-hour scope of practice webinar? Please rate on a scale of 110 (0-will not attend and 10-will definitely attend)
a.
b.
c.
d.
0-2
3-5
6-8
9-10
0%
a.
0%
0%
b.
c.
0%
d.
15
SOP Poll question #12
(A-C)
Please rate on a scale of 1-10 (0 being not interested and 10 being very
interested) how much you would like to receive education on
Understanding and Applying the Proposed Nurses (Registered
Psychiatric) Regulation:
a.
b.
c.
d.
0-2
3-5
6-8
9-10
51%
35%
11%
3%
a.
b.
c.
d.
Please rate on a scale of 1-10 (0 being not interested and 10 being very
interested) how much you would like to receive education on
Overview of CRPNBC Standards, Limits and Conditions:
a.
b.
c.
d.
0-2
3-5
6-8
9-10
54%
36%
8%
1%
a.
b.
c.
d.
Please rate on a scale of 1-10 (0 being not interested and 10 being very
interested) how much you would like to receive education on Specific
CRPNBC Limits and Conditions Related to Restricted Activities (e.g.
venipuncture, wound care, etc):
a.
b.
c.
d.
0-2
3-5
6-8
9-10
68%
26%
1%
a.
5%
b.
c.
d.
SOP Poll question #13
(A-G)
e.g. d,e,a,b,c,g,f
In the scope of practice education sessions, we are considering utilizing a variety of
practice scenarios that RPNs can apply to the proposed Nurses (Registered Psychiatric)
Regulation (when in effect) and CRPNBC Standards, Limits and Conditions. Choose in
order of preference, which scenario topics you would like to see included:
a.
b.
c.
d.
e.
f.
g.
Performing venipuncture
Using restraint and seclusion
Administering, compounding and dispensing
specific Schedule I drugs, without an order for the
purpose of treating anaphylaxis, opiate overdose,
respiratory distress and hypoglycemia
Ordering a chest x-ray for the purpose of TB
screening
Administering, compounding and dispensing
immunizations and chemoprophylactic agents,
without an order
Performing wound care
Another practice scenario topic that is not listed
here
19%
17%
14%
14%
14%
12%
10%
a.
b.
c.
d.
e.
f.
g.
Questions
Colleen Calderwood
Practice Manager
[email protected]
604.931.5200
Gail Ancill
Practice Consultant
[email protected]
Resources
Province of British Columbia, Ministry of Health,
Professional Regulation. 2015
http://www2.gov.bc.ca/assets/gov/health/practition
er-pro/professional-regulation/redline_proposednew-rpn-reg-march-23-2015.pdf
CRPNBC website
http://www.crpnbc.ca/
References
Province of British Columbia, Ministry of Health,
Professional Regulation. 2015
http://www2.gov.bc.ca/assets/gov/health/practition
er-pro/professional-regulation/redline_proposednew-rpn-reg-march-23-2015.pdf
Health Professions Act [RSBC 1996] Chapter 183.
http://www.bclaws.ca/EPLibraries/bclaws_new/docu
ment/ID/freeside/00_96183_01