regulating nursing in the public interest
2 documents that provide the legislative framework for regulating nursing in Ontario:
1. Regulated Health Professions Act, 1991
2. Nursing Act, 1991
1. practice standards.
2. entry to practice.
3. quality Assurance Program.
4. enforcing standards
The entry-level RPN is accountable for:
All client __________ she or he provides.
Professional Responsibility and Accountability
WHICH COMPETENCY STATEMENT?
Demonstrates competence in professional judgments and practice decisions by applying principles implied in the ethical framework, and by using knowledge from many sources. Engages in critical thinking to inform clinical decision- making, which includes both systematic and analytical processes, along with reflective and critical processes. Establishes therapeutic caring and culturally safe relationships with clients and health care team members based on appropriate relational boundaries and respect
DEFINITION
Activities that are considered potentially harmful if performed by unqualified people.
DEFINITION
The formal process that transfers authority to perform a controlled act.
DEFINITION
A relationship that is professional and ensures the client’s needs are first and foremost. The relationship is based on trust, respect and intimacy and requires the appropriate use of the power inherent in the health care provider’s role. The professional relationship between RPNs and their clients is based on a recognition that clients (or their alternative decision-makers) are in the best position to make decisions about their lives when they are active and informed participants in the decision-making process.
What legislation governs health care information privacy in Ontario?
Personal Health Information Protection Act, 2004 (PHIPA)
Quality of Care Information Protection Act (QOCIPA)
What is the purpose of the Quality of Care Information Protection Act (QOCIPA)?
What is personal health information?
TRUE OR FALSE?
Clients have to be named for information to be considered personal health information.
TRUE OR FALSE. Nurses must report suspected child abuse.
Your client with an acquired brain injury has been stabilized and is being transferred to another hospital for continuing care. The client is unconscious. Her husband is aware of the transfer, but does not know it is happening today. You tried to reach him by telephone, without success. Before the client is transferred, you want to share information about the care she received and the current plan of care with the nurse who will receive her. The client’s cost for this transfer is being covered by private insurance, so you also need to share personal health information with the insurance company. How much information can you share, and with whom, under these circumstances?
1. the receiving hospital nursing staff. These nurses are members of the health care team; therefore, there is implied consent for the sharing of information with them to provide health care. You can, therefore, share her personal health information.
2. the insurance company. Express consent is required because this disclosure is not to a custodian and is not required to treat the client. Because the client is incapable of providing this consent, her husband (the substitute decision- maker) must provide express consent either in writing or verbally, before you share information. Since you cannot reach him, you may arrange her transfer. Once you obtain express consent from the husband, you may provide the information to an insurance company staff member.
A man who received severe facial injuries in a motor vehicle crash arrives in your emergency room (ER). He is unable to communicate. No next of kin has come with him. A woman calls in distress and asks if her husband is a patient in your ER. She provides you with details that match the information on the man’s identification. You believe she is the wife of the man with the facial injuries. Can you tell this woman that he is in the ER?
Normally, a client would have an opportunity to request that the hospital not disclose that he is a client in the facility or his location within the facility. This information may be given out in this case, however, because it is reasonably necessary to provide care. Because the law permits disclosure that a person is a client in a facility, and his/her location and general health status, you may provide this information to the woman. PHIPA allows you to contact a friend or relative of an injured client for consent. You may provide more information if the woman indicates she is the person who can act as a substitute decision-maker for consent to treatment.
The issue is correcting a health record made by another health care professional. If the client requested a correction to your note, and you agreed with the correction the client requested, you could have the client write a correction and include it with the record or make the changes yourself. If you did not agree with the correction the client requested, then you can have the client make a note and append it to the record. You can then make a separate note regarding the client’s request in the health record. A client does not have the right to correct an opinion or professional judgment by a health care professional.
Because this is a note by another health care professional (the consulting physician), you cannot be certain about the accuracy of the information that the client wants corrected. You have two options in this case: you can either contact the health care professional who wrote the note and have this physician speak with the client about the corrections; or you can speak with the person responsible for ensuring compliance with PHIPA in your practice setting.
There are two issues here. The first is what is included in the definition of personal health information; the second is if a manager has access to personal health information.
Medical notes to substantiate the employee’s absences may be held in an employee’s health file. If the medical note does not contain other personal health information (e.g., symptoms, treatment, diagnosis), then this information can be provided to the manager. Information concerning accommodation for the employee’s needs may be given so the employer can make provisions to meet these needs. Accommodation information does not include the nature of the illness or the diagnosis.
If there is personal health information included in the note, then the OHN can only provide the information that there were notes to substantiate the absences on the applicable dates. The manager is not entitled to any personal health information. This includes information about the nature of the illness, the diagnosis, the plan of treatment or any care provided; therefore, you cannot respond to any questions about the nature of the illness(es) or health condition(s).
In this example, the nurse is the custodian and is responsible for maintaining the confidentiality of the client’s personal health information. Providing information to the employer without the client’s express consent is a breach of PHIPA. However, if a client would like personal health information to be given to the employer, then the client must give express consent to the nurse. In obtaining express consent, the nurse needs to clarify exactly which information the client is requesting be disclosed, and obtain written express consent that includes the employee’s specific request.
DEFINITION
formal process that transfers the authority to perform a controlled act
DEFINITION
a prescription for a procedure, treatment, drug or intervention
HOW MANY CONTROLLED ACTS ARE SPECIFIED BY THE Regulated Health Professions Act, 1991?
HOW MANY CONTROLLED ACTS CAN A NURSE PERFORM?
WHAT ARE THE 3 CONTROLLED ACTS THAT NURSES CAN PERFORM?
1. Performing a prescribed procedure below the dermis or a mucous membrane.
2. Administering a substance by injection or inhalation.
3. Putting an instrument, hand or finger beyond the external ear canal, the point in the nasal passages where they normally narrow, the larynx, the opening of the urethra, the labia majora, the anal verge, or into an artificial opening into the body.
WHAT ARE THE TWO CONDITIONS BY WHICH AN RPN CAN PERFORM A CONTROLLED ACT?
1. EMERGENCY
2. STUDENT PRACTICING UNDER AN AUTHORIZE PERSON
3. when treating a member of a person’s household and the procedure is within the second or third controlled act authorized to nursing;
4. when assisting a person with his/her routine activities of living and the procedure is within the second or third controlled act authorized to nursing; or
5. when treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment.
1. Appropriate health care provider
2. Authority
3. Competence
4. Managing Outcomes
3 requirements of nursing documentation
1. documentation presents an accurate, clear and comprehensive picture of the client’s needs, the nurse’s interventions and the client’s outcomes.
2. documentation of client care is accurate, timely and complete.
3. safeguard client health information by maintaining confidentiality and acting in accordance with information retention and destruction policies and procedures that are consistent with the standard(s) and legislation.
TRUE OR FALSE?
All nurses must respond to situations in the same way.
TRUE OR FALSE? Ethical disagreements between nurses are acceptable.
FALSE. It is not always possible to find a resolution to a conflict that satisfies everyone. At these times, the best possible outcome is identified in consultation with the client, and the health care team works to achieve that outcome. Nurses may still not be individually satisfied with the resolution; in this case, they need to examine why they’re unsatisfied, and consider the possibility of taking follow-up action.
TRUE OR FALSE.
Clients are always the best people to make decisions about their own health.
When a client’s wish conflicts with a nurse’s personal values, and the nurse believes that she/he cannot provide care, the nurse needs to arrange for another caregiver and withdraw from the situation. If no other caregiver can be arranged, the nurse must provide the immediate care required. If no other solution can be found, the nurse may have to leave a particular place of employment to adhere to her/his personal values.
WHICH ETHICAL VALUE?
facilitating the client’s health and welfare, and preventing or removing harm.
WHICH ETHICAL VALUE?
speaking or acting without intending to deceive.
TRUE OR FALSE.
Omissions are as untruthful as false information.
TRUE. Sometimes a completely good outcome is impossible
One of Joanne’s clients in the psychiatric unit, John, confides to her that he is fascinated by young children, boys and girls. He tells Joanne he is
afraid that he will hurt a child some day. Joanne brings that information to the team. A short time later, John is discharged. Some weeks following his discharge, Joanne notices that John is the ice-cream vendor in her neighbourhood. She is concerned for the children in the neighbourhood, her own as well as the others, and wonders what she should do.
A. ASSESS
There is no absolute duty to respect confidentiality. Confidential information can be disclosed when a person(s) is at serious risk. However, it is preferable if the client discloses the information. Joanne decides that she needs to know more about John’s clinical situation and sees John’s psychiatrist the next time she is working. The psychiatrist shares Joanne’s concerns.
With the information she has, Joanne thinks the dilemma is whether she should break client confidentiality to protect children from the threat of serious harm. Joanne is also concerned about John’s well-being, now that he is living in the community and has found employment. As well, by disclosing confidential information, she will not have maintained a commitment to a client.
Try to meet both her obligation to protect the public and to protect her client’s confidentiality and well-being. Working with the mental health care team, Joanne would arrange for John to be assessed by the team to determine whether he poses a danger to children at this time. If the team determines that John poses a serious danger to children, it must then decide how to respond to this situation. John could be an involuntary client unless he agreed to be admitted to a psychiatric facility. If it were found that John does not pose a danger, then there is no justification to disclose confidential information.
With this option, Joanne can begin to meet her obligations to the client and to the public.
Proper hand hygiene is the single most- important infection prevention and control practice.
The spread of infection requires an _____________ ____________
The infectious agent needs a ______________ where it can live, grow and reproduce
The transmission of infection also requires a _______________ _________
reservoir
susceptible host
route
The four major elements to preventive practice are:
1. HANDWASHING
2. PROTECTIVE BARRIERS
3. CARE OF EQUIPMENT
4. HEALTH PRACTICES OF THE NURSE
DEFINITION
infection acquired in a health care setting.
