The NP jurisprudence information is divided into three (3) categories: Provincial Policies, relevant Federal Legislation, and relevant Provincial Legislation. Within each of these categories is a list of policies and/or legislation to be aware of for safe nursing practice. To guide your study, each section includes a list of competencies, objectives, a synopsis of information and links to relevant resources. This study guide is specific to regulatory policies.
NPs are not defined as medical practitioners under any provincial Act or Regulations. This term is used to define the physician role.
(1) competency
The nurse practitioner prescribes drugs according to the Food & Drugs Act and its regulations
Objective - the nurse practitioner will:
- describe responsibilities in relation to the distribution of drug samples
Synopsis of Information
The Food and Drug Act defines who can distribute drug samples. Under this federal law, nurse practitioners can distribute medication samples to clients. There should be clear policies and guidelines in your practice setting on NP distribution of medication samples to support safe client care.
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(2) competencies
The nurse practitioner prescribes drugs according to the Controlled Drugs and Substances Act and related regulations
Objectives - the nurse practitioner will:
- identify commonly prescribed controlled drugs and substances
- describe the safety implications of prescribing controlled drugs & substances
- describe the controlled drugs and substances that NPs are not authorized to prescribe under the NCPR of the CDSA
The nurse practitioner exercises professional judgment as it relates to the provisions for record keeping, security and reporting for Narcotic Control Regulations, Benzodiazepines and Other Targeted Substances Regulations
Objectives - the nurse practitioner will:
- describe the record keeping, security and reporting for controlled drugs & substances
Synopsis of Information
A monitored drug is defined as any drug that is a controlled drug pursuant to the Controlled Drugs and Substances Act (CDSA) and appears in the schedules to the CDSA as it is amended or any successor legislation – except testosterone (when dispensed as a compound for topical application for local effect) and drugs listed in the Schedule 1, Parts 1 and 2, of the Benzodiazepines and Other Targeted Substances Regulations to the CDSA.
The New Classes of Practitioners Regulations (NCPR), enacted in November 2012, added nurse practitioners as authorized prescribers under the CDSA.
Because of the risk for diversion and misuse associated with CDS prescribing, NPs, their collaborative team members and employers are encouraged to consider strategies for creating a safe work environment. Education is paramount to success and safety for clients, the community and the collaborative team.
Under Section 31(1) of the CDSA, an inspector may enter an NP’s practice setting at any time to ensure compliance with the regulations. For example, the inspector could ask to examine records, books and electronic data related to controlled substances prescribing activities.
The Cannabis Act and Cannabis Regulations came into force on October 17, 2018, replacing the Access to Medical Cannabis Regulations. Under the Cannabis Regulations, nurse practitioners (NPs) are defined as health care practitioners who can provide a medical document authorizing medical cannabis for clients requiring this controlled substance as part of their treatment plan.
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(1) competency
The nurse practitioner practises in accordance with the Canada Pension Plan Act and its Regulations
Objectives - the nurse practitioner will:
- describe who can complete the Canada Pension Plan Disability form
Synopsis of Information
The Canada Pension Plan Act establishes a comprehensive program of old age pensions and supplementary benefits in Canada payable to and in respect of contributors. NPs are authorized to complete Canada Pension Plan (CPP) disability benefit forms.
More specifically, NPs are authorized to complete Medical Reports needed to determine eligibility or continued eligibility for disability benefits and Terminal Illness Application for a Disability Benefit. Additional information for health care professionals is available on the Canada Pension Plan Disability Benefits Toolkit webpage or by contacting the CPP Program.
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(1) competency
The nurse practitioner practises in accordance with the Income Tax Act and its Regulations
Objectives - the nurse practitioner will:
- describe who can complete the Disability Tax Credit Certificate form
Synopsis of Information
NPs are authorized to complete Disability Tax Credit (DTC) certificates. More specifically, NPs are authorized to complete client assessments and required forms to certify eligibility for the DTC (Form T2201) as well as for the Registered Disability Savings Plan, the Working Income Tax Benefit, and the Child Disability Benefit. Additional information on the NP role in completing DTC certificates can be found on the Canada Revenue website.
