COVID-19

As Nova Scotia’s nursing regulator, our mandate is to protect the public by supporting nurses to provide safe, competent, ethical and compassionate nursing care. We recognize the impact of the coronavirus (COVID-19) outbreak and we are taking steps to maintain the health and safety of our staff, guests and the public. 

We look forward to welcoming guests back to the NSCN office and have been preparing our space for your arrival. Our office will be open by appointment only starting July 6th, 2020. For more information about what you can expect click on the link below. 

Scroll down this page or click on the link below for information and tools to support you during the pandemic:

Currently, the number of COVID-19 cases in Nova Scotia indicate that there is no longer an urgent need to issue emergency conditional licences to support health system needs. As a result, we have temporarily closed the rapid re-licensing process for COVID-19 until such a time when it may be needed again. Click here for more information

About COVID-19

For the most current information on the virus, visit:

The Department of Health and Wellness is the lead on informing the public. Visit their website for all health-related questions.

Information for Nurses Currently Practising in Nova Scotia

Nurses who are currently registered and licensed in Nova Scotia do not need to apply for new or additional licensure in order to assist during the COVID-19 outbreak.

Nurses are accountable to continue to meet their standards of practice during the COVID-19 pandemic. Below is information to support nurses in their practice during this unprecedented time, including COVID-19 specific practice scenarios and important notices.

The Nova Scotia College of Nursing (NSCN), in collaboration with Public Health, has developed additional practice guidelines for self-employed nurses whose practice includes direct contact with clients. The guidelines support the delivery of safe and competent nursing services while minimizing the risk for the transmission of COVID-19 in the self-employed practice context.

These guidelines have been approved for use by the Nova Scotia’s Chief Medical Officer of Health and are based on core Public Health principles and current best evidence. 

The additional guidelines do not replace the current Self-Employment Practice Guidelines. They are intended to be used together.  

All health care providers in private practice, including self-employed nurses, must be compliant with the recommendations before returning to or continuing their self-employed practice, regardless of the nature of the services provided or number of clients on your roster.

Nurses whose self-employed practice does not include direct contact with clients need only refer to the Self-Employment Practice Guidelines. Nurses employed by organizations should refer to any additional COVID-19 guidance from their employer.

Click HERE to review the guidelines.

For more information, check out our Q&A on the Additional Guidelines for Self-Employed Nurses During COVID-19

Reach out to an NSCN Practice Consultant at practice@nscn.ca if you have questions.


As part of Nova Scotia’s re-opening, businesses and organizations have been asked to develop Workplace COVID-19 Prevention Plans to prevent the spread of COVID-19. These plans should show how the business or organization will comply with the Health Protection Act Order and public health directives, such as social distancing and gathering limits, and ensure the safety of employees and customers. For more information on Nova Scotia’s reopening, and the Workplace COVID-19 Prevention Plan requirements, visit the Nova Scotia Government website here.

During the Pandemic, LPNs are only authorized to independently enact the collection of COVID-19 swabs using a care directive or other authorizing mechanism such as an order from the Zone Medical Officer, approved protocol, or recognized organizational policy. Enacting other interventions within the care directive/protocol such as determining client deposition, require the LPN to collaborate to determine appropriateness. Please contact a Practice Consultant at practice@nscn.ca if you have questions about LPNs and the collection of COVID-19 swabs.

NSCN has developed Social Media Guidelines to help nurses understand their accountabilities and identify strategies to minimize risk so they continue to meet their standards of practice when using social media.

Individuals, including nurses are using social media during the COVID-19 pandemic to stay connected and informed while the physical distancing requirements are in place. The escalated use, and reliance on social media for information and staying connected in these uncertain times, increases the potential for its misuse.

The following information was developed specifically for during the pandemic. It does not replace the social media guidelines, but rather complements them, and both should be used in conjunction with your standards of practice.

Professional Presence 
It is important to remember that social media is a public forum. This includes private groups, direct messages and messages to and/or from ‘personal’ accounts. When nurses make the decision to use social media and enter a public space, they must always uphold their standards of practice and maintain a professional presence.  

NSCN does not want to censor nurses
We support the appropriate use of social media. However, we want nurses to consider what, when and how they post to ensure they are not contributing to the abundance of misinformation or adding to the pandemic-related anxiety and panic. Additionally, nurses must be sure their posts are not giving the impression that they cannot or will not provide unbiased care. Above all, nurses must not post anything that could negatively affect the public’s confidence in the nursing profession.

What is considered a professional post?

  • Posts that use respectful language demonstrating a positive image and is in keeping with the standards of practice and code of ethics
  • Information from reputable, qualified and verifiable sources
  • Evidenced-based views of subject matter experts and legitimately qualified sources

What is not appropriate to share during the pandemic? 

  • Confidential information (e.g., information about a client, colleague, your workplace or others).
  • Inaccurate or harmful claims about COVID-19 (e.g., unproven health-related advice about the virus, treatments, and therapies, health care information based on personal opinion rather than scientific evidence).
  • Information that gives the impression that you are unable to provide unbiased care
  • Unprofessional, harmful or threatening comments that may incite anxiety, panic, fear or distrust in the nursing profession and/or health system.