DEFINITION
giving the wrong medication
DEFINITION
not administering an ordered medication
error does not reach the client, but had it, the client could have been harmed
WHAT MUST A NURSE POSSESS BEFORE ACCEPTING A TELEPHONE ORDER
MEDICATION TERMS
a prick/puncture procedure to determine allergies, if any.
MEDICATION TERMS
an intracutaneous injection to desensitize to an allergen
DEFINITIONS
A pharmacologically inert substance that has no physiological effect.
DEFINITION
Medications that are prescribed and administered as needed.
RANGE DOSES
Most medications are not prescribed in range doses; however, range doses are used in situations in which the need for the amount of a drug varies from day to day or within the same day. Range doses give nurses the flexibility to administer the dose that best suits the assessment of the client.
DEFINITION
Administrating one’s own medication.
TRUE OR FALSE? A nurse cannot teach a PSW how to administer medication.
This is an appropriate use of restraints that will be discontinued as soon as possible. To avoid frightening the child, the nurse arranged for the family to reassure Jody during the post-operative period. As well, using language Jody could understand, the nurse explained to her why she had to wear mittens. There are circumstances in which a nurse may need to restrain clients when they are not capable of understanding the necessity for the intervention. The nurse needs to consider these situations carefully and use the least restraint possible.
DEFINITION
the misuse of the power imbalance intrinsic in the nurse-client relationship. It can also mean the nurse betraying the client’s trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have known, the action could cause, or could be reasonably expected to cause, physical, emotional or spiritual harm to the client
DEFINITION
the nurse-client relationship is the point at which the relationship changes from professional and therapeutic to unprofessional and personal. Crossing a _____________ means that the care provider is misusing the power in the relationship to meet her/his personal needs, rather than the needs of the client, or behaving in an unprofessional manner with the client.
DEFINITION
In this approach, a client is viewed as a whole person.
PSYCHOTHERAPEUTIC RELATIONSHIP
communication strategies
interpersonal skills
TRUE OR FALSE.
It is acceptable to spend time outside of work hours with a client.
WHAT KIND OF ABUSIVE BEHAVIOUR?
■ sarcasm;
■ retaliation or revenge;
■ intimidation, including threatening gestures/ actions;
■ teasing or taunting;
■ insensitivity to the client’s preferences;
■ swearing;
■ cultural/racial slurs; and
■ an inappropriate tone of voice, such as one
expressing impatience.
WHAT KIND OF ABUSIVE BEHAVIOUR?
■ sexually demeaning, seductive, suggestive,
exploitative, derogatory or humiliating behaviour,
comments or language toward a client;
■ touching of a sexual nature or touching that may
be perceived by the client or others to be sexual;
College of Nurses of Ontario Practice Standard: Therapeutic Nurse-Client Relationship, Revised 2006
■ sexual intercourse or other forms of sexual contact with a client;
■ sexual relationships with a client’s significant other; and
■ non-physical sexual activity such as viewing pornographic websites with a client.
WHAT KIND OF ABUSIVE BEHAVIOUR?
■ borrowing money or property from a client;
■ soliciting gifts from a client;
■ withholding finances through trickery or theft;
■ using influence, pressure or coercion to obtain the
client’s money or property;
■ having financial trusteeship, power of attorney or
guardianship;
■ abusing a client’s bank accounts and credit cards;
and
■ assisting with the financial affairs of a client
without the health care team’s knowledge.
TRUE OR FALSE. UNDER NO CIRCUMSTANCES SHOULD A NURSE PROVIDE CARE FOR A SEXUAL PARTNER.
FALSE.
They cannot delegate an act that has been delegated to them – sub-delegation
TRUE
The RHPA includes an exception allowing UCPs to perform some controlled acts as long as they are considered to be routine activities of living. Procedures are considered to be routine activities of living when the need for, response to, and outcome of the procedure have been established over time and are predictable. For instance, administering the same dosage of insulin to a person with well-controlled diabetes over an extended period of time is a routine activity of living. It is not a routine activity if the dosage or type of insulin requires frequent adjustment.
How many requirements must be met before a nurse can delegate to an UCP.
How many requirements must be met before a nurse can accept delegation?
3 questions a nurse must ask herself when providing complementary therapy:
You are a visiting nurse providing palliative care. Your client has been told by the health care team that there are no more “curative” treatment options available to him, and the plan of treatment is to provide comfort and support. The client is having great difficulty accepting this. He has heard about an unconventional treatment involving IV infusion of ozone and is asking you to provide this treatment.
What should you do?
The client is asking you to participate in an unconventional treatment. You have an obligation to explore with the client his understanding of the treatment and his reason for choosing it. It is important to seek guidance from your agency and colleagues, and as much information about the treatment as possible. If you are unable to obtain adequate information about this treatment to assess the risk and recognize that there may be a significant risk, you would determine that it is not appropriate to get involved in this treatment. You would then explain your decision to the client.
You may propose to a client the use of therapeutic touch if you have the knowledge to believe that the treatment would benefit the client, and therapeutic touch has been recognized by the acute care agency as an appropriate intervention. If the agency has not determined the appropriateness of this intervention, then you may advocate to have it recognized.
You must balance client choice with professional responsibility. At a minimum, you would need information about the purpose, action and anticipated effects of the substance to fulfil your professional responsibility to assess the risks and benefits of providing this treatment in relation to the health status of the client. You would also be responsible for evaluating the effects of the treatment. If you had access to sufficient information to meet this expectation, then you may agree to provide this treatment. One way to achieve this would be to arrange for a team conference with the physician to develop a plan of care related to the administration of the prescribed herbal substances.
TRUE OR FALSE?
All conflict is negative.
Conflict between a nurse and a client can escalate if a client is:
Conflict between a nurse and a client can escalate if a client has:
a) a history of aggressive or violent behaviour, or
is acting aggressively or violently (for example, using profane language or assuming an intimidating physical stance);
b) a medical or psychiatric condition that causes impaired judgment or an altered cognitive status;
c) an active drug or alcohol dependency or addiction;
d) difficulty communicating (for example, has aphasia or a language barrier exists); and/or
e) ineffective coping skills or an inadequate support network.
Conflict between a nurse and a client can escalate if a nurse:
a) judges, labels or misunderstands a client;
b) uses a threatening tone of voice or body language (for example, speaks loudly or stands too close);
c) has expectations based on incorrect perceptions of cultural or other differences;
d) does not listen to, understand or respect a client’s values, opinions, needs and ethnocultural beliefs;12
e) does not listen to the concerns of the family and significant others, and/or act on those concerns when it is appropriate and consistent with the client’s wishes;
f) does not provide sufficient health information to satisfy the client or the client’s family; and/or
g) does not reflect on the impact of her/his behaviour and values on the client.
To manage conflict, a nurse can:
implement a ____________ ______________ management plan;
To manage conflict, a nurse can:
__________ arguing, criticizing, defending or judging;
DEFINITION
Involving the client in making decisions based on the client’s values, beliefs and wishes.
The Health Care Consent Act (HCCA)
The goals of the HCCA include promoting
individual authority and ______________, facilitating __________________ between health care practitioners and their clients, and ensuring a significant ___________ for family members when the client is _______________ of ________________.
autonomy
communication
role
incapable of consenting
The Health Care Consent Act (HCCA)
Health care practitioners have no ___________________ to make treatment decisions on behalf of clients, except in an ________________ when no authorized person is available to make the decisions. Similarly, they have no __________________ to make a decision to consent to the admission of a client to a care facility, except in a ________________.
authority
emergency
authority
crisis
The Health Care Consent Act (HCCA)
When a health care practitioner finds a client is _________________ of making a treatment decision, the legislation requires the practitioner to provide the client with ___________________ about the consequences of the finding. This provision of information must be performed in accordance with __________________ established by the practitioner’s governing body.
incapable
information
guidelines
The Substitute Decisions Act (SDA)
An individual may _______________ a specific person to make decisions about his/her personal care or treatment in the event that he/she becomes
_______________. The person may also express his/her wishes about the kinds of decisions to be made or factors to ______________ decisions.
DEFINITION
A board established by and accountable to the government. Its members are appointed by the government. The Board considers applications for review of findings of incapacity, applications relating to the appointment of a representative, and applications for direction regarding the best interests and wishes of an incapable person.
Consent and Capacity Board (CCB)
DEFINITION
Two persons related by blood, marriage or adoption.
Public Guardian and Trustee (PGT)
DEFINITION
Anything done for a therapeutic, cosmetic or other health-related purpose.
DEFINITION
A plan that is developed by one or more health care practitioners, dealing with one or more of the health problems that a person has and is likely to have. It provides for the administration of various treatments or courses of treatment. It may include the withholding or withdrawal of treatment in light of the person’s health condition.
Power of attorney for personal care
Continuing power of attorney for property
relate
informed
voluntary
obtained
The HCCA does not specify that consent to
a personal assistance service is ________________.
Consent is informed if, before giving it:
TRUE OR FALSE?
A person has to be 18 years of age before they can give an informed consent.
FALSE. There is no minimum age for giving consent. Health care practitioners and evaluators should use professional judgment, taking into account the circumstances and the client’s condition, to determine whether the young client has the capacity to understand and appreciate the information relevant to making the decision.
If a person is incapable, the consent (or refusal to give consent) is to be obtained from who?
Treatment in an emergency can be provided immediately if communication can’t take place because of a ____________ ____________ or _____________, and reasonable efforts to overcome these have been made, but a ___________ will prolong the suffering the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm, and there is no reason to believe the person does _______ ___________ the treatment.
language barrier or disability
delay
not want
Treatment in an emergency can be provided immediately if incapable with respect to a treatment, a substitute decision-maker is not readily ___________, it is not ___________ ____________ to obtain a consent or refusal from the substitute, and a __________ will put the person at risk of sustaining serious bodily harm.
available
reasonably possible
delay
Admission to a care facility without consent may be authorized if:
Hierarchy of substitute decision-makers
1. Guardian of the person — appointed by the court.
2. Someone who has been named as an attorney for personal care.
3. Someone appointed as a representative by the CCB.
4. Spouse, partner or relative in the following order:
a. spouse or partner,
b. child if 16 or older; custodial parent
(who can be younger than 16 years old if the decision is being made for the substitute’s child); or Children’s Aid Society;
c. parent who has only a right of access; d. brother or sister;
e. other relative.
