Transforming and Supporting Patient Care - Health Professions ...

282Chapter 12 – Profession of Nursinghome or providing medications to be taken in another setting, such as in along-term care residence. It does not include immediate administration ofmedications to clients.Proponents have indicated that giving nurses direct authority to dispensedrugs would ensure patients have timely access to needed drugs insituations where a physician or pharmacist is not available. HPRAC was toldthat nurses see patients and clients in a variety of settings, which mayinclude circumstances where there is no pharmacist or physician available,or where patients do not want or might be unable to receive services intraditional settings. Examples of such circumstances include vulnerablepopulations like older adults living with Alzheimer’s or degenerative jointswho may have difficulty travelling to a pharmacy and young women seekingservices in birth control clinics. Nurses working in smaller or remotecommunities with no pharmacy might be able to better serve clients if theyhad the authority to dispense drugs.Proponents state that the act of dispensing is central to the practice ofnursing. Nurses were dispensing routinely and safely before theintroduction of the Regulated Health Professions Act, 1991 (RHPA). Followingthe introduction of the RHPA, nurses continued to dispense medicationsunder delegation of another professional.Medical Directives and DelegationDelegation is a process whereby a regulated health professional legallyauthorized to perform a controlled act transfers that authority to someone,regulated or unregulated, who is not so authorized. 21 A medical directive isa process by which physicians authorize other health professionals inadvance to perform specific acts under specific conditions for specificpatient populations. Medical directives in hospitals frequently delegate thedispensing of drugs to nurses.In community settings, authorizing mechanisms such as medical directivesmay not exist or may be withdrawn. This creates, in effect, anadministrative impediment to good patient care. For example, nursesfrequently dispense medication in travel clinics, correctional facilities,community health clinics, public health clinics and nursing stations underorders from a physician. If the physician moves or retires, the orders are nolonger valid, leaving the nurses unable to provide this service. Theproposed change is intended to apply to situations where access to aphysician or pharmacist is often an issue and lack of dispensing authoritybecomes an impediment to timely and effective patient care.The CNO agrees that delegation is an appropriate mechanism to allow anauthorized profession, such as medicine or pharmacy, to give nurses theauthority to perform procedures beyond the current scope of practice.They also contend that delegation is less useful when it is being used to21Ibid: 8.HPRAC Critical Links January 2009