CARNA’s work is both long-term and future-focused. All of our projects and initiatives are undertaken with the goal of ensuring regulatory excellence, while supporting our members in realizing their professional goals. It is the kind of work that deserves careful planning, consultation and preparation, and can often span several years before we move into the implementation and assessment phases.
As always, many of our projects and initiatives remain ongoing and will continue in that way for the foreseeable future. There were, however, several important milestones that were realized this past year. What follows is a brief summary of our accomplishments. Please click on the link in each description for more information.
CARNA’s centennial celebration began in early 2016, with a launch ceremony at Edmonton City Hall on Jan. 21, 2016. Two centennial champions, First Nations advocate and scholar Madeleine Dion Stout, RN, and past Edmonton poet laureate Mary Pinkoski, spoke at centennial celebrations throughout the year.
A dedicated centennial celebrations website, carna100.ca, was built, and a series of articles featuring the past 100 years of registered nursing history in Alberta were featured in Alberta RN magazine.
CARNA held a multimedia contest, where registered nursing students shared their vision of care for the future with us – of the year 2035 to be exact. We asked “What has changed since you were a nursing student? What do practice settings look like, scope of practice, interdisciplinary collaboration or perhaps patient population?” Nursing students Naomi Kwong and Kristeen Thai took home the grand prize of $2,500, sponsored by TD Insurance Meloche Monnex. All videos are available to view on carna100.ca.
The CARNA centennial conference was held March 16-18 in Edmonton, and focused on the theme of Making a Difference for Albertans. Many nurses from across the province attended the conference, which featured nursing leaders, educators, researchers as well as journalists, authors and patients.
CARNA invited nominations from members to select our 100 Centennial Award Recipients, who were featured on carna100.ca.
The centennial historical display, which featured information and images of the registered nurses who helped build Alberta’s health-care system, began its journey across the province in early May, as part of National Nursing Week. Over the course of the following months, it would travel across Alberta, making visits to local hospitals around the province, including but not limited to Grande Prairie, Canmore, Drumheller and For McMurray.
In total, the display visited 33 communities and a complete list of tour dates is posted on the centennial website at carna100.ca. The tour generated media coverage in most communities and engaged local elected officials and senior Alberta Health Services staff as well as CARNA members and the public.
Two centennial galas took place in Edmonton and Calgary in late October 2016, and a historical postcard book was sent to all members along with the winter 2017 issue of Alberta RN.
CARNA is committed to not only listening to members, but also to acting on their concerns or recommendations. As part of this commitment, CARNA undertook a sweeping organizational transformation that was intended to improve how we serve and support members. The restructuring process, which began in 2015, was completed this past year and each department was positioned to better achieve CARNA’s mandate to protect the public and to meet member expectations.
CARNA continued to prepare for the implementation of the long-awaited changes to the Registered Nurses Profession Regulation, which will allow Alberta to better utilize the skills and experience of almost 37,000 RNs. Staff from CARNA and Alberta Health (AH) staff met in July 2016 to discuss final details of proposed changes to our regulation to ensure any outstanding questions or any clarification needed was addressed.
Following that meeting, the AH policy analyst reviewed all the proposed changes and met with the legislative planner to enable an efficient transition to the legislative drafter who will write the regulation. As of the end of our calendar year, the legislative drafter had not received the next draft from the legislative planner to review and CARNA had not received another version of the amended regulation.
Despite these delays, CARNA continued to move ahead with preparing for the eventual implementation. Temporary permits are being issued with fixed expiry dates (March 31, 2017 and Sept. 30, 2017) in order to accommodate the timelines of many stakeholders involved in seeing the proposed regulation changes through.
Under the new regulation, CARNA will be able to issue provisional registration for up to two years and will include a condition of indirect supervision that requires that a regulated member be readily available for guidance and consultation. Read more information on the transition from temporary registration to provisional registration.
CARNA’s efforts on jurisprudence education continued through 2016. 94 per cent of nurses who tested version two of our module said they learned new information and 97 per cent thought what they learned would influence their practice. Overall, they felt engaged, interested and liked the interactivity of the module.
Volunteer item writers met for a psychometrician-facilitated meeting to establish a pass score for the game. Their pass score recommendation was reviewed by the Registration Committee in March 2016.
CARNA also presented a webinar about the CARNA jurisprudence module to more than 110 regulatory body staff and legal counsel at 42 organizations across North America.
CARNA also brought together a multidisciplinary advisory committee to provide advice, expertise and feedback on the implementation of RN prescribing and ordering of diagnostic tests. Committee members will also help ensure our requirements, standards of practice and competencies for RN prescribing and ordering of diagnostic tests are easily understood and practical.
Right-touch regulation aims to use the right amount of regulation in the right circumstances. CARNA first embraced the concepts of right-touch regulation in 2015 as a way to ensure we do only what is necessary and appropriate in any given situation to protect the public and to regulate the profession.
For example, CARNA has implemented a right-touch regulation approach to complaint resolution. CARNA’s complaints director has the authority under the Health Profession’s Act to resolve valid complaints of unprofessional conduct in a variety of ways. Traditionally, that meant referring the complaint to a hearing, which can take several months to complete and can be costly for both CARNA and the member. The “right-touch regulation” approach allows the complaints director to acknowledge member accountability for unprofessional conduct in certain circumstances and to instead suggest a complaint resolution agreement, which allows for remediation or supervision without the need for a hearing.