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(1) competency
The nurse practitioner practises in accordance with the Employment Insurance Act and its Regulations
Objectives - the nurse practitioner will:
- describe who can complete the medical forms for Employment Insurance benefits
Synopsis of Information
NPs are authorized to complete Employment Insurance (EI) forms. The Employment Insurance Act authorizes NPs to complete medical certificates for sickness benefits as well as for caregiving benefits available under EI including:
- Compassionate Care Benefits,
- Family Caregiver Benefit for Adults, and
- Family Caregiver Benefit for Children
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(1 competency)
Exercise professional judgment as it relates to the registered nurse’s role in medical assistance in dying (MAiD)
Objectives – the nurse practitioner will:
- Define the process of Medical Assistance in Dying (MAiD)
- Explain the NP role in the provision of MAiD
- Identify statutory safeguards that must be met before an eligible client can receive MAiD
Synopsis of Information
On June 17, 2016, the federal government enacted legislation regulating the provision of medical assistance in dying (MAiD). This was in response to the Supreme Court of Canada’s Carter decision delivered on February 6, 2015 which struck down the law prohibiting MAiD for Canadians who met certain conditions outlined by the court.
Definition of MAiD
MAiD refers to the process where, at the client’s request, an NP or physician:
- Prescribes and administers a medication to the client that causes their death; or
- Prescribes or provides a medication to the client so that the client may self-administer the medication and in so doing cause their own death.
Counselling
If a client asks about MAiD, you can explore reasons for the client’s request but do so in the context all other end of life care options, including palliative care. You may provide information and answer client questions about MAiD that is client centered and reflects the client’s values.
Client Eligibility
NPs who provide MAiD as a member of the health care team are required to determine the client’s eligibility. However, before assuming any role in the process, you must:
- discuss the client’s request for assisted dying with other members of the healthcare team,
- review the client record and
- review the client’s written request for assisted dying.
In addition, you must:
- follow employer/agency policy regarding your participation in MAiD
- raise your concerns with the health care team or your manager if you have reason to believe that the client does not meet eligibility criteria.
Statutory Safeguards
The Criminal Code sets out a number of safeguards that must be met before an eligible client can receive assistance in dying. As an NP providing MAiD, you should be aware of these safeguards as well as any additional safeguards outlined in employer or agency policy.
As with client eligibility concerns, if you know or reasonably believe that not all mandatory safeguards have been complied with, you must immediately discuss these issues with other health care team members or your manager.
The safeguards in the Criminal Code include, but are not limited to, the following:
- The client’s request must be made in writing and signed and dated by the client
- The client’s request must be signed and dated before two independent witnesses
- Another NP or physician has provided a written opinion confirming that the client meets all of the eligibility criteria set out in the Criminal Code
- There are at least 10 clear days between the day on which the request was signed by the client and the day on which MAiD is provided or – if both NPs and/or physicians assessing the eligibility criteria are of the opinion that the client’s death, or the loss of capacity to provide informed consent, is imminent – any shorter period that the first NP/physician considers appropriate in the circumstances
- Immediately before the provision of MAiD, the NP or physician must give the client an opportunity to withdraw their request and ensure that the client gives express consent to receive MAiD.
Administration of Medication
NPs are authorized to prepare and administer the medication being used for MAiD. The healthcare provider (NP or physician) who administers the medication must also prepare the medication (e.g. drawing the medication into the syringe).
Witnessing a Written Request for MAiD
A client who wishes to receive assistance in dying must submit a request to the providing NP or physician. The request must be written, signed and dated by the client after they have been informed of or diagnosed with the grievous and irremediable medical condition.
The client may ask you to act as a witness to their signature on their written request for MAiD. You may act as a witness as long as you:
- are aware that the document is a formal request for assisted dying;
- are not directly involved with providing health care services or personal care services to the client making the request;
- do not directly provide personal care to the client;
- are not or reasonably believe that you are not a beneficiary under the client’s will or will receive a financial or other material benefit from the client’s death; are not an owner or operator of a health care facility where the client is being treated or any facility in which the client resides.
NOTE: As per agency policy, NPs employed by the Nova Scotia Health Authority are not permitted to witness the signature of a client requesting MAiD.
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