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December 2011

December 2011 issue of Board Highlights.

DECEMBER 2011  
College of Registered Nurses of British Columbia

CRNBC Board Highlights

Includes decisions made at the Dec. 3, 2012 CRNBC Board Meeting 

Standards of Practice 

NP Scope of Practice: Prescribing Carbonic Anhydrase Inhibitors

The Board approved a change in authority for nurse practitioners to be fully authorized to prescribe Category 11: Eye, Ear, Nose and Throat Preparations – Carbonic Anhydrase Inhibitors, effective January 1, 2012. Section D, Prescribing Drugs: Limits and Conditions on Prescribing in the CRNBC Scope of Practice for Nurse Practitioners: Standards, Limits and Conditions has been revised to reflect this change.

RNs and Acupuncture

Registered nurses do not have independent authority to carry out acupuncture (i.e., to insert acupuncture needles below the dermis). Some registered nurses are interested in incorporating acupuncture into their nursing practice. The Board has directed CRNBC staff to assess the public’s interest in having registered nurses do acupuncture to inform a decision as to whether further work is undertaken to clarify if, and under what conditions, registered nurses may carry out acupuncture.


2012-2013 Budget

The Finance and Audit Committee recommended and the Board approved a budget for the fiscal year 2012-2013 of approximately $18 million. The budget includes a planned deficit of $215,220, which is allowable under board policy.

Registration fees for 2012-13 remain unchanged. In conjunction with last year’s fee increase, the Board had indicated that, if fee increases are required, it would prefer to have regular small fee increases rather than larger, infrequent increases such as the increase in fees in 2011. In light of the approved 2012-2013 budget, it was agreed that a fee increase would not be appropriate for 2012-13.

To fulfill its obligation to protect the public, CRNBC carries out foundational work related to registration and renewal, standards of practice, supporting registrants to meet standards and governance. The cost of most programs to support this work in 2012-2013 has increased slightly from 2011-2012. The cost increase for these programs did not result in a corresponding fee increase due to an offsetting reduction in planned capital spending. Budget cost increases include:

  • Education program review for 10 nursing education programs as compared to none in 2011-2012
  • Implementation of the nurse practitioner and registered nurse Quality Assurance Program
  • Communication project to raise public awareness of RNs’ expert knowledge and experience; identify the contributions RNs make to patient safety; link the brand already established by public opinion with the work and role of regulatory bodies; and enhance understanding of the professional nature of nursing.
  • Credit card fees charged for registrants who choose to pay their fees by credit card.

Learn more about the work of CRNBC at www.crnbc.ca or review the CRNBC Annual Report (PDF).


Regulatory Philosophy and Framework

CRNBC has undertaken a project to develop a regulatory philosophy and framework that will be in place in 2012. The project includes looking at best practice approaches to regulation in Canada and internationally, and reviewing trends and issues that will drive health professions regulation in the future. Stakeholders have also been consulted to find out what they think about various approaches to regulation and what their expectations are regarding regulation.

At its December meeting, the Board received a presentation from the project consultant, which included preliminary findings, and provided input for the next steps of the project.

When this project is complete, the Board will consider and decide upon a regulatory philosophy and framework that will guide decision-making and provide rationale for programs and services offered by CRNBC within its legislative scope.


CRNBC Policies

GOVERNANCE POLICIES

CRNBC Public Representative Board Member Nominees
This policy applies to individuals who are interested in having their name submitted by the CRNBC Board for consideration for appointment by the Minister of Health as a CRNBC public representative board member. The Board approved revising content to make the policy consistent with CRNBC Board Member Expectations/Competencies, and minor housekeeping changes.

Member of the Public Appointments to CRNBC Statutory Committees
The Board approved this new policy governing the appointment of members of the public to CRNBC statutory committees. The policy sets out the required competencies for member of the public appointments to CRNBC statutory committees. The competencies are consistent with the required competencies for registrants appointed to a CRNBC statutory committee. They also require that the individual has work or volunteer skills or experience that demonstrate: acting in the public interest; or governance or financial or legal or operational or technical expertise; or previous executive, leadership or mentorship experience; or knowledge of how government operates and applicable regulatory environments.

Election of Registrant Board Members
Formerly known as the nomination and election policy, this policy outlines the process for election of CRNBC registrant board members in accordance with the provisions set out under the Health Professions Act, the CRNBC Bylaws and board policy. It has been revised to make it consistent with other CRNBC board policies.

Code of Conduct and Ethical Behaviours for Registrant Board Candidates
Previously included in the nomination and election policy, this new policy approved by the Board sets out the standards of professional conduct and ethical behaviour for registrant board candidates.

Housekeeping Changes
Housekeeping changes (minor wording and content formatting) were approved to the following board policies: Endorsement; Mandate, Vision, Purpose, Principles, Strategic Plan Goals and Objectives; Registrant Board Members: Voting at the Annual General Meeting; CRNBC Representatives to External Organizations; Review of Board Policy; and Board Member Eligibility: CRNBC Staff Positions.