How you say it matters
Sometimes it is not what you say but how you say it. A perfectly good message can go from professional to unprofessional simply by using:

  • Profanity and general expletives
  • Offensive comments that hurt others
  • Insulting language towards individuals, groups, communities and/or organizations
  • Dramatization that mimics anger (e.g. all caps, multiple exclamation marks, negative symbols or emojis)

Advocacy
Advocacy is of importance during the pandemic. Every nurse is expected to be an advocate for their clients as outlined in their standards of practice. Nurses are expected to advocate using proper channels, established processes and mechanisms. The use of social media may, or may not be appropriate for client advocacy. Nurses should consider all options and all outcomes if they decide to use social media as an advocacy platform.

Before you post information related to the pandemic, ask yourself: 

  • Is this the right vehicle to share my thoughts? 
  • Is this information credible and does it benefit the public?
  • Does this reflect my professionalism as a trusted nurse?
  • Will this post add to the anxiety or panic about the pandemic?
  • Does the post reflect facts and/or evidence from qualified sources, or does it reflect my opinion?
  • Will this post reflect poorly on my profession, colleagues, employer, union or others?
  • Would it be acceptable for me to say this face to face or in a room full of clients, colleagues or my family? 
  • Will this post violate my standards of practice, or a condition of my employment contract, or union contract?

What to do if you see an inappropriate post 
Every nurse has a duty to address conduct that does not meet the standards of practice and code of ethics. If you see an inappropriate post from a nurse that you know, reach out to them and talk about your concerns. If you do not know the nurse or if you feel that you cannot talk to the nurse directly, contact a Practice Consultant at practice@nscn.ca and provide screenshot(s) of the post in question. 

What to expect from NSCN
NSCN has a process in place to address these issues. If you see an inappropriate post from a nurse, our first action is to ask that you address it with the nurse, or their employer or union directly if you feel comfortable doing so. If not, please share your concerns with us by email at practice@nscn.ca

We will carefully review the information that you provide and take action as required. Action may include a letter of guidance asking the nurse to remove the content or, in the most serious matters, a letter of complaint that may result in professional misconduct.

Check First. Share After.

Visit Canada's Centre for Digital and Media Literacy website for more information on stopping the spread of misinformation. 

Public health officials are working closely with partners here in Nova Scotia and colleagues across the country to respond to the COVID-19 pandemic. 

There is an urgent need to increase the number of health care providers and support staff in Nova Scotia to assist the doctors, nurses, and other health team members to continue to deliver care to residents of Nova Scotia during this pandemic in our nursing homes, home care agencies and hospitals. 

On behalf of the province, the Nova Scotia Health Authority (NSHA) has set up the following open call postings to accept applications from people who are not currently employed with the NSHA but who would be willing to work as a Casual Relief worker - to be deployed as needed at the NSHA, long term care or other publicly funded health care entities.

Open Call for Nursing (Req ID 61275) - 
https://jobs.nshealth.ca/nsha/job/Halifax-Open-Call-for-LPNs%2C-RNs%2C-and-Clerks-Novel-Coronavirus-%28COVID-19%29-Assessment-Centers-Nova-B3H-2Y9/539259717/?locale=en_US

Open Call for Healthcare (Req ID 62884) - 
https://jobs.nshealth.ca/nsha/job/Flexible-within-the-Province-Open-Call-for-Allied-Health-Care-Workers-Nova-B3H-2Y9/539432117/?locale=en_US

Open Call for Administrative Professionals (Req ID 62741) -
https://jobs.nshealth.ca/nsha/job/Flexible-within-the-Province-Open-Call-for-Administrative-Professionals-Nova-B3H-2Y9/539427217/?locale=en_US

Open Call for Support (Req ID) -
https://jobs.nshealth.ca/nsha/job/Halifax-Open-Call-for-SupportFacility-Workers-Housekeeping%2C-Food-Service%2C-Power-Engineer-&-Maintenance-Nova-B3H-2Y9/539426817/?locale=en_US

Open Call for Emergency Support Aides
https://jobs.nshealth.ca/nsha/job/Flexible-within-the-Province-Open-Call-for-Emergency-Support-Aides-Nova-B3H-2Y9/539671617/

This is a pooling posting. To apply: 

  • provide a resume (including basic information, contact details, education, and work and volunteer experience), and
  • fill out the online application, specify your preferences for location and answer other employment related questions

NSHA recruiters will get back to you as needed. 

In addition, please reach out to the following individuals if you wish to help support 811 Telehealth

Wendy Boutilier at Wendy.Boutilier@emci.ca
Michelle Palmeter at Michelle.Palmeter@emci.ca 

If you have a question about finding a role during the outbreak, please email one of the above organizations directly. 

The COVID-19 Pandemic is causing unusual, challenging and rapidly evolving circumstances in our health care system. NSCN recognizes that nurses may need to depart from established procedures and typical practices during these extraordinary times. You must make decisions to do so based on an assessment of the client and situation, and use your best judgement to ensure you continue to provide safe, competent, ethical and compassionate nursing services. 

You are always required to meet your designation’s standards of practice (LPN, RN or NP) regardless of how your procedures and practices may evolve in these unprecedented times. Your standards are broad and flexible which enable you to meet them consistently even though how you meet them may change over the course of the current pandemic.  

If you depart from established procedures and typical practices, you must consider: 

  • What other actions should I take to maintain the safety of the client, others and myself?
  • What supports and resources do I (and maybe others) need?
  • How will I continue to meet my standards of practice?
  • How do I document this?
  • How do I communicate this to others, and whom should I notify?

You must also consider the following:

  • Departures from established procedures and typical practices are anticipated in a time of crisis however, they do not establish precedent practice post-pandemic. 
  • You are not expected to practice beyond the professional scope of practice of your nursing designation.
  • Complaints during, and/or because of the pandemic, will be addressed with full consideration of the circumstances in which nurses are practising.

