Introduction: legislative and regulatory amendments
Amendments to Regulation 965 of the Public Hospitals Act, 1990 make Ontario the first jurisdiction in Canada to legally authorize nurse practitioners (NP) to admit, treat and discharge hospital inpatients. According to Ontario's Ministry of Health and Long-term Care (MOHLTC), "these changes would make better use of our health human resources. For Ontarians this would mean increased access to care, reduced wait times and improved delivery of patient-centred care" [1].
In December, 2009 the Government of Ontario passed Bill 179, the Regulated Health Professions Statue Law Amendment Act, 2009 for the purpose of enabling timely, efficient and effective care. Twenty-six acts required amendment in order to fully enact Bill 179.
The most significant amendments to the various acts / regulations are included in Table 1 (below).
The legislated authority for NPs to discharge hospital in-patients came into effect on July 1, 2011 while the authority for NPs to admit came into effect July 1, 2012. The amendments were made to improve patient flow and system effectiveness in hospitals by providing equitable and timely access to care, particularly in underserviced, rural and remote populations. Expected outcomes of these changes include reduced wait times, improved patient safety and quality of care, improved patient satisfaction and reduced costs of care. (For further information on outcomes linked with NP care, please see the section of this toolkit titled "NP quality of care").
As a result of this enabling authority, time and effort previously used to develop bureaucratic medical directives can now be redirected to quality improvement initiatives that optimize inter-professional practice patterns in the healthcare system. While these amendments provide legislative authority for NP practice in hospital settings, it is the responsibility of each hospital to identify how to operationalize and support NP practice concerning admission, treatment and discharge.
For an additional guide for hospitals to implement the provisions under Regulation 965, please see the Ontario Hospital Association document titled Enabling Nurse Practitioners to Admit and Discharge: A Guide for Hospitals [2].
Table 1: Key regulatory and legislative amendments to facilitate full utilization of nurse practitioners in hospitals
|
Regulation / Legislation |
Amendment |
Date Effective |
|
Health Insurance Act and the Schedule of Benefits for Physician Services
|
|
May 1, 2015 |
|
Regulation 965 of the Public Hospitals Act, 1990
|
Enable NPs to treat, transfer and discharge hospital in-patients Enable NPs to admit hospital in-patients Mandates that hospital Chief Nursing Executives (CNE) be a member of the hospital's board
|
July 1, 2011 July 1, 2012
Jan 1, 2011 |
|
|
Remove prescription "lists" Authorizes RNs and RPNs to accept care orders from an NP to perform controlled act procedures Remove laboratory "lists"
|
October 1, 2011 "
" |
|
Set or cast a fracture of a bone or dislocation of a joint Dispense, sell, compound or broadly prescribe drugs Apply a prescribed form of energy
|
October 1, 2011 "
Regulatory amendment not yet proclaimed |
|
|
Complete medical certificates of death in hospitals
|
July 1, 2011 |
|
|
Ensure laboratory tests ordered by nurse practitioners in independent health facilities and health services ordered by nurse practitioners in hospitals are insured services for patients Remove current restrictions on types of diagnostic scans NPs can order, enabling them to order diagnostic scan appropriate for client care
|
June 3, 2011 |
|
|
Regulation 682 of the Laboratory and Specimen Collection Centre Licensing Act, 1990
|
Remove Appendix C, which limited the ability of NPs to order laboratory tests according to a prescribed list |
July 1, 2011 |
Note: Amendments to the Controlled Drugs and Substances Act, 1996 will further remove many of the restrictions for NP prescription of other controlled substances (e.g. opiates, benzodiazepines). Federal amendments were completed in 2012. However, the relevant provincial regulations (Regulation 275/94 of the Nursing Act, 1991) have not yet been changed.
Other relevant legislation and regulations
Bill 46, Excellent Care For All Act, 2010
Bill 122, Broader Public Sector Accountability Act, 2010
Healing Arts Radiation Protection, 1990
Proposed Amendments to Regulations Regarding Nurse Practitioners
References
1. Ontario Ministry of Health and Long-Term Care. Proposed amendments to Regulation 965 made under the public hospitals act. 2011 [cited 2015 June 24]; Available from: http://www.ontariocanada.com/registry/view.do?postingId=6182&language=en.
2. Ontario Hospital Association. Enabling Nurse Practitioners to Admit and Discharge: A Guide for Hospitals. 2012.