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PRACTICE GIDELINE Authorizing Mechanisms
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Table of Contents continued, Tools for Delegating Accepting Delegation and Developing Directives 10. Assigning Supervising or Teaching a Procedure 10,Assigning a procedure 10. Supervising a procedure 10,Teaching a procedure 10. Decision Tree 1 Deciding to Perform a Procedure 11. Appendix A Procedures That RNs and RPNs May Initiate According. to the Nursing Act 1991 12, Decision Tree 2 Assigning Supervising or Teaching a Procedure 13. Leading in regulatory excellence,Regulating nursing in the public interest.
Authorizing Mechanisms Pub No 41075,ISBN 978 1 77116 151 0. Copyright College of Nurses of Ontario 2020, First published in October 2007 Updated in May 2008 June 2009 July 2009 ISBN 1 897308 33 7 Updated November 2011 for Bill 179. changes Updated 2013 for Delegation Regulation Revised January 1 2014 for Dispensing Updated May 2015 removed footnote for. medication update ISBN 978 1 77116 034 6 Revised January 2018 for Controlled Act of Psychotherapy Updated December 2018 to remove. references to retired practice guideline Disagreeing with the plan of care ISBN 978 1 77116 098 8 Revised January 2020 for the Controlled. Act of Psychotherapy initiation regulation ISBN 978 1 77116 149 7 Update May 2020 for updated delegation restrictions. Commercial or for profit redistribution of this document in part or in whole is prohibited except with the written consent of CNO This. document may be reproduced in part or in whole for personal or educational use without permission provided that. Due diligence is exercised in ensuring the accuracy of the materials reproduced. CNO is identified as the source and, he reproduction is not represented as an official version of the materials reproduced nor as having been made in affiliation with. or with the endorsement of CNO, Additional copies of this booklet may be obtained by contacting CNO s Customer Service Centre at 416 928 0900. or toll free in Canada at 1 800 387 5526,College of Nurses of Ontario.
101 Davenport Rd,Toronto ON M5R 3P1,www cno org, Ce fascicule existe en fran ais sous le titre Les m canismes d autorisation n 51075. PR ACTICE GUIDELINE,Introduction Legislation Governing Nursing. An authorizing mechanism an order initiation Practice. directive or delegation is a means specified in The Regulated Health Professions Act 1991 RHPA. legislation or described in a practice standard sets out a framework for Ontario s regulated health. or guideline through which nurses1 obtain the professions 3 It provides a common set of rules of. authority to perform a procedure or make the procedure for the colleges and is linked to each. decision to perform a procedure profession specific act including the Nursing Act. 1991 The RHPA framework sets out two elements a, The College of Nurses of Ontario the College scope of practice statement and a series of controlled. is responsible for providing clear concise and or authorized acts for each profession Under these. up to date guidance to nurses As self regulating acts nurses are given the authority to perform. professionals nurses are responsible for practising controlled acts and provide client care. in accordance with the practice documents that, the College publishes and with relevant legislation There are other acts that govern the practice of. Understanding legislative responsibilities is critical health care including nursing in Ontario Each. for nurses to make decisions about how to perform sets out requirements for practice in the settings and. procedures safely It is also important to ensure that circumstances to which it applies They include but. nursing practice is consistent with the College s are not limited to the. practice documents Public Hospitals Act,Healing Arts Radiation Protection Act.
Authorizing mechanisms are complex concepts that Laboratory and Specimen Collection Centre. are covered in a number of College documents Licensing Act. To create this practice guideline the College has Mental Health Act and. consolidated and condensed information in its Long Term Care Homes Act 20074. Decisions About Procedures and Authority practice, standard and Working With Unregulated Care Scope of practice and controlled acts. Providers practice guideline 2 The scope of practice statement for nursing is as. This practice guideline provides nurses with The practice of nursing is the promotion of health. expectations about delegation It is intended to help and the assessment of the provision of care for and. nurses provide efficient timely access to health the treatment of health conditions by supportive. care by helping them understand authorizing preventive therapeutic palliative and rehabilitative. mechanisms as well as their accountabilities when means in order to attain or maintain optimal. using them However nurses should still consult function 5. Decisions About Procedures and Authority for more, information on authorizing accountabilities Controlled acts are defined as acts that could cause. harm if performed by those who do not have the,knowledge skill and judgment to perform them 6 A. regulated health professional is authorized to perform. Nurse refers to a Registered Practical Nurse RPN Registered Nurse RN or Nurse Practitioner NP. These documents are available on the College s website at www cno org docs. For more information refer to the College s RHPA Scope of Practice Controlled Acts Model document at www cno org docs. For more information on these and other acts visit the Ontario Statutes and Legislation website at www e laws gov on ca. From the Nursing Act 1991, he RHPA includes exceptions that permit individuals who are not members of regulated health professions to perform controlled acts. in defined circumstances, College of Nurses of Ontario Practice Guideline Authorizing Mechanisms.