Q. What is my accountability and what should I consider if I am supervising or providing guidance and direction to assistive care providers during the COVID-19 pandemic?

A. As needs in the health system increase, employers may rely on assistive care providers  to help care for clients. Individuals hired into these roles may have varying backgrounds in health care and employers may have current employees in similar or different roles temporarily work in this capacity. They may also have their existing assistive personnel perform new or additional tasks.   

As a nurse, use your professional nursing judgment to make decisions in the best interest of clients when supervising or providing guidance and direction to assistive care providers during the pandemic. You are accountable for the client’s care plan. This means that you are responsible to set the direction, assign the care or tasks and follow up to make sure they are completed. Consider the needs of the client, the capacity of the care provider, the context, circumstances and available resources as you do this work. 

Consider the following if you are working with assistive care providers with varying health care background: 

  • Determine how much direction and support is needed.  Ask the care provider questions about their experience in this role to help you assess their capacity. Direction and support may vary between care providers and over time. 
  • Assign care or tasks based on the needs of the client and the care provider’s capacity.
  • Provide instruction and guidance about the specific care or tasks that the care provider will be required to perform as needed.
  • Set clear parameters for the care provider’s care or tasks (e.g., ‘do not remove any dressings or bandages when you are bathing a client’) and expectations, especially around communication (e.g., ‘please stop what you are doing and inform me or another nurse immediately if  the client feels warm or feverish to you’).  
  • Depending on the circumstances and situation of the pandemic, you may be required to document the care delivered by the care provider. If this is the case, use the provider’s first initial and last name in your note (e.g., ‘Personal care provided by M. Smith’). 
  • Follow your employer’s policies. 

Note: Assistive care providers is a generic term to include several care providers including long term care aides. Some assistive care providers may be hired into roles for the duration of the pandemic and others may be existing individual in existing roles who will be performing different tasks under the guidance and direction of the nurse (such as a long-term care aide). In this practice scenario, assistive care providers do not include Continuing Care Assistants (CCAs) or individuals working in roles that require a CCA designation (e.g., Care Team Assistant). For information about working with CCAs, review the Assignment and Delegation: Guidelines for Nurses.

Q. Due to the COVID-19 pandemic I will be providing virtual care to clients whenever possible. What should I consider when doing this?

A. The COVID-19 pandemic is impacting the health care system and as it continues, there will be increased pressure on those working in direct care to provide care in unusual situations and innovative ways. NSCN recognizes these are extraordinary times and expects all nurses to practice within the scope of their practice and expertise and act in the best interest of clients. The adoption of virtual or telemedicine care will be required in the days and weeks ahead. NSCN supports nurses providing care to clients through technology. 

NSCN developed Telenursing Guidelines in 2019 to support nurses since telenursing, also known as virtual care, changes how nurses deliver professional nursing services. These guidelines are applicable during the COVID-19 pandemic.  

While telenursing may change how you conduct your nursing practice, it does not change the requirement to meet your standards of practice or work within your scope of practice. Effective communication is essential in establishing all nurse-client relationships, but this is particularly crucial when using technology. In addition, whether the nurse-client relationship is developed in-person or through technology, you are required to develop, maintain and end therapeutic relationships  in accordance with your standards of practice.

If you are providing nursing services using technology, you must: 

  • Use the nursing process to assess, plan, implement, evaluate and document nursing care.  
  • Collaborate with members of the nursing and care team as needed. This may be required more frequently. 
  • Make care decisions based on the data available to you at the time and in the context in which it is provided.
  • Provide services that are consistent with your scope of nursing practice, your individual competencies and your employer’s expectations.
  • Confirm with your employer their expectations of your role in this care model and follow employer processes. In particular, you should be aware of processes and/or risk mitigation plans related to:
    • Privacy and confidentiality 
    • Documentation 
    • Security and approved type of technology or other required equipment
    • IT support
    • Informed consent  

If you are employed in Nova Scotia and providing nursing services using technology to clients outside of Nova Scotia, you: 

  • Must hold a practising licence with NSCN
  • Are accountable to know what policies or legislation may apply to you in the jurisdiction where your clients reside. Different polices and legislation may affect telenursing in other jurisdictions. You may also be required to be licensed in that jurisdiction. 
  • Must confirm that a prescriber residing in another province is licensed and authorized to prescribe before enacting any order. 
     

Q. I have been asked to provide nursing care to a family member or member of the community during the pandemic, can I do this?

A. A dual role is when a nurse is asked to provide care or perform an intervention for a family member or friend. Nurses often get these requests when individuals are having a difficult time accessing the health care system. We expect these requests will increase as the COVID-19 pandemic continues.  

Under usual circumstances, NSCN would recommend that a nurse who is asked to care for or perform an intervention for an individual outside the formalized nurse-client relationship should refer them back to their regular health care provider. However, we recognize that we are no longer in usual circumstances.

Although not exhaustive, please consider the following as you decide whether you will provide care or perform the intervention for the individual:

  • Do you have the knowledge, skill and judgment (competence) to assess the individual and safely provide care or perform the intervention?
  • How are you determining if a provider has prescribed the care or intervention? 
  • What is the risk to the individual if you provide care? What is the risk if you do not? What strategies can you put in place to minimize the risks?
  • How will you protect the individual, others and yourself if you provide care (e.g. using PPE)?  
  • How will you manage unexpected outcomes?
  • Do you have access to all the necessary supplies?
  • How will you set clear boundaries so the individual understands you are providing care or performing an intervention as a professional nurse?
  • How will you manage future requests when the COVID-19 crisis is resolved?
  • Should you reach out to your liability provider: Canadian Nurses Protective Society (RN/NP) or Lloyd Sadd (LPN) for their advice?