Policies Rescinded
Following a review of governance policies, it was determined that the following policies are no longer required:

  • Governance Instruments: Guidelines. The guidelines, which provide advice to the board members on drafting bylaws and policies, are available in the CRNBC Board Manual.
  • Council of Professional Practice Groups Terms of Reference. The council dissolved in 2009, so polices are no longer required.
  • Annual General Meeting Date and Venue. Requirements related to this are now set out in the College Bylaws, so the policy is no longer required.

 

FINANCIAL POLICIES

Asset Protection
This policy provides for the protection and preservation of the College's assets. The Finance and Audit Committee recommended, and the Board approved minor rewording changes and adding a requirement for data breach insurance.

Financial Authority
This policy outlines the financial authority of the Board and staff. The Finance and Audit Committee recommended, and the Board approved adding statements to: specify that the annual budget includes funds for operating and capital expenses; authorize the capitalization of operating funds; and clarify authority for spending related to capital expense allocations.

Reimbursement of Expenses
This policy addresses compensation for Board members, committee members, contractors, individuals authorized to represent CRNBC, and staff for time spent on business of the College and for reasonable expenses incurred in connection with the business of the College, provided such participation is authorized by CRNBC policy. The Finance and Audit Committee recommended, and the Board approved changes to ensure the policy is consistent with the Bylaws related to compensation for time spent on College business. CRNBC’s primary method for providing compensation for loss of income is now through an honorarium. The purpose of the honorarium is to compensate for presumed costs such as loss of self-employed income, dependent care or loss of casual work. Salary replacement is available in cases in which claiming an honorarium would negatively impact the claimant’s employment standing (e.g., exceeding available leave of absence days).

 

EXAMINATION POLICIES

Nurse Practitioner Examination Committee Terms of Reference
This committee is appointed by the Board to direct the development and scoring of the Nurse Practitioner Objective Structured Clinical Examination (OSCE) and scores the written examination required for nurse practitioner registration. The policy has been revised to include appointment of a deputy chief examiner by the committee. The committee currently appoints a chief examiner. Changes were also made to improve clarity about the committee’s role in establishing responsibilities and qualifications of individuals, other than staff, involved in administering the OSCE.

 

REGISTRATION POLICIES

The Board approved a motion acknowledging the work undertaken by the Registration Committee to streamline and update a number of the Committee’s policies. 

Continuing Competence – Nurse Practitioners
This new policy establishes criteria for the nurse practitioner practice hours, self-assessment and learning activity continuing competence requirements.

Approved Examinations for RN and NP Registration
Provides direction regarding examinations that may be used in accordance with the CRNBC Bylaws to grant registration to applicants. The policy has been revised to reflect changes approved by the CRNBC Board regarding the administration of the Objective Structured Clinical Examination (OSCE).

Assessment of Canadian applicants including B.C. Graduates
The policy has been updated to ensure references are current and delineate requirements for different types of Canadian applicants. The option of a competence assessment for Canadian applicants has been added for those out of practice for over five years.

Registration Renewal and Reinstatement: RN and LGN
The CRNBC Bylaws require registrants to renew their registration status with the College each year. Clarification regarding the counting of practice hours for dually registered individuals has been added. Content regarding applicants for reinstatement who have been out of practice for over five years has been added. The option of a competence assessment for these applicants has been added.

The Board directed the Registration Committee to consider revising language in this policy to make it clear that the person providing a “satisfactory nurse employer reference” shall be a registered nurse.

Eligibility for a Refund of Examination Fees upon Withdrawal from an Examination
Provides direction regarding: eligibility for refunds of examination fees to applicants or candidates who have chosen to withdraw from an examination; when determining eligibility for a refund of examination fees for applicants or candidates affected by exceptional circumstances; and when determining eligibility for a refund of examination fees for applicants or candidates who have not met all examination requirements and conditions prior to the examination date.

The title of the policy has been changed to reflect that individuals may take the Objective Structured Clinical Examination (OSCE) for purposes other than registration. The definition of the OSCE has been updated to reflect changes approved by the CRNBC Board. The wording of the refund policy has been revised for clarity and consistency.

Supervised Practice Experience
Establishes the criteria by which the Registration Committee may approve a supervised practice experience. A supervised practice experience may be used to meet the basic hours requirement for registration. The policy has been updated to provide direction that this option is not recommended for applicants who have been out of practice for more than 10 years.

Provisional Registration – RN
Provisional registration allows the Registration Committee to grant registration subject to limits and conditions. This policy establishes guidelines for the committee in setting limit and conditions for applicants applying for provisional registered nurse registration. The term supervised practice has been replaced with the term monitored practice. Additional detail has been added to the description of monitored practice. Additional content has been added regarding criteria for eligibility for provisional registration. New content regarding limits and conditions has been added. Time limits have been outlined to facilitate applicants completing the registration application process in a timely manner and achieving full registration.

