Consultation on potential changes to scopes of practice for nurse practitioners and registered nurses.
Regulation Number(s):
N/A
Instrument Type:
Proposal
Bill or Act:
N/A
Summary of Proposal:
In February 2023, the MOH released the Your Health: A Plan for Connected and Convenient Care (the Plan). The Plan prioritizes making it easier for the people of Ontario to connect to the care they need. The Plan is built on three pillars: The Right Care in the Right Place, Faster Access to Care and Hiring More Health Care Workers.
Maximizing the expertise of the health workforce is one of the strategies that straddles the pillars noted above. The Plan indicates that as the province expands education and training opportunities, it is also making it easier for regulated health professionals to work to their full training and expertise. The Plan specifically referenced exploring expanding the scope of practice of NPs.
Optimizing the scopes of practice of NPs and RNs may improve access to the care Ontarian's need, when they need it, easing stressors in practice settings and creating a more effective and efficient healthcare system.
The MOH is seeking feedback from the public and other system partners on whether potential expansions to the scopes of practice of NPs and RNs would support more timely delivery of health care. Those potential expansions to the scopes of practice of NPs and RNs fall into two areas:
1. Ordering and Applying Electricity:
• Allowing NPs to order and apply electricity to treat heart conditions using defibrillation
(without any limitations) and for transcutaneous cardiac pacing.
• Allowing NPs to order electricity for the purposes of cardiac pacemaker therapy to
treat heart conditions.
• Allowing NPs to order and apply electricity for electrocoagulation.
2. Completing and Signing the Mandatory Blood Testing Forms:
• Allowing NPs to complete and sign the mandatory blood testing forms for an
applicant that needs to apply to have the blood of another person tested for
specific infectious diseases if they have come into contact with their bodily fluids.
The MOH and MPBSD are also seeking feedback on:
• Amending the General regulation under the Vital Statistics Act to remove the
limiting circumstances when NPs can certify death. Those limiting circumstances
are where:
o The nurse had primary responsibility for the care of the deceased during the last
illness of the deceased;
o The death was expected during the last illness of the deceased;
o There was a documented medical diagnosis of a terminal disease for the
deceased made by a legally qualified medical practitioner during the last illness
of the deceased;
o There was a predictable pattern of decline for the deceased during the last
illness of the deceased; and
o There were no unexpected events or unexpected complications during the last
illness of the deceased.
• Amending the General regulation under the Vital Statistics Act to authorize RNs to,
immediately after the death, complete and sign a Medical Certificate of Death if:
o The RN had an established nurse-patient relationship with the deceased during
the last illness of the deceased;
o The death was expected during the last illness of the deceased;
o There was a documented medical diagnosis of a terminal disease for the
deceased made by a legally qualified medical practitioner or a registered nurse
who holds an extended certificate of registration under the Nursing Act, 1991,
during the last illness of the deceased;
o There was a predictable pattern of decline for the deceased during the last
illness of the deceased;
o There were no unexpected events or unexpected complications during the last
illness of the deceased; and
o The death did not result from medical assistance in dying within the meaning of
section 241.1 of the Criminal Code (Canada).
No changes are being implemented at this time as this is a consultation only.
Although this proposal is posted for 45 days, ending October 25, 2024, comments related to the proposal to allow NPs to complete and sign the mandatory blood testing forms would be appreciated by September 22, 2024 (comments provided after September 22, 2024, will still be considered).
Payment for services and/or fees are not a part of this consultation.
To provide your feedback, please respond to any or all of the following questions:
1. What impact(s) on specific populations might these scope of practice changes have? Indicate
the population group(s) and describe the nature of the impact(s). Examples of specific
populations may include the general public, patients, families and caregivers, rural and
northern Ontarians, women, seniors, low-income individuals/families, Indigenous
communities, persons with disabilities, and residents in long-term care homes or retirement
residences.
2. What impact(s) might these potential scope of practice changes have on the patient/client
experience?
3. Which health care setting(s) might be most positively impacted by these potential scope of
practice changes? Please identify the setting, the related specific scope change, and how the
setting may be impacted.
4. Are there any anticipated risks to safety and public protection? If yes, describe the risk(s)
and what supports might need to be put in place to mitigate any risk.
5. Are there any potential benefits or risks for other regulated health professions, integrated
care, health care service delivery partners, or Ontario businesses? If yes, please describe
them. For potential risks, please include ways to lessen them.
6. Are there any anticipated costs and/or savings to patients and/or health providers?
7. Provide any additional comments you may have.
Analysis of Regulatory Impact:
The ministry is not making any specific legislative or regulatory changes at this time; however, feedback from this consultation could inform potential legislative or regulatory amendments aligned with this proposal. The ministry will undertake necessary analysis to identify associated legislative/regulatory impacts, including costs, savings, and time impacts.
Further Information:
Proposal Number:
24-HLTC022
Posting Date:
September 10, 2024
Comments Due Date:
October 25, 2024
Contact Address:
Health Workforce Regulatory Oversight Branch Nursing and Professional Practice Division
438 University Avenue, 10th Floor
Toronto ON M5G 2K8
Regulatoryprojects@Ontario.ca