We recognize the highly unusual circumstances the COVID-19 pandemic has created. We expect nurses to use their best judgment when making decisions. It is important to note that deviations from usual practices because of the pandemic do not set a precedent for practice post-pandemic.    

Q.We are preparing to accept clients with COVID-19. I am concerned about becoming infected or passing the virus onto my family members. What is my duty to provide care?

A. This is a tough question as you are caught between your professional obligation to provide care and your obligation not to put your family at risk.

You are expected to make your decision based on an analysis of all the data at hand. This includes understanding the needs of the client, your employer policies, being aware of what protective gear is available to you, how to access and use it and the risk to the client should you refuse to provide care in relation to the risk to you should you decide to provide it.

Nurses have a duty to provide care. It is part of your professional obligation when you accept employment as a nurse or hold yourself out to be a nurse. The duty applies in every day scenarios and in natural or human made disasters, including a COVID-19 outbreak. 

Being a nurse means there is always a certain amount of risk associated with the performance of your duties. There is also an expectation that you make every effort to minimize your personal risk by using the necessary and recommended safety precautions. You are not expected to provide care without taking action to protect yourself.

When thinking about your duty to provide care, consider the following:

  • You are accountable to make decisions that are in the best interest of clients and to protect them and yourself from harm.
  • You are accountable and responsible for your actions, including inactions, at all times.
  • You are not expected to expose yourself unnecessarily to risks.
  • You are expected to protect your client and you by using appropriate resources and equipment. 
  • Discuss your concerns with your manager. Find out what information and supports are available for staff. 
  • Contact your employer’s infection control service to discuss the most appropriate measures to manage any risk. Make sure you know how to use and where to access protective equipment.
  • Review your employer’s infection control policies and procedures.
  • Consider resource availability. 
    • What is the plan to access more resources when needed?
    • What is the plan if resources become scarce? 
    • How do you protect yourself and clients when resources are scarce?

Q. A high percentage of our clients have tested positive for COVID-19. We are running low on isolation spaces and personal protective equipment (PPE). Nurses on the unit are concerned and are considering refusing to work on the unit. Can I refuse or withdraw from care? 
A. Nurses are accountable for their actions and inactions at all times. They make decisions based on an analysis of all the data at hand, the needs of the client, employer policy, their duty to provide care and their obligation to protect themselves and their families.

An unreasonable burden may exist in rare situations, such as public health emergencies, where the nurse is unable to provide safe care and meet professional standards of practice because of unreasonable expectations, lack of resources or ongoing threats to personal safety.

Refusing to provide care or withdrawing from care may be appropriate in very specific circumstances. Before withdrawing from care, you must fully consider the risk and impact to clients. Additionally, you must first attempt several other strategies to improve the safety of the situation, such as working with your employer to obtain the appropriate PPE and isolation spaces. 

Consider the following when contemplating withdrawing from care: 

  • What is the risk to the client(s) if I withdraw from care?
  • Is the care I am providing directly preventing harm to the client(s)?
  • Does the benefit of the care I am providing outweigh my risk of harm?  
  • What can I do to minimize my risk?
  • What can I do to minimize the risk to the client(s) if I withdraw from care? 

If you do decide to withdraw from care you must:

  • Negotiate a mutually acceptable withdrawal from care plan with your employer (or the client if you are self-employed). 
  • Provide care until a replacement is found.
  • Provide your employer a reasonable amount of time to find a suitable replacement or make alternative arrangements. What is reasonable will vary from situation to situation; however, you are obligated to work with your employer. 
  • Ensure care is transferred to a care provider willing and professionally able to provide safe care. 

You are accountable for your actions and inactions at all times. While you have the right to refuse to work in situations where you cannot manage or reasonably mitigate the risk, it is equally important to note that you are accountable to take every reasonable action to prevent withdrawal from care and abandoning clients.

Q. I am the primary caregiver for dependent family members. How do I manage my obligations both to my employer and to my family during the COVID-19 outbreak?

A. Nurses are accountable for their actions and inactions at all times. They make decisions based on an analysis of all the data at hand, the needs of the client, employer policy, their duty to provide care and their obligation to protect themselves and their families.

This is tough question and there is no clear answer or one best solution to this ethical dilemma. The best action is to be prepared. You should:

  • Discuss your concerns with your employer. Work with them to develop a plan to manage your personal and professional obligations.
  • When developing the plan you should: 
    • refer to your code of ethics and standards of practice to support your reflections and actions
    • use the most current information related to the outbreak to help you to make evidence informed decisions
    • identify other resources available to you, such as EAP, OH&S and extended family 
  • Review and discuss your plan with your family
  • Review your plan regularly and often, especially as the outbreak situation unfolds and evolves.

Being prepared with a plan will help you to be clear about your decisions in this ethical dilemma.

Q. It is likely I will be re-deployed to an unfamiliar practice setting during the COVID-19 outbreak. What should I consider when I get to the new unit?

A. Temporary re-deployment is a legitimate employer practice to ensure they can meet the needs of the clients they serve every day.
 