5. PGT is the substitute decision-maker of last resort in the absence of any more highly ranked substitute, or in the event two more equally ranked substitutes cannot agree.
Nurses should not provide a treatment if there is
any ______________ about whether the client understands and is capable of consenting. This applies whether or not there is an _____________, or even if the client has already consented. It does not ________________ if a substitute decision-maker has consented.
Consent can be __________________ at any time.
Informed consent does not always need to be
______________, but can be oral or implied.
If the nurse proposing a treatment or evaluating
capacity to make an admission or personal assistance service decision determines the client is __________________ of making the decision, then the nurse _______________ the client that a substitute decision-maker will be asked to make the final decision. This is __________________ in a way that takes into account the particular circumstances of the client’s condition and the nurse-client relationship.
If there is an indication that the client is uncomfortable with this information, then the nurse ________________ and _________________ the nature of the client’s discomfort. If it relates to the finding of incapacity, or to the choice of substitute decision-maker, then the nurse informs the client of his/her _______________ to apply to the CCB for a review of the finding of incapacity, and/ or for the ________________ of a representative of the client’s choice.
explores
clarifies
options
appointment
If there is an indication that the client is uncomfortable with the finding of incapacity when the finding was made by another health care practitioner, then the nurse _______________ and ________________ the nature of the client’s discomfort. If it relates to the finding of incapacity, or to the choice of substitute decision-maker, then the nurse informs the health care practitioner who made the _________________ of incapacity and discusses appropriate _____________-_____.
explores
clarifies
finding
follow-up
The nurse uses _______________ ______________ and _______________ __________ to determine whether the client is able to ________________ the information. For example, a young child or a client suffering advanced dementia is not likely to understand the information. It would not be reasonable in these circumstances for the nurse to inform the client that a substitute decision-maker will be asked to make a decision on his/her behalf.
professional judgment
common sense
understand
FALSE.
All the attributes of the nurse, including age, gender, past experiences, strengths and weaknesses, have an impact on the interaction with the client. Through reflection, learning and support, nurses will be better able to strengthen the quality of care they provide to the diverse communities they serve.
TRUE OR FALSE.
Everyone has a culture.
TRUE OR FALSE.
Culture is individual.
Culture is _______________. It changes and evolves over time as individuals change over time.
TRUE OR FALSE.
Reactions to cultural differences require a lot of thought and reflection.
A nurse, working as a community case manager, visited the home of a toddler with severe physical and developmental delays. She explained to the parents that with their consent she would refer the child to a physiotherapy and occupational therapy program that would help the child be more independent. The parents refused, saying that it was their duty to care for their child because the child’s condition is punishment for having conceived before they were married. They were not supportive of a program to increase independence. The nurse was upset and felt the parents were not acting in the child’s best interests.
The nurse did not understand the family’s initial refusal of treatment. After reflection and discussion with colleagues, she realized that her personal and professional values of independence were causing her to feel upset with the parents’ refusal. She decided to explore with the family their goals for their child. In doing this, she learned that the parents wanted their child to become stronger and have fewer infections. When the same therapies were described as a means of meeting these goals, the parents were quite willing to participate. The program was developed to meet the goals that the family identified as important.
Regardless of her personal feelings about female genital excision, the nurse needs to understand the meaning of this custom for the client, which is linked to values about family purity and family honour. The nurse, however, also knows that the practice is illegal in Canada. The nurse needs to inform the client, in a nonjudgmental manner, of the potential risks and harm associated with the practice and of the legal implications. By exploring the custom and providing education and support to the woman, the nurse has a better chance of preventing a practice that carries considerable risk of harm.
A client from a First Nations community requests that a sweetgrass ceremony be performed in the hospital as part of the treatment. The ceremony involves chanting and burning some substances, which will result in small amounts of smoke (similar to that of burning an incense stick). The nurse’s initial reaction is that something like this has never been done, and that it is against hospital policy. However, she also understands the significance of this ritual for the client. The nurse raises the issue with the unit administration and, with the support of colleagues, explores the potential impact on other clients. The nurse also reviews relevant fire policies and consults with appropriate staff in other departments. It is determined that any risk to other clients can be removed by transferring the client to a private room. This is done, and the ceremony is performed.
The nurse’s commitment to client-centred care prompts her to explore ways of meeting the client’s needs within the limits of the hospital setting. Lack of experience and fear are two of the most common barriers to providing culturally sensitive care. Through collaboration with other colleagues, the nurse is able to address the assumption that it cannot be done and to determine ways of meeting client needs without exposing other clients to discomfort or risk. The nurse succeeds in meeting the needs of her client, not only because of her creativity, but because she takes responsibility for influencing policies and procedures in the practice setting.
TRUE OR FALSE.
Rules of confidentiality do not apply to interpreters.
FALSE.
Interpreters need to recognize that, by virtue of their role, they are gaining access to personal health information that must be protected. To help the client feel comfortable with the interpreter, the nurse should inform the client that confidential information is shared only within the health care team. The interpreter must not disclose client information to anyone. Family members and friends, in particular, need to realize that the role they play as interpreter needs to be separated from their personal role.
WHAT IS AN INTERPRETER’S ROLE?
The interpreter’s role is to be the voice of the client.
FALSE.
Talk to the client, not to the interpreter. Maintain eye contact as appropriate. Looking at the client directly reinforces that the communication is between the provider and the client, assisted by the interpreter. This also allows the provider to assess the non-verbal reactions and responses.
While it is often convenient to rely on children to interpret for their parents, it is important for the nurse to be sensitive to the needs of the parent and the child. If no other interpreter is readily available, the nurse will have to work with the child to do the initial assessment and determine the severity of the situation. The woman and the son may feel uncomfortable talking about health issues such as vaginal discharge, menstruation and pregnancy, thus compromising the accuracy of the health history. An adult, preferably female, interpreter should be sought with urgency to ensure a thorough and comprehensive history. The nurse also needs to address the child’s concerns and fears appropriately, as well as the stress associated with having to interpret for his mother. When using family members as interpreters, the nurse must carefully evaluate each situation on an ongoing basis.
A nurse is asked to teach a 60-year-old woman of Chinese descent how to perform self-continuous ambulatory peritoneal dialysis. The woman has no family, speaks only Mandarin and lives in a Chinese housing environment. The visiting nurse identifies the language barrier and creates a care plan with the goal of promoting communication. The client identifies her next-door neighbour as an interpreter she would be comfortable with. The nurse asks the neighbour if she is willing to help in this role. The neighbour agrees, and the nurse reviews with the neighbour the need to maintain client confidentiality. A written list of visit dates and times is given to the neighbour, who agrees to be available for scheduled nursing visits. The care plan indicates that the nurse will knock at the neighbour’s door at the start of each visit, the neighbour will accompany the nurse to the client’s apartment, and the nurse will use the interpreter to promote communication throughout the visit.
The care planning demonstrates a thoughtful process, responsive to the client’s needs. There is evidence of the nurse consulting with the client and supporting the client’s choice of an interpreter. The nurse stresses confidentiality and respects the neighbour’s schedule by providing a list of planned visits.
A couple comes to a walk-in clinic with a young child who is crying and tugging at his ears. The couple has recently come to Canada, but understands English well enough that the nurse feels language is not an issue. An assessment reveals that the child has an infection in both ears, and the couple is given a prescription for an antibiotic and Tylenol drops for fever and pain. The situation is fairly routine, and an interpreter is not considered necessary. The parents are informed about the diagnosis and treatment, and they nod in understanding. The next day the couple returns with the child whose condition seems to have worsened. There is now pink discharge from both ears, and the entire family is in distress. An interpreter is called to assist. Through the interpreter, the nurse learns that the parents had the prescription filled promptly, and they understood the child was to be given
the medicine every four hours. They had been administering the antibiotic orally, but since they had treated previous ear infections with ear drops, they had administered the Tylenol drops in the child’s ears.
This example illustrates the importance of confirming that accurate communication has been achieved. To reduce the chance of confusion, the nurse could have demonstrated how to measure, and then administer, both medications. Culturally appropriate client education materials would also have been helpful.
A woman, 35, is admitted to the general medical unit. While in the hospital, she expresses concern about her partner’s ability to care for her children. She also appears worried about how she will manage at home after she is discharged. The nurse suggests that perhaps a family meeting is necessary and offers to contact her husband. The nurse further suggests that maybe the client’s mother, who has called often to inquire about her daughter, should be involved in the meeting.
The nurse has made an assumption that the client’s partner is male and that the relationship with the mother is one that will be supportive to the entire family. For many couples in a homosexual relationship, the issue of family can be sensitive. For some people, “family” is often their chosen family as opposed to kin. By using the word “partner,” and asking the client who would be appropriate for a family meeting, the nurse shows openness and a nonjudgmental attitude.
A home care client has lost sensation and mobility in her legs. On a home visit to provide wound care for a severe burn on the sole of her left foot, the nurse discovers a picture of St. Francis of Assisi covered in plastic and carefully placed between the layers of bandage around the foot. The client describes the picture as a relic that can prevent or positively influence life’s problems, and that St. Francis is known for healing animals and people. She believes that placing the picture in the dressings will help the wound to heal.
A nurse is providing direct care to an elderly woman newly diagnosed with angina. She has been prescribed nitroglycerine to manage her angina attacks. The client reveals to the nurse her firm belief that her illness is caused by the “evil eye,” a glance cast upon her by another to cause this condition. She shows the nurse her own remedy, which she claims will lift the curse of the evil eye and cure her.