On June 17, 2016, Bill C-14 received royal assent, making it possible for eligible Canadians to receive medical assistance in dying. NPs were specifically named as being able to provide medical assistance in dying. The Act to amend the Criminal Code establishes minimum conditions for avoiding criminal liability and establishes safeguards for clients. It also offers protection to health professionals who provide medical assistance in dying, or those who assist in the process in accordance with the law.
CARNA has worked closely with Alberta Health, Alberta Health Services and the College of Physicians and Surgeons of Alberta to develop a regulatory framework that is aligned, legally sound and consistent with the Act to amend the Criminal Code. This framework includes additional provincial safeguards for consistency and patient safety. Alberta Health in conjunction with CPSA and CARNA has developed mandatory standards of practice through an Order in Council. We anticipate distribution of these standards of practice in spring 2017.
Alberta’s three nursing regulators collaborated on a frequently asked questions document. CARNA is developing guidelines for RNs and NPs for provincial council approval in spring 2017.
CARNA understands that this is an uncharted area and a sensitive subject for many members. That’s why we invited members and stakeholders to participate in an online consultation to help shape practice in this area. Over 2,500 people participated and we are working on a report for distribution to all members and stakeholders that will summarize these findings.
CARNA continues to be a member of the CNA task force for the development of a nursing framework on medical assistance in dying. The group has met three times and this draft framework was sent out in fall 2016 for stakeholder feedback. CARNA also served on the MAiD Regulatory Review Committee to review the regulation and practice of medical assistance in dying in Alberta.
CARNA continues to work on analyzing and interpreting the results of the NCLEX-RN exam introduced in January 2015. In the spring of 2016, a practice analysis was conducted to ensure the exam keeps pace with the changes in entry-level nursing practice. This exam is evaluated on a three-year cycle and also aims to test the minimum required knowledge, skills and abilities required of Canadian RNs in the first year of practice.
On Dec. 9, 2015, the NCSBN Board of Directors voted to uphold the existing passing standard.
In late March 2016, Alberta’s first-time and ultimate pass rates were released as part of a report detailing Canadian and Alberta-specific data. First-attempt pass rates measures the number of candidates who passed the exam on their first attempt. The initial pass rates in Alberta was around 69 per cent. Since then, pass rates have been steadily improving, and we ended the 2015 calendar year with an 84 per cent ultimate pass rate.
From Jan. 1 to Dec. 31, 2015 two individuals failed NCLEX three times and requested a fourth writing of the NCLEX. One individual failed NCLEX four times and requested fourth and fifth write of the NCLEX. A total of 10 individuals failed the combination of CRNE and NCLEX three times and requested fourth writing of the NCLEX. The total requests in 2015: 14 from 13 individuals.
The passing standard for the NCLEX-RN is re-evaluated periodically (every one to three years) to ensure it remains appropriate for evolving nursing practice.
In December 2015, Alberta’s Health Minister, Sarah Hoffman, issued a ministerial order that authorized registered nurses to prescribe Naloxone in an effort to combat the dramatic increase in opioid overdoses. The order was scheduled to expire March 31.
In order to prescribe Naloxone, Alberta RNs must meet the terms and conditions as set by CARNA:
Both CARNA and Alberta Health recognize the skill and experience of registered nurses in intervening in opioid overdoses, and have been working to increase RN access to resources such as Take Home Naloxone (THN) kits.
CARNA collaborated with AHS to develop clinical support tools and flow charts to support and guide RNs in prescribing and dispensing THN kits. AHS now recognizes the success of this process as a starting point for implementing RN prescribing and ordering of diagnostic tests with the use of a clinical support tool once the Registered Nurses Profession Regulation has been approved.
Over the past year, CARNA staff members have participated in several education sessions and workshops, including as panel members in four AHS telehealth education/Q&A sessions on the fentanyl crisis.
In July 2016, the Government of Alberta extended the ministerial order until Jan. 31, 2017 and passed amendments to the Schedule Drugs Regulation that designates Naloxone as a Schedule 2 drug for use in emergency treatment of opioid overdose outside of hospital. RNs that meet the CARNA requirements and conditions continued to be able to prescribe and dispense take-home naloxone (THN) kits to clients who meet eligibility criteria.
CARNA’s Uniquely RN® project helps define and distinguish the unique role of RNs and communicate the value we bring to the health-care system.
We partnered with the United Nurses of Alberta for a joint ad campaign in May to share the project messages on yourRN.ca, in online ads, on billboards and on transit shelters throughout Alberta. Surveys of the public conducted after the campaigns conclusion found that:
A member working group formed in December 2015 and met throughout the year to strategize and determine the next steps. They began articulating their own value in stories that are shared with members on the CARNA website, newsletter and social media.
CARNA’s commitment to working collaboratively with other health-care providers has led to our involvement with a variety of organizations and initiatives, including the Health Quality Council of Alberta (HQCA). This past year, CARNA worked with HQCA on a project that aimed to refresh the patient concerns framework and involved representatives from Alberta Health Services, College of Physicians and Surgeons of Alberta, Alberta Health, Alberta Health Advocates and a patient/family panel.
CARNA also worked closely with HQCA on their Just Culture project, which looks for ways to shift the emphasis on errors or mistakes from a focus on blame to a focus on learning how to prevent mistakes in the future. CARNA will be working closely with HQCA and other health-care professionals to develop messages, tools, resources and strategies that will support the project’s goals.