Pam K i n g - Jesso RN, BN , MN N u r s i n g C o n s u l t a n t – P o l i c y &

P r a c t i c e

Tru d y Bu t to n BSW, L L B, L e g a l C o u n s e l

Mi ch e l l e O smo n d RN, MS(N) , D i r e c t o r o f R e g u l a t o r y S e r v i c e s

Introducing ARNNL’s Quality Assurance

Framework for RNs and NPs

April 25, 2017

Milestones of Quality Assurance ARNNL

On December 2, 2014 an amendment to the Registered Nurses Act, 2008 was introduced into the House of Assembly.

"The primary goal of the quality assurance provisions is to strengthen and improve the practices of registered nurses

and ultimately provide better protection for the people of Newfoundland and Labrador. There are currently over 6,800

nurses registered with the Association of Registered Nurses of Newfoundland and Labrador who are providing the

highest level of care every day to the people of this province. However, in those cases where there are concerns, it is

important for the association to have the tools it needs to address those concerns rather than wait until they become

more serious and thereby require engagement in the disciplinary process."

- Minister Kent

Bill 32, entitled An Act to Amend the Registered Nurses

Act, 2008

Quality assurance committee

35.1 (1) The council shall establish a quality assurance committee that shall have responsibility for, and shall

establish and operate, a program of quality assurance for registered nurses.

(2) The committee may appoint persons registered as registered nurses under this or another Act, including

an Act of another province or a territory of Canada, to act as assessors or to assist the committee to perform its duties

and exercise its powers under this Act.

(3) The committee and a person appointed under subsection (2) shall have the powers, privileges and

immunities that are conferred on a commissioner under the Public Inquiries Act, 2006.

(4) A person appointed under subsection (2) has the powers of the committee under paragraphs 35.3(2)(a),

(b) and (c).

Bill 32, entitled An Act to Amend the Registered Nurses

Act, 2008

Registered nurse shall comply

35.2 A registered nurse shall comply with a request or a directive of the committee, or a person appointed to act on

behalf of the committee, in connection with the conduct of a quality assurance review with respect to the registered nurse

or his or her practice by the committee.

Bill 32, entitled An Act to Amend the Registered Nurses

Act, 2008

Conduct of Review

35.3 (1) The quality assurance committee may itself initiate a quality assurance review of a registered nurse or his or her practice or at the request of the

Director of Professional Conduct Review or the complaints authorization committee.

(2) In connection with a quality assurance review, the quality assurance committee may

(a) require a registered nurse, or another person who has information pertaining to or possession of records that relate to the registered nurse's

practice, to provide information, including patient records, for inspection or review and to permit them to be copied by the committee or a person appointed by the

committee for the purpose;

(b) order a registered nurse to undergo an examination, evaluation, assessment or review of his or her professional practices or capacity or fitness to

practice, to the extent and under the circumstances required by the committee;

(c) engage in periodic or random reviews or audits of a registered nurse's performance including the consequential review of patient records; and

(d) order a registered nurse to:

(i) obtain counselling, including substance abuse counselling, until the registered nurse can demonstrate to the committee, or

another body or a person designated by the committee, that a condition related to the counselling has been overcome,

(ii) obtain medical treatment and authorize a person participating in the provision of that treatment to report on it to the committee,

(iii) complete a course of studies or an educational or training program,

(iv) restrict his or her registered nursing practice,

(v) obtain supervised clinical experience as directed by the committee and to the satisfaction of the committee,

(vi) continue his or her registered nursing practice under conditions the committee may specify, or

(vii) report his or her compliance with an order of the committee and authorize a person to report to the committee on whether he or she is

complying with an order.

Bill 32, entitled An Act to Amend the Registered Nurses

Act, 2008

Termination of Review

35.5 (1) Where the quality assurance committee believes, in the course of or as a result of a review, that a registered

nurse may be guilty of conduct deserving of sanction within the meaning of section 18, the review, if still in progress, shall

be terminated, the registered nurse shall be advised, and the matter shall be referred to the Director of Professional

Conduct Review who shall refer it to the complaints authorization committee to be dealt with as an allegation.

(2) The quality assurance committee shall provide all information and documents in its possession relating to the

review to the complaints authorization committee.

(3) An order of the quality assurance committee issued before it refers a matter to the complaints authorization

committee under subsection (1) remains in effect notwithstanding the referral of the matter to the complaints

authorization committee.

Bill 32, entitled An Act to Amend the Registered Nurses

Act, 2008

Commencement

4. This Act comes into force on a day to be proclaimed by the Lieutenant-Governor in Council.

Milestones of Quality Assurance (QA) ARNNL

On June 14, 2015 ARNNL Council Approved Council Policy: Quality Assurance Program Development Committee Terms

of Reference.

Milestones of Quality Assurance ARNNL

On September 23, 2015 ARNNL Council approved membership for Quality Assurance Development Committee.

Committee Members:

Professional Practice Coordinator (2): Maxine Power-Murrin, Sylvia Diamond-Freak

Front-line Manager: Darlene Mahar

QA, QI or Risk Management Consultants (2): Dale Nixon, Deanne Emberly

RN/NP who have participated in ARNNL’s PCR process: Moira O’Regan-Hogan

ARNNL Resource: Pam King-Jesso

Public Representative: Bea Courtney

Milestones of Quality Assurance ARNNL

In November, 2015 first meeting of ARNNL’s Quality Assurance Development Committee

In June, 2016 the Quality Assurance Development Committee provided Council with an initial update on work-to-date

and in October 2016 a presentation was made to Council

In January, 2017 the Quality Assurance Development Committee completed its work which included the production of

documents related to:

Quality Assurance Principles

ARNNL’s Quality Assurance Framework

ARNNL’s Quality Assurance Program and Intersections with ARNNL’s Professional Conduct Review Process

Recommendations of issues/concerns for referral to the Quality Assurance Programs (QA Review)

Screening Process

Quality Assurance Principles

Principles:

Within the Mandate of ARNNL

Value – added

Preventative

Evidence – Informed

Agile

In absence of a legislated definition of Quality Assurance (QA), the QADC defines QA as a set of activities (i.e. structure,

process) that are planned for and carried out systematically to ensure registered nurses practice safely, competently,

compassionately and ethically.

ARNNL’s Quality Assurance Framework

ARNNL’s Quality Assurance Program and Intersection(s)

with ARNNL’s Professional Conduct Review Process

Screening Process

Next Steps Quality Assurance ARNNL

While awaiting proclamation of a Quality Assurance Committee pursuant to Section 35 of the RN Act 2008:

Continue with “operational planning” related to recommendations of Quality Assurance Development

Committee/specific role of QA Committee

Move forward in naming committee members Quality Assurance Committee

Questions?