The nurse assesses the client’s remedy for possible health risks, such as a high sodium content. As well, the nurse negotiates with the client to take the nitroglycerine. In doing so, the nurse will need to be vigilant to potential objections the client may have to taking the medication. The goal is to have a plan of care that includes the remedy for the evil eye, but also includes the appropriate use of the nitroglycerine. The nurse and the client may not fully understand each other’s preferences, but are willing to accommodate both interventions.
A 35-year-old client is diagnosed with chronic renal failure and has started peritoneal dialysis. Maintaining adequate protein intake is an essential part of the client’s ongoing treatment, and animal protein is the recommended source. The client is a Hindu by religion and has been eating eggs, chicken and goat all his life. However, since the commencement of dialysis, he has stopped eating these foods and has become a vegetarian. He tells the health care team that he wants to become a good Hindu so that God will help him with his ordeal. He says that even though many Hindus eat meat, not eating meat is a more devout way of life and one he wishes to follow.
Recognizing that, at times of crisis, clients may revert to more traditional beliefs, the team needs to work with this client to determine the reason for his change in dietary practices. The goal is not to change his beliefs, but to increase the client’s choices about how to achieve adequate protein intake. The team could involve a dietitian to teach ways to increase protein intake from vegetarian sources, such as cheese, lentils, nuts, beans and tofu. They also want to help the client explore his perceptions of what caused his illness and the role religion plays in his care. Involving a Hindu priest may be an effective way of addressing spiritual needs, and the priest may, in fact, be able to assist the client in resuming some intake of animal protein, if he chooses to do so. Regardless of approach, the ultimate decisions about diet remain with the client.
Who Should Be Involved in Developing a Directive?
Steps a nurse should take if they are concerned with the plan of care.
■ assess the situation, consult with the client (as
appropriate), nursing colleagues and other experts (for example, other health care professionals) and refer to relevant reference material;
■ inform the responsible health care provider of the concern and support the concern;
■ discuss the concern with the immediate manager (if the concern remains unresolved);
■ contact the responsible health care provider for further discussion (if the immediate nursing manager shares the concern);
■ refer to agency policy to identify how to bring the concern to the attention of a higher medical or other authority in the facility (if the health care provider doesn’t consider alternatives to the original treatment plan);
■ decide whether to report the concern to a higher management authority (if the immediate manager does not share the concern and cannot provide information that will eliminate the concern);
■ continue to report to higher authorities in the facility until convinced of the appropriateness of the treatment or until the treatment is changed;
■ inform the health care provider of the decision and the action taken to date (if the decision is to refuse to implement the treatment plan); and
■ document in the client’s record the concern and
the steps taken that directly relate to client care. If necessary, refer to agency policy for the appropriate format to document information not directly related to client care.
DEFINITION
An invasive and immediate life- saving treatment that is administered to a client who has a sudden unexpected cardiac or respiratory arrest. It may include basic cardiac life support involving the application of artificial ventilation (such as mouth-to-mouth resuscitation and bagging) and chest compression. It may also include advanced cardiac life support, such as intubation and the application of a defibrillator.
assessing
informed
resuscitation
Nurses communicate the goals of care and treatment by: identifying the client’s wishes about preferred treatment and/or end-of-life care as ___________ as ________________, while considering the client’s condition and the degree to which the therapeutic nurse-client relationship has been established;
■ reviewing the client’s plan of treatment including resuscitation wishes as needed or when required by organizational policy. (For example, in long-term care settings, the review could be part of the regular client health review);
■ documenting the relevant information; and
■ communicating any changes in client’s wishes to the interprofessional team and ensuring the wishes are included in the plan of treatment;
interprofessional team and the client
■ the client’s condition has changed and it may be necessary to modify a previous decision;
■ the nurse is concerned the client may not have been informed of all elements in the plan of treatment, including the provision or withholding of treatment;21
■ the nurse disagrees with the physician’s plan of treatment;22 and
■ the client’s family disagrees with the client’s expressed treatment wishes;23
Nurses implement a client’s treatment and end-of- life care wishes by: initiating treatment when:
■ the client’s wish for treatment is known through a plan of treatment and informed consent;
■ the client’s wish is not known, but a substitute decision-maker has provided informed consent for treatment; or
■ it is an emergency situation, there is no information about the client’s wish, and a substitute decision-maker is not immediately available;
■ the client has not given informed consent, and/or the plan of treatment does not address receiving the treatment;
■ the incapable client’s wish is not known, and the substitute decision-maker has indicated that he or she does not want the client to receive the treatment;
■ the attending physician has informed the
client that the treatment will be of no benefit and is not part of the plan of treatment that the client has agreed to. In this situation,
the nurse is not expected to perform life-sustaining treatment (for example, resuscitation), even if the client or substitute decision-maker requests it; or
■ the client exhibits obvious signs of death, such as the absence of vital signs plus rigor mortis and tissue decay;
■ identifying whom to notify when the client dies;
■ identifying the most appropriate category of health care provider to notify the family;
■ identifying the client’s and family’s cultural
and religious beliefs and values about death,
and management of the body after death;24
■ identifying whether the family wants to see
the body after death; and
■ documenting according to policies and
procedures;
TRUE OR FALSE. All nurses do not have the authority to certify death in any situation.
TRUE OR FALSE.
Consent for flu shot must be given in writing.
TRUE OR FALSE.
CNO requires that all registered members receive annual influenza vaccination.
Who is responsible for ensuring client safety when learners participate in providing client care?
DEFINITION
A clinical practice guideline, decision guide, algorithm or standardized interview tool.
Decisions about the utilization of an RN and an RPN are influenced by these three factors:
1. Complexity
2. Predictability
3. Risk of negative outcomes
RN OR RPN?
– predictable changes in health condition
– predictable outcomes
RN OR RPN?
high risk of negative outcomes
FALSE.
An RPN working in a UCP role is still accountable
as an RPN
practising as an RN or RPN until a member practising at the RN or RPN level is available
A nurse who teaches, assigns duties to or supervises UCPs must:
know the UCP is _______________ to perform the
particular procedure or activity safely for the client in the given circumstances. When ________________ a UCP, a nurse is expected to have first-hand knowledge of the UCP’s competence. A nurse who assigns or supervises is expected to ___________ that the UCP’s competence has been determined.
A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements:
Requirement 3
The nurse accepts ____________ ________________ for the decision to teach the procedure after considering:
■ the known __________ and _____________ to the client of performing the procedure
■ the ________________ of the outcomes of performing the procedure
sole accountability
risks and benefits
predictability
A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements:
Requirement 6
Considering the factors in Requirements 3 and 4, the nurse ________________ the continuing competence of the UCP to perform the procedure or reasonably believes that a mechanism is in place to determine the UCP’s continuing competence.
________________ involves the monitoring and directing of specific activities of UCPs. It does not include ongoing managerial responsibilities. Often, the person who assigns a task also _______________ the performance of that task. This can be direct or indirect, depending on the circumstances. For direct, the supervisor is physically present during the provision of care. For indirect, the supervisor is not physically present but monitors activities by having the UCP report regularly to the supervisor, or by periodically observing the UCP’s activities.
Jurisprudence Exam Questions and Answers Review – Alberta
Practice questionnaires
1. The Complaints Director can only act on a written complaint: ALSE
Even if written complaint is not received, but the Complaints Director has
reasonable grounds to believe the conduct of a regulated or former member
constitutes unprofessional conduct, he/she may treat the matter as a complaint
and act on it
2. The legislated obligations for the CLPNA in dealing with complaints are stated in:
HPA
3. The Complaints Director may request an expert to review and assess the issues
surrounding a complaint. This would involve:
Opinion as to whether service was acceptable practice, Review of client files, a
written report
4. LPNs wishing to set fracture and/or apply a cast are required to have:
Advanced authorization restricted activities
5. LPNs wishing to insert or remove instruments, devices, fingers or hands beyond the
urethra, anal verge or artificial opening into the body must have:
Entry-level restricted activities
6. What level of authorization is required for a LPN to “administer anything by an invasive
procedure on body tissue below the dermis for the purpose of administering
subcutaneous injections”?
Entry-level restricted activities
7. The roles, responsibilities and scope of practice of health care aides is defined by the
HPA
The ultimate deciding factor in what health care aides can or cannot do is
determined by the employer’s policy
8. A random group of LPNs is selected each year to participate in the Continuing
Competence Program audit: TRUE
Validation is an annual event of providing proof of. Participation in CCP, and a
formal means of evaluating learning completed in the previous two years
9. The Complaints Director can direct the investigated person to submit to specified
physical or mental examinations if the Complaints Director has ground to believe the
investigated person in incapacitated: TRUE
10. LPNs are encouraged to use electronic and social media to communicate and develop
relationships with Clients: FALSE
Code of Ethics requires that professional boundaries and strict confidentiality be
maintained when using electronic or social media
11. Only regulated RNs, RPNs, and LPNs are permitted to use the term “nurse”: TRUE
Other rems protected by the HPA are “college”, “registered”, and “specialist”
12. Clients are much less likely tofile a complaint if they perceive that their service provider
cared for, and communicated with them: TRUE
Poor communication is the root of many unprofessional conduct complaints
13. A regulated member must provide certain demographic and employment information
when there isa change to the information or at the request of the registrar: TRUE
The information includes such things as current contact information, full names,
years of registration, birth and gender, employer’s name and other related
information
14. A regulated LPN on the temporary register may only practice under supervision: TRUE
15. Individuals without a valid practice permit are transferred to the temporary register and
are allowed to work only under supervision: FALSE
According to the HPA (section 43), individuals without a valid practice permit are
NOT authorized to work as an LPN nor use the title “LPN”
16. What constitutes a quorum of all meetings of the CLPNA
15 regulated members present
17. A quorum at all meetings of the CLPNA consists of 10% of regulated members present:
FALSE
A quorum consists of 15 regulated members present
18. Why do LPNs need to be familiar with their regulatory requirements?
Client safety and well-being, Requirement to register with CLPNA, Affects their
daily practice decisions, avoid being subject of complaints
19. All LPNs applying for registration in Alberta must be proficient in: English
20. The HPA provides the overall framework and authority for CLPNA to regulate its
members: TRUE
21. Failure to adequately document or chart is a common element in unprofessional
conduct complaints: TRUE
Good documentation practices are the best defense in terms of providing an
objective account of what happened
22. Personal difficulties affecting work performance are NOT grounds for unprofessional
conduct: FALSE
Individuals should seek help or counselling before they become at risk or
unprofessional conduct
23. Which governance document states that CLPNA must establish, maintain and enforce
standards for registration and continuing competence
HPA
24. Under what authority does CLPNA have legislated responsibility to establish, maintain
and enforce standards of registrations?
