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PR ACTICE guIdElInE

Authorizing Mechanisms

Table of Contents
Introduction Legislation Governing Nursing Practice Scope of practice and controlled acts Controlled acts authorized to nursing Additional controlled acts authorized to NPs Authorizing Mechanisms Orders Direct orders Directives Initiation Delegation Who can delegate? Which acts can be delegated? Delegation and orders Delegation by nurses Accepting delegation Tools for Delegating, Accepting Delegation and Developing Directives Assigning, Supervising or Teaching a Procedure Assigning a procedure Supervising a procedure Teaching a procedure 3 3 3 4 4 4 4 5 5 5 6 6 7 7 7 8 8 8 9 9 Continued on next page

Table of Contents

continued 10 11 13 15

Decision Tree #1: Deciding to Perform a Procedure Appendix A: Conditions for Initiating, Delegating and Accepting Delegation of Controlled Acts Appendix B: Procedures That Nurses May Initiate According to the Nursing Act, 1991 Decision Tree #2: Assigning, Supervising or Teaching a Procedure

Our MISSION is to protect the public’s right to quality nursing services by providing leadership to the nursing profession in self-regulation. Our vISION is excellence in nursing practice everywhere in Ontario.

Authorizing Mechanisms ISBN 1-897308-33-7

Pub. No. 41075

Copyright © College of Nurses of Ontario, 2009. First published in October 2007. Updated in May 2008, June 2009, July 2009. 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 • The 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 Ontario at 1 800 387-5526. College of Nurses of Ontario 101 Davenport Rd. Toronto, ON M5R 3P1 www.cno.org Ce fascicule existe en français sous le titre : Les mécanismes d’autorisation, n° 51075

PR ACTICE guIdElInE

3

Introduction

An authorizing mechanism — an order, initiation, directive or delegation — is a means specified in legislation, or described in a practice standard or guideline, through which nurses1 obtain the authority to perform a procedure or make the decision to perform a procedure. The College of Nurses of Ontario (the College) is responsible for providing clear, concise and up-to-date guidance to nurses. As self-regulating professionals, nurses are responsible for practising in accordance with the practice documents that the College publishes and with relevant legislation. Understanding legislative responsibilities is critical for nurses to make decisions about how to perform procedures safely. It is also important to ensure that nursing practice is consistent with the College’s practice documents. Authorizing mechanisms are complex concepts that are covered in a number of College documents. To create this practice guideline, the College has consolidated and condensed information in its Decisions About Procedures and Authority, Revised 2006 practice standard and Working With Unregulated Care Providers practice guideline.2 Authorizing Mechanisms provides nurses with new information on delegation. However, nurses should still consult Decisions About Procedures and Authority, Revised 2006 for more information on authorizing accountabilities. Authorizing Mechanisms is intended to help nurses provide efficient, timely access to health care by facilitating their understanding of the processes of authorizing mechanisms, as well as their accountabilities when using them.

The Regulated Health Professions Act, 1991 (RHPA) sets out a framework for Ontario’s...
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