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NP Scope of Practice in Outpatient Nephrology
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Hi Everyone,

In Ontario, there is growing interest in the changes to the NP role that will be impacted by Bill 179 - legislation that once passed will take away the "lists" that NPs working in acute care organizations (ie not Primary Care NPs) are bound by in practice. Currently, NPs working in outpatient settings can prescribe independently but only from set lists for drugs, diagnostics and labs. The problem is that these lists are not broad enough to cover our practice in nephrology - many drugs are "reorder only" and many are not represented at all. Therefore, we work under Medical Directives - that allow us to write orders that RNs and other health disciplines can carry out.  With Bill 179, there will be no more lists. NPs will be able to prescribe all investigations and treatments excepting narcotics. This will eliminate in many cases the need for medical directives. However, our organization needs to be ok with this, and approve our working to full scope once the legislation is passed.


Out of curiosity - how many of you across the country who work in outpatient areas (dialysis, clinics) are able to work to full scope of practice within your organization without medical directives?


 


 


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Replies (7)
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  1. 9 years ago
Accepted Answer
Hi Alison,

Is Bill 179 available in print to review?

Jordan
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  1. 9 years ago
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Here is a link to the document. It's a lot of complex jargon to read through:

http://www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=2189

Or, here is a quick "hit me with the highlights" version, compliments of the College of Nurses of Ontario:

http://www.cno.org/what-is-cno/regulation-and-legislation/legislation-governing-nursing/faq-bill-179/
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  1. 9 years ago
Accepted Answer
Hi Alison,

In British Columbia we have for the most part a fairly broad and expansive scope, however there are limits and conditions the our college does impose upon us. On a separate note I am also registered as NP in Alberta where there no limitations except for narcotics.

In BC there are no medical directives, all legislation is reviewed by our college and submitted to government for review and approval as they see fit under the Health Professions Act.

Narcotic prescriptive authority remains a federal issue as Health Canada would need to change the narcotic control act to allow NP's to prescribe. This is an issue at times when I don't have an MD available to write a triplicate for narcotics as we do a fair bit of pain management in our HD unit.


Cheers,
Stan

CRNBC Links:
http://www.health.gov.bc.ca/msp/infoprac/np/s5-encounter_codes.pdf
https://crnbc.ca/Standards/Lists/StandardResources/424ScopeNursePractitionerFamily.pdf
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  1. 9 years ago
Accepted Answer
Interesting Stan,

Can I ask, with the limits expanded in British Columbia, where does liability fall. So, for example, with broader privileges to prescribe etc, are all of those activities still under a physician's supervision? Or do NPs become responsible entirely for the orders they write. In Ontario for example, I as a physician still find the regulations murky. So if an NP working with me has expanded privelages and something goes wrong, who is liable.

Now fortunately, I work with Alison Thomas, so I have none of these concerns, but I'm just thinking in the larger picture
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  1. 9 years ago
Accepted Answer
Hi Stan and Jordan,
Stan, thanks for your posting. Very interesting - BC has really embraced the NP role. Jordan, as for the question of liability - see this link to a website with some good info about liability and NPs. As an NP in Ontario, I am expected to have liability protection and I do (and yes, I need it!) However, I am also working within an organization and therefore am responsible to that legal employer/employee relationship. That said, NPs working independently in practice in Primary Care would be solely responsible for care provided within their scope. Clear as mud!!

http://www.srna.org/images/stories/pdfs/nurse_practitioner/liability_protection.pdf

Ali
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  1. 9 years ago
Accepted Answer
Hi Dr. Weinsten,

Nurse practitioners in BC are solely responsible for the orders, consultations and treatments they administer including that of prescribing medications, orders of labs and diagnostics and consultation follow-up. We carry malpratice insurance just as physicians and other health providers do.

That being said NP's work in collaboration with physicians and other health providers to addresss health conditions and for health conditions that are outside of their scope of practice.

I work with a great bunch of nephrologists who I can consult with readily to get assistance with health conditions and/or management of various conditions that I need assistance with.
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  1. 9 years ago
Accepted Answer
Thanks, Stan. This is exactly the way it works in Ontario. We are responsible for the activities that we carry out outside of medical directives that are within our scope of practice.
However, I also rely heavily on my Nephrologist colleagues. It is very much a collaboration in my situation, and I very much appreciate that. These patients are often very complex.
Ali
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