HPA
25. Schedule 10 of the HPA applies to the LPN profession: TRUE
This section describes the services generally provided by regulated members of
the LPN profession
26. Under the HPA a college may set and negotiate professional fees: FALSE
HPA prohibits a college from setting or negotiating professional fees, or from
being a certified bargaining agent
27. When a regulated member encounters a difficult situation for which they may not have
to necessary skills, they should do the best they can: FALSE
It is important to recognize their limitations and when necessary, to seek
assistance from a colleague or to refer the client to someone with the
appropriate skills
28. The LPN scope of practice is defined only in one document- the HPA: FALSE
It is defined in multiple documents: HPA, Regulation, Standards of practice, code
of ethics, and the competency profile
29. For how many years should Continuing Competence program CCP learning records by
kept by members:
Four years
30. The college’s registration year is January 1 to December 31: TRUE
31. A practice permit must be on display or made available for inspection upon the request
of employers or the public: TRUE
32. CLPNA is governed by council consisting of regulated members and at least 25% public
members: TRUE
HPA states that at least 25% of the voting members of a governing council must
be members of the public
33. The Complaints Director may appoint an investigator to obtain further information
regarding a complaint: TRUE
Investigator may be a qualified, unbiased LPN, or an independent professional
investigator hired by CLPNA
34. All applicants for registration as regulated members of CLPNA must provide evidence of
having good character and reputation: TRUE
This can be done via written references from colleagues; a declaration stating
that the applicant has no history of unprofessional conduct or disciplinary
actions; and the results of a criminal check
35. Both LPN code of ethics and standards of practice must be available to the public: TRUE
36. Regulated members of CLPNA have a legal responsibility to report offences and
instances of professional negligence; such reporting is not considered a breach of
confidentiality: TRUE
HPA and the Protection for persons in care Act state circumstances where there is
a duty to report information to the proper authority
37. Individual who resigns from the College and wishes to reapply for registration at a future
date can simply submit a status change form: FALSE
Individual must meet ALL the registration requirement in place at the time of
their application
38. A temporary Registration with CLPNA can be held for three years: FALSE
Temporary registration is for persons who have not yet successfully passed the
registration examination. It is only valid for a Maximum of ONE year
39. Bylaws can be created and/or amended by simple majority vote of council: FALSE
A two-thirds majority vote is needed to create or amend a bylaw
40. Matters such as member registers and registration, restricted activities, continuing
competences and practice permits are all defined by the College’s Bylaws: FALSE
These are defined by the LPN regulation
41. The standards of practice for the LPNs are unique to Alberta: FALSE
Standards are part of a national framework that was developed and
implemented
42. CLPNA regulates LPNs in Alberta as authorized by the HPA: TRUE
The HPA states that the key regulatory responsibilities of a College, which relate
to registration and practice permits, professional practice standards, continuing
competence and professional conduct.
43. Complaints against regulated members can be made anonymously: FALSE
Complaints must be made in writing with the name, signature and contact
information of the person filing the complaint
44. An investigated person may have their practice permit suspended pending the outcome
of a professional conduct hearing: TRUE
45. Self-regulation means that a profession governs and manages itself: TRUE
Although self-regulation is constrained by the legislation and regulation
46. Self-regulation means that a health profession, such as LPN, governs and manages itself
without outside assistance or influence: TRUE
The government of Alberta, through legislation, grants self-regulating status to
recognize professions
47. Under what conditions is registration with CLPNA mandatory for educationally-qualified
LPNs?
Teaches practice of regulated profession, Meets registration requirements,
intends to provide professional services, and supervises regulated members
48. The registrar has the power to establish and manage college comities such as the
competence committee: FALSE
This is the responsibility of Council
49. The LPN Code of ethics provides ethical guidelines to practical nurses in dealing only
with their clients and colleagues: FALSE
The Code of Ethics provides guidelines for dealing with the public, clients, the
profession, colleagues and one’s self
50. The Code of Ethics requires LPNs to disclose any personal or legal conflict that makes it
difficult to participate in an intervention or provide service: TRUE
Any potential or existing personal or legal conflict should be disclosed to the
supervisor and/or employer
51. A regulated member has the responsibility to inform a college if employment has been
terminated, suspended or the member resigned for reasons related to professional
conduct: FALSE
The Employers have a legal obligation to inform the College
52. Code of Ethics is one of the mandatory requirements of all regulated health profession in
Alberta: TRUE
Code of Ethics is required by the HPA, must be reviewed and approved by the
government, and must be made available to the public
53. In which registration category can a member practice only under supervision?
Provisional register
54. If a CLPNA regulated member is found to be guilty of unprofessional conduct by a
Hearing Tribunal, they may be having their practice permit suspended or cancelled:
TRUE
Other penalties are caution or reprimand, counselling or treatment, remedial
training and/or a fine
55. If the Complaints Director of the College has grounds to believe that a regulated
member is incapacitated, he may direct the individual to seek treatment and to cease
practice: TRUE
These condition shall prevail until such time that the Complaints Director is
satisfied that the member is no longer incapacitated
56. When a complaint is filed, a formal process is always followed where the regulated
member of the profession is charges with unprofessional conduct and a hearing is held:
FALSE
The Complaints Director can attempt to have the concerned parties settle the
dispute informally by communicating with each other, or through assistance by
the Complaints Director or a neutral third-party mediator
57. Health Care Aides are permitted certain restricted activities provided they are done
under supervision of an LPN: TRUE
HCA are also permitted to perform ADLs. The employers policies determines
what HCAs can and cannot do
58. CLPNA must first receive a formal complaint before it can investigate the conduct or
competence of a regulated member: FALSE
If the Complaints Director has grounds to believe that a regulated member is
incapacitated, they may direct that person to submit to a specified physical
and/or mental examination. Failure by the member to do so would constitute
unprofessional conduct
59. Council is bound by any resolution passed by a majority of regulated members at an
annual general meeting: FALSE
Council is NOT bound by theses solutions. Council does have to provide report on
the deposition of any resolutions.
60. The contact information of each LPN is available on the CLPNA’s Public registry: FALSE
Thein formation provided on the registry includes data on each member’s
registration and practice permit status and any condition or restriction. NO
contact information is included.
61. The LPN Code of Ethics requires regulated members to report unethical behaviour,
incompetence, impairment or misconduct of one’s colleagues and oneself: TRUE
Reporting others and self is part of the Code of Ethics
62. Informed consents mean that the client must have knowledge and be able to
understand the options and risks associated with proposed treatment or intervention:
TRUE
63. Health professions in Alberta are organized into regulatory bodies called:
Colleges
64. An example of unprofessional conduct is behaviour that harms the integrity of the
regulated profession: TRUE
This includes any type of member action that might harm the integrity or
reputation of a profession
65. CLPNA Council may make, amend, or delete bylaws: TRUE
66. LPN who are registered in one province are permitted to work and use protected titles in
another province: FALSE
Healthcare professionals must be registered in the province where they want to
practice in order to have the right to use the protected titles of their profession
67. Which of the following is federal (Canada-wide) legislation?
Controlled Drugs and substances act
68. Health professions in Canada are regulated by the federal government: FALSE
69. Practicing in breach of the standards of practice, code of ethics or any other professional
practice documents may constitute “unprofessional conduct” as defined by the HPA:
TRUE
If a regulated member is found guilty of unprofessional conduct, a range of
penalties, including loss of practice permit may be applied
70. Restricted activities are defined in the HPA: FALSE
Restricted activities are defined in Schedule 7.2 of the Government Organization
Act. Restricted activities are those activities that are considered high risk to the
public and therefore are restricted to perform such activities
71. The Complaints Director may hire an expert to determine whether the regulated
member subject to a complaint is competent to continue to practice: FALSE
The expert is hired to report on whether the services in question constituted
acceptable practice
72. Employers are prohibited by law from knowingly employing any individual who is
required to be registered with the College but is not: TRUE
The employer may be guilty of an offence and may be subject to a fine
73. The individual making a complaint against a regulated CLPNA member has the right to
appeal a decision of the Hearing Tribunal: FALSE
Under the HPA, only the member being investigated, and the Complaints Director
have the right to appeal the decision of a Hearing Tribunal
74. A complaint against a regulated member:
Must be in writing
75. The term of registration for an LPN on a courtesy register is 3 months: TRUE
76. The registrar may require an applicant want to register with the CLPNA to demonstrate
English language proficiency: TRUE
77. If a quorum at the AGM is not present, the College is obliged to call for another meeting:
FALSE
Council shall be authorized to proceed with the business that was to have been
done at such a meeting. Council is NOT required to call a further meeting during
that calendar year
78. Individuals volunteering their nursing professional services are exempt from mandatory
registration: FALSE
Mandatory registration requirements apply regardless of whether an individual
engages in paid employment or volunteer, or practices full-time, part-time or on
a casual basis
79. What Defines the information that must be on a practice permit
HPA
80. CLPNA is required to notify an employer when a practice permit is suspended, or
condition are applied: TRUE
The HPA requires a college to notify an employer when a practice permit is
suspended, or conditions are applied
81. Which jurisprudence document states how the College will operate on a day-to-day
basis?