You and your employer have an accountability to ensure clients are receiving safe and competent care. It is also very important to note that a public health emergency is not usual circumstance. While in this unusual circumstance nurses and employers are accountable to work together to make the best decisions based on the information at hand, fully recognizing that the evolving situation may result in a different decision at a different time.

Nurses Accountabilities

There are elements of nursing knowledge and entry-level competencies that transcend to all client groups and practice. While you may not be able to carry a full client assignment in the unfamiliar setting, there are many things you can do competently within your individual scope of practice to support the care area.

Ask for a brief orientation to the new practice setting, an identified staff member, ‘a buddy’, to answer questions and negotiate your assignment based on the things you can do, versus the things you cannot.  Recognize that in some cases your assignment may be to assist regular staff as they care for clients rather than caring for clients independently. This may be the case for an acute care nurse re-deployed to an ICU, for example.

Employer Obligations

Your employer has an obligation to:

  • Provide staffing and resources and to ensure that nurses are supported to work within their role and scope of practice. 
  • Arrange for support for nurses re-deployed to unfamiliar practice settings.
  • Assist nurses in understanding their expectations when providing care in an unfamiliar practice setting.
  • Consider the competencies and qualifications of nurses or other care providers when making client assignments.

Information for Nurse Practitioner Practising in Nova Scotia

In addition to the information for all practising nurses noted above, the following information is specific to nurse practitioner practice.

Upon request of the Chief Medical Officer and pursuant to the advice of Infectious Diseases experts, effective March 20, 2020:

Only physicians recognized as specialists in infectious disease may prescribe or initiate treatment with lopinavir/ritonavir (Kaletra) and/or hydroxychloroquine. Clients already taking these medications may be maintained on their regime by their regularly prescribing physician.

This message supplements the approach adopted by the Nova Scotia College of Physician and Surgeons and the Nova Scotia College of Pharmacists who has instructed its pharmacists not to dispense these medications

Government of Canada
Chloroquine and hydroxychloroquine can have serious side effects. These drugs should be used only under the supervision of a physician. For more information, visit the Government of Canada website here

British Medical Journal (BMJ)

To read the British Medical Journal article on the lack of efficacy of hydroxychloroquine in COVID-19, visit their website here

Last week, Health Canada’s Office of Controlled Substances issued a short-term exemption from the Controlled Drugs and Substances Act in the public interest, made necessary by the COVID-19 pandemic.

In order to take effect in Nova Scotia, the directive of Health Canada required coordinated action from government, the Nova Scotia Prescription Monitoring Program (NSPMP) and the regulatory colleges. The necessary steps have been taken. 

Effective immediately:

  • Pharmacists may extend and renew prescriptions of controlled drugs and substances
  • Pharmacists may transfer prescriptions of controlled drugs and substances to other pharmacists
  • Pharmacists may accept and practitioners may verbally provide prescriptions for controlled drugs and substances
  • Pharmacy employees may deliver controlled substances to patients at their homes or an alternate location

These changes will improve access to needed medications during this state of emergency while reducing unnecessary in-person contact with health professionals.

The specific changes implemented by the NSPMP are as follows:

1. Nurse Practitioner Prescribing

As per the March 19, 2020, Health Canada exemption, prescribers are permitted to issue verbal orders for monitored drugs. Nurse Practitioners may e-prescribe within the DIS, fax or call in prescriptions of controlled substances to pharmacists.

To assist with verbal prescribing, under NSPMP, prescribers will not be required to complete or maintain a prescription form, however, will be required to relay appropriate content required for a prescription and maintain a record consistent with NSCN requirements.

2. Pharmacists Authority to Prescribe Controlled Substances Expanded

As per the March 19, 2020, Health Canada exemption, pharmacists may extend or renew a monitored drug prescription without the use of an NSPMP Prescription Form/duplicate pad, if it meets the requirements of a prescription and the conditions set out under Health Canada’s exemption s56(1) dated March 19, 2020.

As per the March 19, 2020, Health Canada exemption, pharmacists may dispense a monitored drug prescription extended or renewed by a Pharmacist, not written on an NSPMP Prescription Form/duplicate pad, if it meets the requirements of a prescription and the conditions set out under Health Canada’s exemption s56(1) dated March 19, 2020.

Pharmacists are requested to refer to the Nova Scotia College of Pharmacists for all requirements relating to prescribing and dispensing.

Please also refer to Health Canada’s FAQs regarding this class exemption.

Warning on the use of unproven treatments and medications for COVID-19

As the COVID-19 pandemic continues, the world is hopeful a cure or treatment can be found quickly. At this time, a proven treatment for COVID-19 does not exist. A number of therapies have been suggested or tried on an anecdotal basis and in small non-randomized trials, some of which have been in the scientific literature. There is no evidence that anti-malarial, antibiotic and HIV and other anti-viral medications are effective in prophylaxis or treatment of COVID-19.

It is important to understand that with all therapies there are potential harms to the patient, some of them very serious. Diversion of treatments not known to be effective risks depleting access to therapies known to be helpful or essential to patients with other diseases. As well, treating patients outside of well-designed randomized clinical trials risks our understanding of what is truly a beneficial treatment or not. For these reasons, the use of unproven therapies for COVID-19 is not recommended outside clinical trials.

Health professionals all have a responsibility to their patients and to their profession to focus only on evidence-based care and not yield to patient or social pressure around unproven and potentially dangerous uses of existing medications.