Failure of an Exam for RN Registration (including eligibility for provisional registration)
This policy provides guidance to the Registration Committee when reviewing applicants who have failed the RN exam. Clarification has been added regarding when an applicant who has failed an exam may or may not be eligible to continue on provisional registration as well as when such an applicant may or may not be granted provisional registration and what conditions may be applied.

Housekeeping Changes
Housekeeping changes (minor wording and content formatting) were approved to the following board policies: Eligibility to Take an Examination for RN or NP Registration; Temporary Registration – Special Event; Continuing Competence and Quality Assurance; Provisional Registration – NP

Policies Rescinded
Following a review of registration policies, it was determined that the following policies are no longer required:  

  • Competence to Practice as a Registered Nurse
  • Temporary Registration and Temporary (Supervised) Registered Nurse Registration – RN
  • Temporary Registration – 2010 Olympic and Paralympic Winter Games


New RN Exam to be Developed

CRNBC, along with nine other Canadian registered nurse regulators, have selected the National Council of State Boards of Nursing to partner in the development of a state of the art, computer-adaptive RN entry-to-practice exam. The new exam will allow for greater flexibility, accessibility, affordability and faster registration.

Some important features of computer adaptive examinations are that they:

  • differentiate border-line candidates, an important public safety consideration for regulatory bodies;  
  • allow applicants to register to write the examination as soon as the regulatory body declares that they are “examination eligible”; 
  • enhance timely access to professions with examination services accessible throughout the year;
  • expedite registration with the regulatory body receiving results within 48 hours;
  • provide the opportunity to offer a variety of item formats (e.g., multiple choice, graphics, audio) and to easily adapt the test to address changes in entry-to-practice competencies; 
  • minimize the exposure of items in the examination item bank, thereby enhancing the regulator’s ability to offer a fair, legally defensible entry exam.

To ensure the exam meets Canadian requirements, the 10 regulators will participate in oversight of the exam development and administration. This will include a thorough study of RN practice and entry-level competencies in Canada and input from Canadian nursing experts and practising nurses. It is expected that the new exam will be introduced in 2015. At its December 2011 meeting, the CRNBC Board passed a motion to endorse this decision. More


Managing Exam Failures

The Board requested staff to undertake a review of best practices for determining the number of times a candidate can re-take/re-write a registration examination. Presently, CRNBC’s Bylaws allow candidates three writings. Further writings require approval by the Board.

Following a review of literature, surveys of other nursing and B.C. regulatory bodies, it was determined that there was no clear answer to the question of what constitutes a best practice. As such, CRNBC’s Board made no recommendations to change the current practice of allowing candidates three attempts of a registration examination followed by a review by the Board for any further attempts. However, changes to registration policies have been made so that the provisional registration of candidates who fail a second time will expire and they will not be permitted to work until such time as they have successfully passed the exam.


CRNBC/CNA Agreement

The Board accepted a request from the Canadian Nurses Association to provide the Association of Registered Nurses of British Columbia (ARNBC) Board with a confidential copy of the joint CRNBC/CNA agreement that assigns CRNBC’s jurisdictional membership in CNA to CNA, effective Aug. 31, 2011. In return the CRNBC Board is to receive a confidential copy of the agreement between CNA and ARNBC. 
The CRNBC Board decided in April 2010 that, due to incompatibility between CRNBC’s and CNA’s respective mandates and functions since 2005 when CRNBC was established as a health profession college under the British Columbia Health Professions Act, CRNBC could no longer be a member of CNA. More


Nursing Excellence Awards

On the recommendation of the Awards Committee, the CRNBC Board approved the names of 45 registrants who will receive Nursing Excellence Awards at a ceremony in Vancouver on April 19, 2012. Award recipients’ names will be posted Dec. 19, 2011 on the CRNBC website www.crnbc.ca 


Appointment

Education Program Review Committee: Doug Larson


CRNBC Call for Nominations

The Nominations Committee is seeking nominations from RN or NP registrants in good standing for one At-large Board Member. Term of office is three years and commences September 1, 2012. Nomination form deadline is Feb. 3, 2012. More


CRNBC Call for AGM Resolutions

The Call for AGM Resolutions is posted on the CRNBC website. The deadline for submitting resolutions to the 2012 CRNBC Annual General Meeting is Jan. 27, 2011. The 2012 AGM is scheduled for June 15, 2012 in Vancouver.

© CRNBC 2011

Board Highlights is published by the College of Registered Nurses of British Columbia and distributed to select CRNBC registrants and stakeholders following each board meeting and posted on the CRNBC website for all registrants and the public. Publication of information in this newsletter is one of CRNBC's official methods of notification to registrants.

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