CLPNA Bylaws
82. The document that states how the College will operate on a day-to-day basis is the
College Bylaws: TRUE
Also, policies state the principles or rules developed and approved by the College
to support achievement of its legislated mandate and strategic goals
83. The LPN Code of Ethics are only suggested guidelines for conduct and behaviour;
regulated members are free to use their discretion in following them: FALSE
Unethical practice can lead to a charge of unprofessional conduct. This may lead
to the suspension or loss of their practice permit
84. The LPN Standards of practice represent the level of professional performance expected
of all practical nurses to demonstrate competent, safe and ethical practice: TRUE
Each health profession is required to have standards of practice; these are
reviewed and approved by the government
85. Which level of authorization are restricted activities acquired through experience, on-
the-job education or post-basic education?
Additional-restricted activities
86. Jurisprudence is about the legislation, standards and regulatory requirements that affect
the nursing practice of LPNs: TRUE
87. Mandatory registration requirements are only applicable to those LPNs in clinical
practice: FALSE
A LPN who teaches or conducts research (as well as other roles) related to their
profession in Alberta must be registered, even if they are not involved in clinical
practice
88. A regulated member has the legal right to refuse to participate in the complaints
process, alternative complaint resolution, investigations, hearing, decisions and appeals:
FALSE
In doing so, they can be charged with unprofessional conduct
89. If a regulated member fails or refuse to comply with CLPNA Continuing Competence
Program, it is considered unprofessional conduct: TRUE
According to HPA, unprofessional conduct is failure or refusal to comply with the
requirements of the Continuing Competence program, or to cooperate with the
Competence Committee, or with the person make a practice visit
90. Any decision by the Hearing Tribunal may be appealed by the investigated person, the
complaints director or the complainant: FALSE
Under current legislation, the complainant does NOT have the right to appeal a
decision made by a hearing tribunal
91. What enables employers, LPNs and the public to check on the status of any regulated
member?
Public LPN registry
92. Specialty competencies are acquired through completion of approved programs and
advanced certification: TRUE
93. Practice permit expires on December 31 of each year: TRUE
LPNs are not authorized to work without a valid practice permit
94. All regulated members on the general or specialized practice register are eligible to run
for Council and cast a vote: TRUE
95. CLPNA bylaws must be approved by the government and made available to the public:
FALSE
Only the Standards of Practice and code of ethic have to be approved by the
government and made available to the public
96. A regulated LPN on the temporary register may only practice under supervision: TRUE
97. Regulated members may change their annual learning plan if circumstances or needs
change during the year: TRUE
98. CLPNA may approve programs of study and education courses for the purposes of
registration requirements: TRUE
This is one of the powers of the College has under the HPA
99. Which of the following are part of CLPNA’s mandate
Establish and enforce code of ethics, Set standards for registration, Approve
educational programs, Govern its regulated members
100. The Mandate of the Hearing Tribunal is to determine on the basis of the
evidence, whether the LPN is competent enough to continue to practice: TRUE
101. The CLPNA Council appoints the registrar, president, complaints director and
hearing director and college Committees: TRUE
102. The president and vice-president are elected by the Council from the elected
members for one-year term: FALSE
103. Regulated members must meet requirements for participating in the Continuing
Competence Program (CCP) in order to renew their practice permit: TRUE
Under the LPN regulation, CLPNA is required to link renewal of practice permits
to meeting the requirements of the CCP
104. Practice permit renewals are subject to a member meeting all the requirements
of the continuing competence program: TRUE
105. Every regulated LPN may provide immunization services: FALSE
LPN must have additional approved training and be authorized by the Registrar
or registration Committee
106. LPNs who handle and administer narcotic medication should be familiar with the
Occupational Health and Safety Act: FALE
They should be familiar with Controlled Drugs and Substances act
107. College Bylaw can be created and/or amended by a simple majority vote of
Council: FALSE
Two-thirds majority vote of Council is required to create or amend College
bylaws
108. The Registrar must compile information on the regulated members and disclose
such information to the minister and other authorized persons: TRUE. As per HPA
109. The Standards are authoritative statements that define the legal and professional
expectations for LPN practice: TRUE
110. All regulated members on the general register or specialized practice register are
eligible for nomination, and to cast a vote: TRUE
LPNs on the courtesy register are NOT eligible to vote
111. Which piece of legislation requires the College to establish a continuing
competence program?
HPA
112. Where can LPNs regulated by CLPNA use their protected titles: ONLY in Alberta
Titles are not portable. They can only be used in the province where they are
registered
113. Which Jurisprudence document deals with Matter such as member registers and
registration, restricted activities, continuing competence, practice permits and titles
LPN Regulation
114. Which jurisprudence document isthe governing legislation for regulated health
professions in Alberta: HPA
115. Which register is used for regulated practical nurses from another jurisdiction
who want to work in Alberta for a short period of time?
Courtesy register
116. Which jurisprudence document isa set of guidelines and principles that guide
the conduct of LPNs and outlines the conduct that regulated members are expected to
follow?
Code of ethics
117. When a complaint is filed, a formal process is always followed where the
regulated member of the profession is charged with unprofessional conduct and a
hearing is held: FALSE
The complaints director will first attempt to have the concerned parties settle the
dispute informally by communicating with each other or through assistance by
the Complaints Director or a neutral third-party mediator
118. The CLPNA registration year is from:
January 1 to December 31
119. Which document requires that regulated members on annual basis submit a self-
assessment, learning plan, and list of continuing competence activities completed during
the past registration year?
LPN regulation
120. The Registrar has the powers to establish and manage College committees such
as the competence committee: FALSE
This is the role of Council
121. The following terms are also protected by the HPA
College, Regulated, Registered, Regulated Health professional
122. Which standard of practice requires LPNs to “provide relevant and timely
information to clients and co-workers”: Service to the Public and Self-regulation
(Standard 3)
123. Which standard of practice requires LPNs to “Maintain documentation and
reporting according to establish legislation, regulations, laws and employer policies”:
Professional Accountability and Responsibility (Standard 1)
124. The investigator has the authority to investigate other matters unrelated to the
original complaint that are related to the conduct of investigated person: TRUE
125. CLPNA’s authority to regulate their profession is delegated by the provincial
government through the: HPA
126. Which Standard of practice requires LPNs to “Practice with honesty and integrity
to maintain the values and reputation of the profession”: Ethical Practice
127. Three specific learning objectives, chosen from the Competency Profile, are
required in the annual CCP learning plan: FALSE
Two learning objectives
128. The following does the College use to protect and serve the public interest:
Continuing competence, Complaints process, Registration standards, standards of
practice
129. The Standards of practice for LPNs in Canada were develop by the CLPNA
Council: FALSE
Standards used in Alberta are from a national framework developed for LPNs in
Canada
130. What legislation outlines the professions-specific titles that health professionals
may use
HPA (part 10, schedules)
131. The regulated member will receive a copy of the written letter of complaint and
asked to provide a response
TRUE
132. A CLPNA nomination committee seeks a minimum of two nominees from each
district to run for council: TRUE
133. Which College committee review Hearing Tribunal decisions? Council appeal
committee
134. The College approves programs of study and education courses for the purposes
of registration as an LPN in Alberta: TRUE
135. Which Standards of Practice requires LPNs to “recognize the impact of their own
values and beliefs on nursing practice and nurse-client therapeutic relationships”?
Ethical practice (Standard 4)
136. Which Standards of Practice requires LPNs to “provide relevant and timely
information to client and co-workers”? Service to the public and self-regulation
(Standard 3)
137. Which governance document outlines the key regulatory responsibilities of
CLPNA
HPA
138. Regulation of health profession in Canada occurs at the Provincial level
139. Which of the following does the College use to protect and serve the public
interest? Standards of practice, Registration standards, Continuing competence and
Complaints process.
140. Which of the following terms are also protected by the HPA?
Regulated, College, Regulated health professional, registered
141. Where can LPNs regulated by CLPNA use their protected titles?
Only in Alberta
142. Which jurisprudence document prescribe the minimum standards for LPN
practice? Standards of practice
143. What should a regulated member do if he or she suspects someone misusing a
protected title?
Report to CLPNA and Check the LPN register
144. Which College committee must be independent of Council or other committees?
Hearing tribunal
145. The AGM of the CLPNA is help at a date, time and place determined by Council:
TRUE
146. Any resolutions passed by the regulated members by a majority vote at an
annual meeting shall be considered at the next meeting of Council: TRUE
Council is NOT bound by these resolutions
147. For the purpose of election to the CLPNA Council, how many electoral districts
are there in the province?
7 electoral districts
148. Which Jurisprudence document deals with the matters such as member registers
and registration, restricted activities, continuing competence, practice permits and
titles?