Information around COVID-19 is rapidly evolving and new recommendations and evidence will become available and will be rapidly shared. Given the critical role health professionals play in ensuring the appropriate distribution of medications, all must assist in ensuring that care decisions are based solely on the most current evidence available. This will ensure the best possible care for Canadians through this pandemic, both those who have COVID-19 and those who do not. 

Physicians and nurse practitioners should not prescribe these therapies for COVID-19 outside the context of a clinical trial, and pharmacists should not dispense them if they do.

Q. I may be re-deployed to an unfamiliar practice setting during the COVID-19 outbreak. What should I consider?

A. COVID-19 is affecting the health care system. As the pandemic continues, there will be increased pressure on those working in direct care to provide care in unusual situations and innovative ways. NSCN expects all nurses, including nurse practitioners (NPs), to practice within their scope of practice and expertise, use their professional judgment and act in the best interest of their clients during these extraordinary times. 

NPs have entry-level competencies that reflect the knowledge, skills, and judgment required to provide safe, competent, ethical and compassionate care. It is also important to consider that NPs are registered nurses who have nursing knowledge and entry-level competencies that apply to all client groups and practice settings. 

You may be deployed to a different practice setting during the pandemic. While specific roles and responsibilities may vary by context, your NP entry-level competencies, in addition to your RN entry-level competencies can be applied across practice settings. You are also always required to meet your standards of practice. The Nurse Practitioner Standards of Practice are broad and flexible which enables you to meet them while deployed to a different practice setting. 

If you are re-deployed to a different setting within your same client population:  

  • Ask for a brief orientation to the new practice setting 
  • Request that there be an identified staff member to answer questions 
  • Negotiate your assignment based on the things you can do versus the things you cannot do.  Recognize that in some cases, your assignment may be to assist regular staff as they care for clients rather than caring for clients independently. 

Employer Obligations

Your employer has an obligation to:

  • Provide staffing and resources and to ensure that nurses are supported to work within their role and scope of practice. 
  • Arrange for support for nurses re-deployed to unfamiliar practice settings.
  • Assist nurses in understanding their expectations when providing care in an unfamiliar practice setting.
  • Consider the competencies and qualifications of nurses or other care providers when making client assignments.

Q. What are my accountabilities when providing virtual care to unfamiliar clients during the COVID-19 Pandemic?

A. COVID-19 is impacting the health care system. As the pandemic continues, there will be increased pressure on those working in frontlines to provide care in unusual situations and innovative ways. NSCN expects all nurses, including nurse practitioners (NPs), to practice within the scope of their practice and expertise and act in the best interest of their clients recognizing that these are extraordinary times. 

The adoption of virtual or telemedicine care will be required in the days and weeks ahead. NSCN supports NPs providing care to clients, whether clients are known or new to the NP, through technology. 

NSCN has developed Telenursing Guidelines because telenursing or virtual care changes how professional nursing services are delivered. While it may change how you conduct your nursing practice, it does not change the requirement to meet your standards. 

The Nurse Practitioner Standards of Practice are broad and flexible which enables you to meet them even though how you meet them may change by the use of technology.

While not exhaustive, please consider the following when providing service virtually or through technology:

  • Develop the client’s plan based on your virtual assessment and evaluation of their history and current health care needs. Ask the client enough questions to ensure that you have relevant data to guide your decisions.
  • Collaborate with your physician colleagues and other members of the team as needed. This may be required more frequently than usual. Collaboration is especially important when:
    • providing care to new clients to help relieve pressures in the health system (e.g. clients referred from 811, with chronic health needs or those without a primary care provider in the community)
    • usual data is not available such as recent lab or diagnostic test results because clients cannot access the health system
    • needs of the client are beyond your individual scope of practice, area of expertise or competence. 
  • Confirm your employer expectations of your role in this care model. Follow employer processes. 

All nurses are accountable for their own actions at all times. They are only accountable for the things they know or reasonably should have known. They are expected to make care decisions based on the data available to them at the time, and in the context in which it is provided.

Information for Employers in Nova Scotia

Nurses are accountable to continue to meet their standards of practice during the COVID-19 pandemic. Below is information to support employers to understand their obligations to protect and support employees and nurse accountabilities during this unprecedented time, including COVID-19 specific practice scenarios and important notices.

Q. We are preparing to accept clients with COVID-19. The nursing staff are concerned about becoming infected or passing the virus onto their family members. What is my duty as the manager?

A. Employers are obligated to protect and support employees by ensuring staff have adequate access to the appropriate protective equipment and supplies. This includes providing employees with education and resource materials around proper use of equipment.

Employers are obligated to:

  • Make decisions in the best interests of clients and staff.
  • Provide staffing and personnel with the necessary competencies to provide competent care to clients.
  • Provide appropriate resources, equipment, clearly defined policies and procedures and education about the use of equipment.
  • Discuss staff concerns to address information and support being provided.  
  • Ensure policies and procedures regarding care of potentially infectious clients and infection control are current and reflective of best practice.

As the employer you have an accountability to ensure clients are receiving safe and competent care. It is also very important to note that a public health emergency is not usual circumstance. While in this unusual circumstance you are accountable to work with your staff to make the best decisions based on the information at hand, fully recognizing that the evolving situation may result in a different decision at a different time.

Q. A high percentage of our clients have tested positive for COVID-19. We are running low on isolation spaces and personal protective equipment (PPE). Nurses on the unit are concerned and are considering refusing to work on the unit. Can they refuse or withdraw from care? 

