Transforming and Supporting Patient Care - Health Professions ...

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280Chapter 12 – Profession of NursingThe CNO submission outlined principles related to dispensing that aretaught in the entry-level curriculum. Students are given opportunities toparticipate in dispensing drugs as part of their clinical training. Clinicalsimulation laboratories address many areas of the medication process,including dispensing. Programs focus on creating a culture of client safetyand introduce the CNO’s standards of practice.Core competencies of NPs have been identified through a consensusprocess conducted by the Canadian Nurse Practitioner Initiative (CNPI),which developed the Canadian Nurse Practitioner Core CompetencyFramework. The framework sets out four broad competencies that areshared by all NPs:• Health assessment and diagnosis;• Health care management and therapeutic intervention;• Health promotion and prevention of illness, injury and complications;and• Professional roles and responsibility.Students studying to become NPs are taught the primary components ofdrug therapy as part of a standardized curriculum provided by a network ofnine accredited Ontario universities. NP candidates must be competent to:Critically appraise and interpret concepts and frameworks integral topharmacotherapy, advanced counselling, and complementary therapiesfor common conditions across the lifespan. Develop, initiate, manage,and evaluate therapeutic plans of care that incorporate client valuesand acceptability, goals of therapy, analysis of different approaches,pharmacotherapeutic principles. 16The “Health Care Management and Therapeutic Intervention” of theCanadian Nurse Practitioner Core Competency Framework clarifies theexpectations relating to NPs’ ability to function competently with allcomponents of pharmacology (e.g., pharmacokinetics andpharmacodynamics). NPs must be knowledgeable of best practices inselecting, prescribing, monitoring and dispensing drugs. 17Continuing EducationWith support from the Ministry of Health and Long-Term Care, the Councilof Ontario University Programs in Nursing (COUPN) 18 provides continuingeducation to NPs and RNs working under an expanded mandate.Starting in February 2009, the course “Pharmacotherapeutics in PrimaryHealth Care” will offer further opportunities for nursing professionals todevelop their competencies in the area of prescribing.16Ontario Primary Health Care Nurse Practitioner Program. Therapeutics in Primary Health Care I.Available: http://np-education.ca/index.php?fuseaction=public.welcome&intMenItemID=19&nid=36.17Canadian Nurses Association. Canadian Nurse Practitioner Core Competency Framework. January 2005.18Council of Ontario University Programs in Nursing. Continuing Education for Primary Health CareNurse Practitioners. Available: http://cert.np-education.ca/ce/index.cfm?main=main.html.HPRAC Critical Links January 2009
281Chapter 12 – Profession of Nursing“Content focuses on common drugs used to treat particular clientconditions, their effects, side effects, interactions along with nonpharmacologicalinterventions that may improve client conditions andquality of life.” 19Requests for ChangeHPRAC received three submissions respecting drug authorities for nurses.The CNO has recommended that RNs and RPNs be authorized to dispensedrugs, and that NPs be authorized to dispense, sell and compound drugs, inaddition to existing prescribing authorities. The CNO also supports openprescribing by NPs, comparable to existing authorities for physicians anddentists, in which limits are self-imposed, based on individual competenciesand a legislated scope of practice. Accordingly, there would be no regulationslisting a schedule of drugs under the Nursing Act, 1991 related to prescribing,whether by class, category or individual list of drugs. In conjunction with therequest for open prescribing, the CNO is requesting that limitations onadministering a substance by injection and inhalation be removed.The NPAO is also requesting that NPs be given the authority to prescribeoxygen and blood products. The CNO proposals are supported by theRNAO and the NPAO.The changes proposed are meant to facilitate access to controlled acts aspart of the current scope of practice of nursing.Request 1: Dispensing a DrugThe profession is seeking authority to dispense drugs for all classes ofregistrants as an activity that falls within the existing scope of practice. 20The knowledge and skills involved in this controlled act are part of entrylevelcompetencies and the routine practice of all nurses. The proposedchange is intended to apply in situations where there is no pharmacistreadily available and to a wide variety of practice settings such as acutecare units, long-term care facilities, northern outposts, community clinicsand public health clinics. Limitations and conditions related to thesecircumstances would be developed in the CNO’s practice standards. TheCNO would work in collaboration with other colleges such as the OntarioCollege of Pharmacists (OCP) and the College of Physicians and Surgeons ofOntario (CPSO) to develop these standards of practice.Proponents’ RationaleUnder the Nursing Act, 1991, nurses are unable to dispense a drug without aseparate order to dispense a drug that has been prescribed. The CNOinterprets the act of dispensing as providing medication to clients for selfadministration.This includes providing medications for clients to take at19Council of Ontario University Programs in Nursing. Pharmacotherapeutics in Primary Health Care.February 2009. Available: http://cert.np-education.ca/ce/pharm_coursedesc.html.20CNO. Submission to HPRAC: 6.HPRAC Critical Links January 2009
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Table of ContentsCritical Links:Tra
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20Chapter 2 - Excellence in Health
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56Chapter 3 - A New Drug Approvals
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88Chapter 4 - Critical Links: Propo
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164Chapter 7 - Professions of Chiro
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186Chapter 8 - Profession of Dental
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214Chapter 9 - Profession of Dentis
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224Chapter 10 - Profession of Midwi
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330Chapter 13 - Profession of Optom
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340Chapter 14 - Profession of Pharm
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366Chapter 15 - Profession of Physi
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378Chapter 16 - Profession of Respi
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394Chapter 17 - Conclusionscontinui
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396Chapter 17 - Conclusionsincluded
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398Chapter 18 - Summary of Proposal
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