LPN regulation
149. LPN in Alberta are:
Self-regulated
150. A code of ethics optional for the self-regulating health professions in Alberta:
FALSE
Under the HPA, Council is required to establish and enforce a code of ethics for
its regulated members. The code of ethics is subject to review by the government
151. How often must the College submit reports to the Alberta government?
Annually
152. Any additions or changes to the College’s bylaws have to be reviewed and
approved by the regulated members and the government: FALSE
Council has the full authority to make changes to the bylaws by a two-thirds
majority votes
153. The CLPNA Code of Ethics is a private document for use by regulated LPNs only:
FALSE
The Code of Ethics is a public document. One reason is that it informs public
about the ethical values and responsibilities of the LPN profession and conveys
the profession’s commitment to society
154. The CLPNA Standards of Practice are authorized by:
HPA
155. In Alberta, the governing legislation for all health professions is the:
HPA
156. Why do LPNs need to be familiar with their regulatory requirements?
Requirement to register with CLPNA, Affects their daily practice decisions, Client
safety and well-being, Avoid being subject of complaints
Jurisprudence Exam Review Sheet – Alberta
Health Professions Act:
the governance document that outlines the key regulatory responsibilities
Lays out consistent rules by which regulated health professions must provide
competent, safe and professional service to the public
Committees
Competence Committee:
oConsiders application for registration, review practice permits renewal, place
conditions or cancel practice permit and address issues referred by registrar
Registration Review Committee:
oConducts reviews of registration decision
Complaints Review Committee:
oConducts reviews of dismissals of complaints
Hearing Tribunal:
oEstablished by council as per HPA, Independent of council or other committees,
and conducts hearings as required
Council Appeal Committee:
oEstablished by council as per HPA. President, public member and one other
Council member. Reviews Hearing tribunal decisions
Function of CLPNA
Delegated powers by the HPA
College Role:
oGovern its regulated members
oRegulate practice of members
oStandards for registration, continuing competence and practice
oCode of ethics
oCarry out activities of the College
oApprove education programs
CLPNA Prohibitions
oMay not set professional fees
oProvide guidelines for professional fees or negotiate professional fees
oMay not be a certified bargaining agent (defined in the labour Relations Code
MANDATE
o“To regulate and lead the profession in a manner that protects and serves the
public through excellence in Practical nursing”
VISION
o“Influencing a quality person-centered system through regulatory excellence”
MISSION
oLPNs are progressive nursing professionals who provide safe, competent and
ethical person-centered care in collaboration with clients, families and other
providers
CLPNA bylaws
oDefine day-to-day operations of the College
oCreated or amended by two-thirds majority of Council
oDo NOT need approval from government
Council Role (What the College’s Council do)
Governing body of the College
Consists of president, vice-president, elected members and public members
Manages and conducts college’s day-to-day operations and activities
Creates and manages bylaws and policies
Appoints registrar. President, complaints director and hearings director
Establishes committees such as the competence committee
Elections
Province divided into 7 electoral districts
Nominations committee seeks a minimum of 2 nominees per district
All active and in good-standing members allowed to run and vote for Council
membership except where stated in Sec 24 (2) of the bylaws
President and vice-president elected by Council from elected members for 2 year terms
Annual General Meeting (AGM)
Council sets date, time, and place
Quorum consists of 15 regulated members personally present
If quorum NOT present (within 30 minutes), Council can proceed with business
All regulated members vote at AGM
Resolution passed by members at AGM shall be reconsidered by Council but are not
binding
Standards of Practice
National framework developed for LPNs in Canada
Define legal and professional expectations
Describe elements of quality LPN practice
Applicable to LPN in all settings
Provide benchmarks to assess performance
Indicators describe expectation in detail
Six Foundational Principles
i. LPNs are self-regulating and accountable for providing safe, competent,
compassionate and ethical care within the legal and ethical framework or nursing
regulation
ii. LPNs are autonomous practitioners and work collaboratively with colleagues in
health care to assess, plan and deliver quality nursing services
iii. LPN practice is client centered and includes individuals, families, groups and
communities
iv. LPN standards are broadly based and address variations in client needs, provider
competence, experience and environmental factors
v. LPN standards allow for growth in the profession to meet changing approaches,
treatment and technologies within the health care system
vi. LPN standards encourage leadership through self-awareness and reflection,
commitment to individual and professional growth, and promotion of the best
possible service to the public
Four Standards
i. Professional accountability and responsibility
1.1 Practice to their full range of competence within applicable legislation,
regulations, by-laws and employer policies
1.2 Engage in ongoing self-assessment of their professional practice and
competence, and seek opportunities for continuing learning
1.3 Share knowledge and expertise with others to meet client needs. This also
applies to mentoring and preceptor situations
1.4 Recognize their own practice limitations and consult as necessary
1.5 Identify and report any circumstances that potentially impede professional,
ethical or legal practice
1.6 Take action to avoid and/or minimize harm in situations in which client safety
and well-being are compromised
1.7 Incorporate established client safety principles and quality
assurance/improvement activities into LPN practice
1.8 Advocate in the interest of the public for continuous improvement in LPN and
health care environment that promote client-centred care. Expect nurses to
advocate as such
1.9 Practice in a manner consistent with ethical values and obligations of the
Code of Ethics for LPN
1.10 Maintain documentation and reporting according to established
legislation, regulations, laws, and employer policies
1.11 Advocate for and participate in the development of policies and
procedures that support evidence-informed LPN practice
ii. Knowledge-based practice
2.1 Possess current knowledge to support critical thinking and professional
judgement
2.2 Apply knowledge from nursing theory and science, other disciplines,
evidence to inform decision-making and LPN practice
2.3 Access and use relevant and credible information technology and other
resources
2.4 Review and integrate relevant nursing research findings into LPN practice
2.5 Maintain awareness of current trends and issues in health care and society
that impact clients and nursing outcomes
2.6 Evolve their own LPN practice in response to changes and new developments
affecting the profession
2.7 Demonstrate understanding of their role and its interrelation with clients and
other health care colleagues
2.8 Collaborate in the development, review and revision of care plans to address
client needs and preferences and to establish clear goals that are mutually
agreed upon by the client and the health care team
2.9 Provide holistic LPN care considering the whole person, the environment and
the concepts of health promotion, illness prevention, health maintenance,
restoration and protection
2.10 Recognize how LPN practice environments and other environmental factors
affect professional practice and client outcomes, and develop/modify care plans
to assure client safety and well-being
2.11 Use critical inquiry to assess, plan and evaluate the implications of
interventions that impact client outcomes
2.12 Practice in a culturally competent manner
2.13 Modify and communicate to appropriate person changes to specific
interventions based on the client response
iii. Service to public and self-regulation
3.1 Engage clients in a therapeutic nurse-client relationship as active partners for
mutual planning of and decisions about their care
3.2 Collaborate with clients and co-workers in the analysis, development,
implantation and evaluation of LPN practice and policy that guide client-focused
care delivery
3.3 Support and contribute to an environment that promotes and supports safe,
effective and ethical practice
3.4 Promote a culture of safety by using established occupational health and
safety practices, infection control, and other safety measures to protect clients,
self and colleagues from illness and injury
3.5 Provide relevant and timely information to clients and co-workers
3.6 Demonstrate and understanding of self-regulation by following the standards
of practice, the code of ethics and other regulatory requirements
3.7 Attain and maintain professional registration/licensure with the regulatory
authority of the jurisdiction in which they practice
3.8 Practice within the relevant laws governing privacy and confidentiality of
personal health information
iv. Ethical practice
4.1 Practice in a manner consistent with ethical values and obligations of the
Code of Ethics for LPNs
4.2 Recognize the impact of their own values and beliefs on nursing practice and
nurse-client therapeutic relationships
4.3 Identify ethical issues and communicate them to the health care team
4.4 Develop ethical decision-making capacity and take responsible action toward
resolution
4.5 Advocate for the protection and promotion of clients’ right to autonomy,
respect, privacy, confidentiality, dignity and access to information
4.6 Maintain professional boundaries in the nurse/client therapeutic relationship
at all times
4.7 Communicate in a respectful, timely, open and honest manner
4.8 Collaborate with colleagues to promote safe, competent and ethical practice
4.9 Support and contribute to healthy and positive practice environments
4.10 Practice with honesty and integrity to maintain the values and reputation of
the profession
Code of Ethics
Ethical values and responsibilities
Expected to uphold and promote
Be accountable
Purpose of Code of Ethics
i. Required by the HPA
ii. Guide ethical reflection and decision-making
iii. Informs public about ethical value
Consequences of Unethical conduct
i. Clients at risk
ii. Nurse- client therapeutic relationship
iii. Health team effectiveness
iv. Conflict and disharmony
v. Findings of unprofessional conduct
LPN Ethical principles
i. Responsibility to the public:
oLPN self- regulating professionals, commit to provide safe, effective,
compassionate and ethical care to members of the public.
oRespect the rights of all individual regardless of their diverse values, beliefs
and cultures.
oProvide only those functions for which they are qualified by education or
experience
ii. Responsibility to the Clients:
oLPN provide safe and competent care for their clients.
oMaintain professional boundaries in the use of electronic media.
