Expanded Nursing Services for Patients Act, 1997
EXPLANATORY NOTE
The Bill will allow registered nurses who hold an extended certificate of registration to provide, with members of other health professions, primary health care services. The Bill will expand the scope of practice of registered nurses who hold such a certificate by allowing them to perform certain controlled acts, such as communicating a diagnosis to patients, prescribing certain drugs and ordering the application of certain forms of energy.
Consequential amendments are made to the Healing Arts Radiation Protection Act, the Medical Laboratory Technology Act, 1991, the Respiratory Therapy Act, 1991 and the Vital Statistics Act.
Bill 1271997
An Act to amend the Nursing Act, 1991
and to make consequential amendments to
the Healing Arts Radiation Protection Act,
the Medical Laboratory Technology Act, 1991,
the Respiratory Therapy Act, 1991
and the Vital Statistics Act
Her Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows:
PART I
AMENDMENTS TO THE NURSING ACT, 1991
1. Clause 5 (1) (b) of the Nursing Act, 1991 is repealed and the following substituted:
(b) the procedure is ordered by a person who is authorized to do the procedure by section 5.1 of this Act or by the Chiropody Act, 1991, the Dentistry Act, 1991, the Medicine Act, 1991 or the Midwifery Act, 1991.
2. The Act is amended by adding the following section:
Authorized acts by certain registered nurses
5.1 (1) In the course of engaging in the practice of nursing, a member who is a registered nurse and who holds an extended certificate of registration in accordance with the regulations is authorized, subject to the terms, conditions and limitations imposed on his or her certificate of registration, to perform the following acts in addition to those the member is authorized to perform under section 4:
1. Communicating to a patient or to his or her representative a diagnosis made by the member identifying, as the cause of the patient's symptoms, a disease or disorder that can be identified from,
i. the patient's health history,
ii. the findings of a comprehensive health examination, or
iii. the results of any laboratory tests or other tests and investigations that the member is authorized to order or perform.
2. Ordering the application of a form of energy prescribed by the regulations under this Act.
3. Prescribing a drug designated in the regulations.
4. Administering, by injection or inhalation, a drug that the member may prescribe under paragraph 3.
Consultation
(2) A member is not authorized to communicate a diagnosis under paragraph 1 of subsection (1) unless the member has complied with the prescribed standards of practice respecting consultation with members of other health professions.
3. (1) Section 14 of the Act is amended by adding the following clauses:
(c) prescribing the forms of energy that a member may order for the purpose of paragraph 2 of subsection 5.1 (1) and prescribing the purpose for which, or the circumstances in which, the form of energy may be applied;
(d) designating the drugs that a member may prescribe for the purpose of paragraph 3 of subsection 5.1 (1) and prescribing the circumstances in which a member may prescribe the drugs;
(e) prescribing standards of practice respecting the circumstances in which registered nurses who hold an extended certificate of registration should consult with members of other health professions.
(2) Section 14 of the Act is amended by adding the following subsections:
Incorporation by reference
(2) A regulation under clause (e) may adopt by reference, in whole or in part and with such changes as may be necessary, any document or publication and may require compliance with the document or publication.
Rolling incorporation
(3) If a regulation under subsection (2) so provides, a document or publication adopted by reference shall be a reference to it, as amended from time to time, and whether the amendment was made before or after the regulation was made.
PART II
CONSEQUENTIAL AMENDMENTS
4. Section 6 of the Healing Arts Radiation Protection Act is amended by adding the following subsections:
Same
(2) Despite subsection (1), a person may operate an X-ray machine for the irradiation of the chest, the ribs, the arm, the wrist, the hand, the leg, the ankle or the foot of a human being if the irradiation is prescribed by a member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991.
Same
(3) Despite subsection (1), a person may operate an X-ray machine for the purpose of performing a mammography that has been prescribed by a member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991.
5. Subsection 5 (1) of the Medical Laboratory Technology Act, 1991 is amended by adding "or by a prescribed person" at the end.
6. Subsection 5 (1) of the Respiratory Therapy Act, 1991 is repealed and the following substituted:
Additional requirements for authorized acts
(1) A member shall not perform a procedure under the authority of paragraph 1, 2, or 4 of section 4 unless the procedure is ordered by,
(a) a member of the College of Physicians and Surgeons of Ontario; or
(b) a member of another health profession who is authorized to perform the procedure under an Act referred to in Schedule 1 of the Regulated Health Professions Act, 1991 and who is prescribed by regulation.
7. (1) If on the day this section comes into force subsection 102 (17) of the Statute Law Amendment Act (Government Management and Services), 1994 is not in force,
(a) subsection 21 (3) of the Vital Statistics Act is amended by striking out "subsection (4)" in the first line and substituting "subsections (3.1) and (4)"; and
(b) section 21 of the Vital Statistics Act is amended by adding the following subsection:
Same
(3.1) In the prescribed circumstances, a prescribed person shall, immediately after the death of a person, complete and sign a medical certificate of death in the prescribed form stating the cause of death according to the classification of diseases adopted by reference in the regulations and shall deliver themedical certificate to the funeral director or other person in charge of the body.
(2) On the later of the day this section comes into force and the day subsection 102 (17) of the Statute Law Amendment Act (Government Management and Services), 1994 comes into force, section 21 of the Vital Statistics Act, as re-enacted by subsection 102 (17) of the Statute Law Amendment Act (Government Management and Services), 1994, is amended by,
(a) striking out "shall provide" in the second line of subsection (2) and substituting "shall, in the prescribed circumstances, provide"; and
(b) repealing subsection (4) and substituting the following:
Copying of medical certificate
(4) Except as provided in the regulations or as provided under any other Act, no person shall copy or duplicate a document signed by a legally qualified medical practitioner, or by any other person, who is required to sign the document under this Act or the regulations; nor shall any person obtain or attempt to obtain any such document or a copy of it.
(3) If on the day this section comes into force subsection 102 (17) of the Statute Law Amendment Act (Government Management and Services), 1994 is not in force, section 60 of the Vital Statistics Act is amended by adding the following clause:
(k.1) prescribing persons for the purposes of subsection 21 (3.1) and the circumstances in which such persons shall complete and sign a medical certificate of death;
(4) If on the day subsection 102 (17) of the Statute Law Amendment Act (Government Management and Services), 1994 comes into force this section is in force, clause 60 (k.1) of the Vital Statistics Act is repealed.
PART III
COMMENCEMENT AND SHORT TITLE
Commencement
8. This Act comes into force on a day to be named by proclamation of the Lieutenant Governor.
Short title
9. The short title of this Act is the Expanded Nursing Services for Patients Act, 1997.