A. Nurses are not expected to unnecessarily expose themselves to risks resulting from a lack of appropriate resources, equipment or clearly defined policies and procedures. They may refuse to provide or withdraw from care in very specific circumstances. They should fully consider the impact to clients and attempt several other strategies to improve the safety of the situation, such as working with their employer to obtain the appropriate PPE and isolation spaces.
 
To withdraw from care a nurse must:

  • Negotiate a mutually acceptable withdrawal from care plan with their employer (or the client if you are self-employed). 
  • Provide care until a suitable replacement is found.
  • Provide their employers with a reasonable amount of time to find a suitable replacement or make alternative arrangements. What is reasonable will vary from situation to situation.
  • Ensure care is transferred to a care provider willing and professionally able to provide safe care. 

Employers are obligated to protect and support employees by ensuring staff have access to the appropriate protective equipment and supplies. These recommendations may assist you in situations where a nurse is considering withdrawing from care:

  • Be open about the realities of the care situations at hand.
  • Engage the nurse in an open and honest conversation about their concerns.
  • Work together to create solutions.
  • Keep the dialogue focused on the needs of the client.
  • Recognize that in unusual circumstances, such as a public health crisis, nurses are expected to prioritize care to the most critical activities, i.e., assessments, treatments, medications, and that some non-critical routine care may be deferred until the situation improves.

Nurses are accountable for their actions and inactions at all times. While they have the right to refuse to work in situations where risk cannot be managed or reasonably mitigated, it is important to note that you both are accountable to take every reasonable action to prevent withdrawal from care and abandoning clients.

Q. The nurses are concerned about balancing their work and family obligations, especially if a dependent family member gets ill. What is the nurse’s duty to provide care to clients in these circumstances? 

A. This is a tough question and there is no clear answer or one best solution to this ethical dilemma. The best action is for everyone to be prepared. Consider the following: 

  • Discuss your staff’s concerns and help them create a plan to manage possible situations.
  • Ensure they have access to the most current information related to the outbreak to help them make evidence informed decisions.
  • Help them use their code of ethics and standards of practice to guide their planning and actions.
  • Help them identify other resources such as EAP, OH&S and extended family that may be able to provide support.
  • Identify what supports may be offered by the employer.
  • Encourage ongoing dialogue and frequent evaluation of their plans.

Q. We likely will be re-deploying nurses if the outbreak intensifies and staff become impacted. In addition, in the past, nurses have ‘come out of retirement’ to help during a crisis. What things should I consider if nurses are redeployed to my area and/or a nurse who recently returned to practice is sent to my area?

A. All nurses have a set of basic competencies that transcend all care areas. Re-deployment is an opportunity to capture these competencies. However, you must recognize that a re-deployed nurse may not have the unique or specific competencies to provide advanced care for some of your clients. Sometimes, it may be necessary to assign a re-deployed nurse to assist your regular staff to care for clients. This may be the case if an acute care nurse is deployed to an ICU setting. You have a few obligations when nurses are deployed to your practice setting for the first time. These include:

  • Providing a brief orientation to the unit or care area.
  • Identifying a ‘buddy’ or a staff member to be a resource to answer questions and provide support.
  • Making their care assignment based on what they can do within their individual scope of practice.

NSCN has a process to help nurses who have retired from the profession to temporarily return to practice during a public health emergency. Only nurses otherwise eligible for licensure, those who have practiced within the last 5 years and who retired with a non-restricted license, qualify for this temporary license. 

Given the nurse has been away from practice, engage them in a conversation about their capacity to determine the level of support they require. They may need more support than a re-deployed nurse because they have been away from practice. Assign and arrange for supports as needed and make a plan for frequent check-ins with the nurse and their ‘buddy’. Reach out to the College at practice@nscn.ca if you have questions or there are any concerns about the nurse’s practice.

Q. During previous outbreaks, the legacy College's had implemented a process to register and license former nurses who have retired from the profession. Will NSCN have a similar process? What other things should I consider?

A. Yes. NSCN will have a process for the quick registration of former or retired nurses. TO be eligible, individuals must have had active practice in the last 5 years, be otherwise eligible for licensure and have had no practice restrictions or conditions on their license when they retired. 

Consider the following when working with a nurse re-entering practice for the purposes of assisting with the COVID-19 outbreak:

  • They may need additional employer support as they re-enter practice. The nature, type and intensity of support will vary based on how long they have been out of practice and where they last practiced. 
  • Once licensed, their names will be visible on the Search for a Nurse function on our website.
  • They will receive a time-limited conditional license for 4 months. The license can be extended if the COVID-19 outbreak persists.
  • They may have a limited individual scope of practice due to their time away from practice. Effort should be made to prevent excessive "floating" across multiple units until they have been deemed competent, by the employer, to do so.

Individuals interested in returning to practice to assist during the COVID-19 outbreak should contact the College at registration@nscn.ca.

Information for Faculty & Nursing Students

On Tuesday March 17, the Nova Scotia Health Authority (NSHA) suspended student learner placements due to the COVID-19 outbreak. As the situation rapidly evolves, NSCN is in continuous contact with all LPN, RN, NP and re-entry program faculty to discuss contingency plans for their curriculum.

The focus continues to be on exploring solutions that will enable students to graduate as soon as possible. Alternate learning strategies are being developed to allow students to meet the program outcomes and achieve the entry-level competencies for safe practitioners.

This unprecedented time requires agility, creativity and untapped options for our faculty and students. Both NSCN and faculty are committed and confident that together we will arrive at a plan in the best interest and safety for the public, students and faculty.