oRespect and support client choices
oReport to appropriate authorities and take other action in a timely manner to
ensure a client’s safety and quality of care when unethical or incompetent
care is suspected
iii. Responsibility to the Profession:
oLPN have a commitment to their profession and foster the respect and trust
of their clients, healthcare colleagues and the public
oPractice in a manner that is consistent with the privilege and responsibility of
self-regulation
iv. Responsibility to the Colleagues:
oLPN develop and maintain positive, collaborative relationships with nursing
colleagues and other health professionals
oTake appropriate action to address the unprofessional conduct of other
members of the interprofessional team
v. Responsibility to the Self:
oLPN recognize and function within their personal and professional
competence and value systems
oPrevent and manage conflict of interest situations
oDemonstrate honesty, integrity, and trustworthiness in all interactions
oAccept responsibility for knowing and acting consistently with the principles,
practice standards, laws and regulations under which they are accountable
Legislation – HPA
Parts 1-9 common for all profession
Establishment and governance
Registration and continuing competence
Complaint and disciple
Protection of professional titles
Schedule 10 specific to LPN profession
oLegislation that outlines the profession-specific titles that health
professionals may use
Sets out practice statements
Identifies acceptable professional titles
Protection of Titles
Only regulated members of CLPNA may use:
oLPN
oPN
oNursing assistant
oLPN or RNA
Other terms are also protected by HPA
Regulation of LPNs
LPN Registration requirements
oDiploma or certificate in practical nursing
oRegistration examination
oGood character and reputation
oCriminal records check
oProficiency in English language
Registration Categories
oGeneral register: for most of the regulated members that meet the
requirements
oProvisional register: applies to members who have met all the registration
requirements but have not yet successfully passed the registration. Can only
be held for a maximum of 1 year. May only practice only under supervision
oCourtesy register: approved by the registrar. Term only for 3 months or less
Registration renewals
oFailure to renew results in suspension or cancellation
Practice permits
oRegistration year is Jan 1 – Dec 31
oPractice permits expire each Dec 31
oPractice permit required to be: authorized to work as an LPN and to use the
title “LPN”. According to HPA individuals without a valid practice permit are
not authorized to work as LPN in Alberta nor to use the title “LPN”
oMust have: full name, name of college, issued pursuant to HPA, registration
number, category of registration, any practice condition, expiry date
Other Membership
i. Associate membership is for members who:
oDo not plan to practice as LPN
oWant to receive CARE magazine, practice updates and renewal notices
oMust meet all registration requirement when reinstating
Continuing Competence Program
i. Mandated by HPA:
oHPA Specifies that Council must establish a continuing competence program
that provides for regulated members to maintain competence and to
enhance the provision of professional services
ii. Annual Continuing competence program process
oLPN regulation requires that regulated members, on annual basis, submit a
self-assessment, learning plan, and a list of continuing competence activities
undertaken during the past registration year
iii. Continually enhance and expand knowledge
iv. Practice and conduct meet current standards
v. Purpose of the CCP
oIs to legally require regulated LPNs to continually enhance and expand their
professional knowledge, skills and competence
oAlso a mechanism that the college can use to ensure that nursing practice and
conduct meet current professional standards
Conduct process
Relevant Documents
Part 2: Registration
oApplying for registration: Section 28 to 32
oRegistration: Section 33 to 37
oPractice permit renewal: Section 38 to 41
oSuspension, Cancellation and reinstatement: Section 43 to 45
oRegistration Required: Section 43 to 45
Regulation
oContinuing Competence: Section 22 to 23
Bylaws
oPart 4 – registration and continuing competence
HPA
oPart 3: Continuing competence
Conduct expectations
Provide competent, safe and ethical services
Comply with legislation and practice standards
Build trust and confidence in their profession
Unprofessional Conduct define as
Lack of knowledge, skill or judgement
Contravention of HPA, Code of Ethics, Standards or applicable legislation. Example,
failure to practice in compliance with privacy legislation
Practicing without registration or practice permit
Not complying with condition on permit
Failure to comply with CCP requirements
Failure to cooperate with investigator
Refusal or ignoring directions of registrar
Noncompliance with agreement of settlement
Refusing to undergo examination (section 118)
Failure to comply with a notice to attend or a notice to produce under Part 4
Conduct harmful to integrity of profession
Failure to adequately document or chart
Personality conflicts: any dispute should be resolved before they escalate to a major
confirmation
Professional conduct expectations:
Maintaining high practice standards
Providing competent, safe and ethical services
Building trust and confidence in the profession
Complaints can be filed/made by
Patient/client or family member
Regulated or former member
Another health care professional
Employer
Member of the public
Filing a Formal complaint
Submitted to Complaints Director in writing and must include:
i. Name of regulated member
ii. Description of facts and events
iii. Any other information / documents
iv. Name, signature, and contact information of complaint
Complaints Director during review:
i. Contacting other individuals / organizations
ii. Review of client files / records
iii. Interviews with involved parties
Complaints Director of College can direct the individual to seek treatment and to cease
practice if regulated member is incapacitated
Complaints Director may dismiss a complaint if
i. There is insufficient or no evidence
ii. The complaint is deemed trivial or vexatious
Appeals
Decision of Hearing Tribunal may be appealed by:
i. Investigated person
ii. Complaints Director
Complaint does NOT have right to appeal
Annual Learning Plan
Must include: Timeline for completion, resources for meeting objectives, Success
indicators, specific learning objectives
Hearing Tribunals Penalty
Fine and costs of hearing
Counselling or treatment
Caution or reprimand
Suspension of practice permit
Good character and reputation by
Written references from colleagues; declaration stating that the applicant has no history
of unprofessional conduct or disciplinary actions; and the results of a criminal records
check
Scope of Practice
Defines: what nursing activities LPNs are allowed and not allowed to do
There is NO ONE document that defines all the aspects of the LPN scope of practice
LPN Role and Responsibilities (HPA, Schedule 10 (3))
i. Apply nursing knowledge skills and judgement to assess patients; needs
ii. Provide nursing care for patients and families
iii. Teach, manage and conduct research in the science, techniques and practice of
nursing
iv. Provide restricted activities authorized by the regulations
Professional Nurse: (Standards of Practice)
i. Professional accountability and responsibility: LPNs are accountable for their
practice and responsible for ensuring that their practice and conduct meet both the
standards of the profession and legislative requirements
ii. Knowledge-based practice: LPNs possess knowledge obtained through practical
nurse preparation and continuous learning relevant to their professional LPN
practice
iii. Service to the public and self-regulation: according to standards of practice LPNs are
self-regulating and accountable for providing safe, competent, compassionate and
ethical care within the legal and ethical framework of nursing regulation. LPNs
practice nursing in collaboration with clients and other members of the health care
team to provide and improve health care services in the best interests of the public
iv. Ethical practice: LPN uphold, promote and adhere to the values and beliefs as
prescribed in the Code of Ethics (Document Standards of practice)
LPN Competencies
i. Competency profile: provides a detailed and comprehensive description of the
competencies found in the total LPN profession in Alberta. NO ONE LPN is expected
to be proficient in all of the competencies listed
oEntry-level competencies: acquired through formal practical nurse education
oPost entry-level competencies: may be gained through informal or formal
learning, experience, on-the-job training, post-basic education or certification
oAdvanced authorization competencies: acquired through completion of
approved programs and advanced certification
LPN Scope of practice directed by:
i. HPA
ii. LPN regulation
iii. Standards of Practice
iv. Code of Ethics
v. Competency Profile
Restricted Activities: are those activities that are considered high risk to the public and
therefore are restricted to those regulated health professionals authorized to perform such
activities. Defined in Schedule 7.1 of GOA
Restricted activities for LPN profession is defined by LPN regulation
Legislative Structure
i. Governments Organization Act (GOA): Identifies the restricted activities performed
by
oAuthorized under professional regulation
oPerson or group authorized by minister: to perform one or more restricted
activities subject toany conditions included in the regulations; and, for the
purpose of preventing, combating or alleviating a public health emergency,
the Minister may be order authorize a person or category to perform on of
the more restricted activities subject to any terms or conditions the Minister
may prescribe
oAuthorized by other legislation
LPN authorizations include:
i. Entry-level restricted activities taught in basic practical nurse program
ii. Post entry-level restricted activities: acquired through experience, on-the-job
education or post-basic education
iii. Advanced authorization restricted activities: requiring advance education
recognized by the College
Only perform restricted activities within competence and area of practice
Supervision and Delegation
Health Care Aides (HCA): come from a variety of backgrounds including internationally
educated nurses who are working towards meeting their licensure requirement,
students in nursing programs, or those who have no experience in health care. HCA are
NOT a regulated health profession. Effective communication is critical to ensure the
sharing of the necessary information between the health care aide and the nurse and to
integrate the care activities
i. Part of nursing care staff in variety of settings
ii. Diverse training health profession
iii. Nurse and HCA work together to integrate the care activities
Restricted activities for HCA
i. HCA permitted certain restricted activities under supervision of regulated nurse
ii. HCA allowed to perform activities of daily living
iii. Policy determines what can or cannot be done by HCA (by employer)
Supervision of HCA’s
i. Consultation and guidance by regulated nurse
ii. Supervision may be direct, indirect or indirect remote
iii. Nurse is responsible for assigning client care to HCA and ongoing evaluation of care
iv. HCA is responsible for assigned tasks and care provided
Professional accountability and responsibility
LPNS are required to:
i. Demonstrate legal accountability
oLPNs are required to be accountable for their own practice. This means that
they must understand the concept of duty of care; adhere to the duty to self-
report; practice only within their competence and scope of practice
ii. Adhere to confidentiality requirements
oThis means managing all client information appropriately; identifying and
reporting breaches in confidentiality; and recognizing and managing related
risks
iii. Follow informed consent rules
oThe client must give permission prior to any treatment being provided.
Informed consent means that the client must have knowledge and be able to
understand the options and risks associated with the proposed treatment or
intervention
iv. Respect professional boundaries
oLPNs must respect professional boundaries with clients, family, colleagues,
supervisors and employers. They must recognize and maintain professional
boundaries both on and off duty. Respecting professional boundaries applies
to use of technology and social media
v. Participate in teamwork
oLPNs must work effectively through inter-professional collaboration and
communication. They should know and use the principles of team dynamics
and group processes, including recognizing and managing conflict
vi. Maintain fitness to practice
oMaintain physical, mental and emotional health to provide safe, competent
care. An LPN should inform the appropriate authority if they feel they are
unable to safely practice
Other relevant legislation
Provincial Legislation – Privacy
i. Health Information Act (HIA) – Guidelines and Practical Manual
oRules for collection, use and disclosure of health information
oProtects privacy of individuals and confidentiality of their health records
oHealth records shared, managed and protected properly
oAlso lays out the requirements as to how health records are to be managed,
stored, shared, protected and destroyed
ii. Protection of persons in Care Act (PPCA)
oPublicly funded service providers required to protect clients form abuse and
prevent abuse
oRequires abuse be reported
oProtected from liability for reporting
o*Any LPN who suspects or actually observes abuse, they are required by this
law to report it*
iii. Occupational Health and Safety Act (OH&S): Focuses on safety in the workplace
oMinimum legislated standards
oHealth and safety advice and information
oEnsures compliance with legislated standards
oInvestigations of incidents
oTargeted inspections
iv. Controlled Drug and Substances Act
oOutlines regulations around controls of narcotic drugs