PR ACTICE GUIDELINE, a portion or all of the specific controlled acts that are if ordered by a physician dentist chiropodist. appropriate for her his profession s scope of practice midwife or Nurse Practitioner NP. Because some scopes of practice overlap some, professionals are authorized to perform the same or Controlled acts authorized to NPs. parts of the same controlled acts NPs can perform the following controlled acts. 1 Communicating to a client or client s, Controlled acts authorized to nursing representative a diagnosis made by the NP. Performing controlled acts represents only a small identifying as the cause of a client s symptoms. portion of nursing practice It is important to note that a disease or disorder. controlled acts are not the only procedures that 2 Performing a procedure below the dermis or a. can cause harm mucous membrane, having the authority to perform a procedure does 3 Putting an instrument hand or finger. not automatically mean it is appropriate to do so i beyond the external ear canal. and ii beyond the point in the nasal passages, each nurse is accountable for her his decisions and where they normally narrow.
actions iii beyond the larynx,iv beyond the opening of the urethra. All nurses are authorized to perform the following v beyond the labia majora. controlled acts vi beyond the anal verge or, 1 Performing a prescribed procedure below the vii into an artificial opening of the body. dermis or a mucous membrane 4 Applying or ordering the application of a. 2 Administering a substance by injection or prescribed form of energy. inhalation 5 Setting or casting a fracture of a bone or. 3 Putting an instrument hand or finger dislocation of a joint. i beyond the external ear canal 6 Adminstering a substance by injection or. ii beyond the point in the nasal passages inhalation in accordance with the regulation. where they normally narrow or when it has been ordered by another health. iii beyond the larynx care professional who is authorized to order the. iv beyond the opening of the urethra procedure, v beyond the labia majora 7 Prescribing dispensing selling and compounding. vi beyond the anal verge or a drug in accordance with the regulation. vii into an artificial opening into the body 8 Treating by means of psychotherapy technique. 4 Dispensing a drug delivered through a therapeutic relationship an. 5 Treating by means of psychotherapy technique individual s serious disorder of thought cognition. delivered through a therapeutic relationship mood emotional regulation perception or. an individual s serious disorder of thought memory that may seriously impair the individual s. cognition mood emotional regulation judgement insight behaviour communication or. perception or memory that may seriously impair social functioning. the individual s judgement insight behaviour, communication or social functioning Authorizing Mechanisms. Authorizing mechanisms provide nurses with, A Registered Nurse RN or Registered Practical the authority to implement treatment plans and.
Nurse RPN is authorized to perform these protocols Choosing the appropriate authorizing. controlled acts under the following two conditions mechanism depends on the nurse s category or class. if initiated in accordance with the conditions role and practice setting. identified in the regulation 7 or, See Conditions for Initiating Controlled Acts on page 5. College of Nurses of Ontario Practice Guideline Authorizing Mechanisms. PR ACTICE GUIDELINE, Orders Although a directive is a medical document by. An order is a prescription for a procedure treatment definition the College recommends that every. drug or intervention 8 An order is required when health care professional who is affected by the. a procedure falls within one of the controlled directive be involved in its development to. acts authorized to nursing when a nurse has not determine whether a directive is most appropriate. initiated the act 9 for the client or if direct assessment of the client by. a procedure does not fall within any controlled the authorizer is required before treatment proceeds. act but is part of a medical plan of care, a procedure falls within one of the controlled acts Initiation. not authorized to nursing or Under the Act RNs or RPNs who meet certain. a procedure treatment intervention is not conditions have the authority to initiate specific. included in the RHPA but is included in another controlled acts This means that RNs or RPNs can. piece of legislation 10 decide independently that a specific procedure is. required and they may initiate that procedure in, Direct orders the absence of a specific order or directive from an. A direct order is client specific A health care authorizing professional When initiating a controlled. professional such as a physician midwife dentist act an RN or RPN must. chiropodist or NP or an RN who is initiating a assess the client and identify the problem. controlled act can give a direct order for a specific consider all of the available options to address the. intervention to be administered at a specific time or problem. times weigh the risks and benefits of each option,considering the client s condition.
A direct order may be written or verbal oral decide on a course of action. Verbal orders must only be used in emergency anticipate the management of potential outcomes. situations or when the prescriber is unable to and. document the order such as in the operating room accept accountability for deciding that the particular. There is an inherent risk in accepting a verbal order procedure is required and for ensuring that any. and nurses should advocate for systems that allow potential outcomes are managed appropriately. their use only in emergency situations or when, the order is unable to be documented Procedures RNs or RPNs who consider initiating procedures are. that necessitate direct assessment of the client by advised to clarify with their colleagues and employers. the authorizer such as when the client s condition the scope of their roles and responsibilities within the. becomes unstable require direct orders health care team If initiating is within the scope of. the RN or RPN s role and competence and is not, Directives prohibited by legislation or organizational policy the. A directive is an order for a procedure or series of initiating RN or RPN may perform the procedure. procedures that may be implemented for a number or an RN may write the order for the procedure and. of clients when specific conditions are met and another nurse may perform it 11. specific circumstances exist A directive is always. written by a regulated health professional who has. the legislative authority to order the procedure for. which she he has ultimate responsibility, T he use of the term standing order is not supported by the College No order regardless of how routine it may seem should be. automatically implemented without the appropriate knowledge skill and judgment Standing orders should not be confused with. preprinted orders that are signed by the authorized person before being implemented. For more information refer to the College s RHPA Scope of Practice Controlled Acts Model reference document at www cno org docs. For example X rays are not included in the RHPA but they are included in the Healing Arts Radiation Protection Act. For more information refer to Appendix A Procedures That RNs and RPNs May Initiate According to the Nursing Act 1991 on page 12. College of Nurses of Ontario Practice Guideline Authorizing Mechanisms. PR ACTICE GUIDELINE, Conditions for initiating controlled acts Delegation. medication update ISBN 978 1 77116 034 6 Revised January 2018 for Laboratory and Specimen Collection Centre Licensing Act Mental Health Act and Long Term Care Homes Act 20074 Scope of practice and controlled acts The scope of practice statement for nursing is as follows The practice of nursing is the promotion of health and the assessment of the provision of care for and the

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