Considerations for nursing program contingency plans include:

  • All Nova Scotia LPN, RN, NP and re-entry programs approved by NSCN can and should use alternate and feasible learning approaches as deemed appropriate by faculty in response to the COVID -19 outbreak to minimize the effect on student graduation times.
  • The expectation is that at the time of graduation, students will have met the entry-level competencies for their respective designation and will have been evaluated by faculty to ensure they have the knowledge, skills and judgement required to practise safely and ethically.
  • Nursing programs are required to document all changes made to the curriculum theory and clinical during the COVID-19 outbreak. Faculty will continue to provide reports of these changes to NSCN and also document in their June annual reports to NSCN. Any program modifications for the purpose of the COVID-19 outbreak are not considered permanent.
  • The programs will continue to submit the approved graduation list of their students to NSCN. NSCN will take necessary and additional measures to ensure these graduates are licensed to practise nursing.

NSCN recognizes that this is a challenging time for faculty, staff and students and we are committed to collaborating on next steps as this unprecedented situation persists.

Canadian Practical Nurse Registration Exam (CPNRE)

The Canadian Practical Nurse Registration Exam (CPNRE) will now be offered through secure Online Proctoring for Nova Scotia practical nurse exam candidates. Information about next steps will be posted here as information becomes available. Please contact us at registration@nscn.ca if you have any questions.

Due to current test centre closures related to the COVID-19 pandemic, NSCN in partnership with Yardstick Assessment Strategies is pleased to announce that the CPNRE will be administered in June 2020 using secure online proctoring in our jurisdiction. 

Moving the CPNRE to an online proctoring environment will help ensure that practical nursing candidates have access to their licensing exam despite test centre closures and social distancing guidelines. Given the rapid evolution on online proctoring technologies and methodologies, we are satisfied that this administration modality presents a secure and reliable administration option for the CPNRE.

We have worked in close partnership with Yardstick for several decades to develop and deliver the CPNRE and look forward to implementing this solution during these challenging times.

About Yardstick Strategies: Yardstick ensures that professionals are qualified and ready to serve to the public. Their team uses a combination of technology, psychometric best practice, and evidence-based research to assess the knowledge and abilities of millions of candidates around the world.

NCLEX-RN Exam

As previously communicated, due to the COVID-19 pandemic, the NCLEX-RN testing will resume on a limited basis at Pearson VUE centers. Please periodically log into your Pearson VUE account to check availability in Nova Scotia. Click here for more detailed information. Please reach out to registration@nscn.ca if you have any questions.

Canadian Nurse Practitioner Exam (CNPE)

As a result of the impact of the COVID-19 global pandemic, the May 6, 2020, writing of the Canadian Nurse Practitioner Examination (CNPE) has been cancelled. At this time, we expect that the October 14th date will continue as planned. Anticipating an increase in the number of candidates writing the October 14th CNPE, Canadian nursing regulatory bodies are working with the examination provider to be prepared. Candidates who applied for the May 6th examination will receive communication from their regulatory body on the process to write on October 14, 2020.
 
We thank all nurses for their professional dedication during this challenging time. 

Information for the Nova Scotian Public

Members of the public can do their part by following the direction set by our governments.

Government Direction

Preventative Measures

Nova Scotia Public Health encourages everyone to practice usual cold and flu season hygiene measures:

  • Wash your hands frequently with soap and water or use hand sanitizer
  • Cough or sneeze into your elbow or a tissue, then dispose of the tissue.
  • Limit contact with others when you're sick. 
  • Limit touching your eyes, nose and mouth. 
  • Do not share items that may have saliva on them, such as utensils and bottles/glasses.
  • Clean surfaces like taps, doorknobs and countertops often.

Source: https://novascotia.ca/coronavirus/

For information on volunteer opportunities with the Nova Scotia Health Authority, visit here

For information on a job opportunity within pop-up shelters and/or hotel sites in Halifax, visit here

Our NSCN Approach

On March 15, the provincial government directed organizations and businesses in Nova Scotia to practice social distancing and to support staff to work from home where possible. We take this direction very seriously and are committed to doing our part to keep Nova Scotians safe. 

Due to the nature of our work, combined with our proactive response plan and modern infrastructure in place, we are able to remain open to the public and all stakeholders and continue to deliver all of our services through phone and virtual technology. As a result, effective March 16, our physical office will close to the public until further notice. Stakeholders should not experience any disruption in service during this time. Staff in all service areas are working to their full capacity to:

  • Respond to phone and email requests
  • Register and licence LPNs, RNs and NPs
  • Answer practice questions and deliver practice advice
  • Respond to complaints and intervene if practice is unacceptable
  • Share updates through the website, social media and newsletter

To practice social distancing, we are also pausing business travel inside and outside of Nova Scotia. At this time and until further notice, all inter-provincial and national work will be supported through virtual technology. If you have any questions, contact a member of our team.

We are monitoring the COVID-19 outbreak very carefully and we will keep stakeholders informed as the situation evolves. Decisions will be made based on what is in the best interest of the public, direction from the provincial and federal government and current information available. As a result of the impact COVID-19 is having on the personal and professional lives of all Nova Scotians, the NSCN Board has made the decision to postpone NSCN’s first annual meeting until October 1st, 2020. For more information on the NSCN Annual Meeting, click here. These efforts, along with all of our work, is part of our mandate to protect the public.


In the spirit of collaboration, other regulatory bodies are permitted to adapt the material on this page. We ask that you add the following disclaimer to any adapted materials: “Adapted by the Nova Scotia College of Nursing”.