Provincial Legislation: NP Jurisprudence Exam

The NP Jurisprudence Examination uses a multiple-choice format that consists of a variety of questions that have been developed to assess the applicant’s competencies within three (3) categories, relevant Federal Legislation, relevant Provincial Legislation and relevant Provincial Policies. Within each of these categories is a list of policies &/or legislation to be tested. To guide your study, each section includes a list of competencies, objectives, a synopsis of information and links to relevant resources.  This study guide is specific to provincial legislation. 

Note for all Acts: NPs are not defined as medical practitioners under any provincial Act or Regulations. This term is use to define the physician role. 

(9) competencies 

1.  Practise in a manner consistent with the Act governing nursing practice 

Objective – the nurse practitioner will: 

  • define the mandate of the College  
  • define ‘practice of nursing’, ‘nursing services’ and ‘scope of practice of the designation’ and ‘scope of practice of the nursing profession’ 
  • define the terms incapacity, incompetence, conduct unbecoming and professional misconduct 

SYNOPSIS OF INFORMATION 

The mandate of the College is to serve and protect the public interest, preserve the integrity of the nursing profession, and maintain public confidence in the ability of the nursing profession to regulate itself.  

The College regulates the practice of nursing, advances and promote the practice of nursing, encourages registrants to participate in the affairs promoting the practice of nursing in the best interests of the public, and carries out other regulatory acts to achieve its legislated mandate.   

Practice of nursing: means the provision of nursing services. 

Nursing services: means the application of specialized and evidence-based knowledge of nursing theory, health and human sciences inclusive of principles of primary health care, in a variety of roles including clinical services to clients, research, education, consultation, management, administration, regulation, policy or system development relevant to such application, and such other services, roles, functions, competencies and activities for each nursing designation that are related to and consistent with the foregoing, including those set out in the regulations taught in approved education programs, authorized for practice under federal or provincial legislation, and generally accepted as constituting nursing practice. 

Scope of practice of the designation: means the services authorized for practice by a registrant holding a particular designation. 

Scope of practice of the nursing profession: means the combined scopes of practice of the nursing designations. 

Scope of practice of the LPN designation: means the nursing services authorized for practice by LPNs under the Act, the Regulations and the bylaws. 

Scope of practice of the NP designation: means the nursing services authorized for practice by NPs under the Act, the Regulations and the bylaws. 

Scope of practice of the RN designation: means the nursing services authorized for practice by RNs under the Act, the Regulations and the bylaws. 

Individual scope of practice: means the services for which a registrant is educated, authorized and competent to perform.  

Incapacity means the status whereby a registrant has or had a medical, physical, mental or emotional condition, disorder or addiction that renders or rendered the registrant unable to practise with competence or that endangers or may have endangered the health or safety of clients. 

Incompetence, in relation to a registrant, means a lack of competence demonstrated in the registrant’s care of a client or delivery of nursing services that, having regard to all the circumstances, rendered the respondent unsafe to practise at the time of such care of the client or delivery of nursing services or that renders the respondent unsafe to continue in practice without remedial assistance. 

Conduct unbecoming the profession means conduct in a registrant’s personal or private capacity that tends to bring discredit upon registrants or the nursing profession.  

Professional misconduct includes such conduct or acts relevant to the practice of the profession that, having regard to all the circumstances, would reasonably be regarded as disgraceful, dishonourable or unprofessional, including:  

  1. failing to maintain the standards of practice, 
  2. failing to adhere to any code of ethics adopted by the College, 
  3. abusing a person verbally, physically, emotionally or sexually, 
  4. misappropriating personal property, drugs or other property belonging to a client or an employer, 
  5. inappropriately influencing a client to make or change a will or power of attorney, 
  6. abandoning a client, 
  7. neglecting to provide care to a client, 
  8. failing to exercise appropriate discretion in respect to the disclosure of confidential information, 
  9. falsifying records, 
  10. inappropriately using licensing status for personal gain, 
  11. promoting for personal gain any drug, device, treatment, procedure, product or service that is unnecessary, ineffective or unsafe, 
  12. publishing, or causing to be published, any advertisement that is false, fraudulent, deceptive or misleading, 
  13. engaging or assisting in fraud, misrepresentation, deception or concealment of a material fact when applying for or securing registration or a licence or taking any examination provided for in this Act, including using fraudulently procured credentials, and 
  14. taking or using a designation or any derivation or abbreviation thereof, or describing the person's activities as "nursing" in any advertisement or publication, including business cards, websites or signage, unless the referenced activity falls within the practice of nursing.  

As a registered nurse (RN) or nurse practitioner (NP) you are a member of a profession that has been granted the privilege to self-regulate. The College has been delegated the authority to oversee the self-regulation of nurses by the government of Nova Scotia as outlined in the Nursing Act and Regulations. 

Self-regulation recognizes that members of a profession have the specialized knowledge needed to govern themselves with public input. Through self-regulatory mechanisms, the profession registers, licenses, monitors and when necessary, disciplines its registrants appropriately with the overall goal of ensuring public protection. 

There are two levels of self-regulation: 

  1. The individual level - nurses are accountable for their own practice, adhering to the standards of practice for RNs and NPs and Code of Ethics in all practice settings; and 
  2. The College level - We are accountable for supporting nurses to help ensure that the profession acts in the best interest of the public and fulfills the role that has been entrusted to them by government and society. 

If self-regulation fails at either of these levels, the government can remove the right for nurses to self-govern. 

As a nurse, you self-regulate in various ways. This could include maintaining a current license to practice, pursuing continuing competence, demonstrating personal accountability, and appropriately reporting unsafe practice. 

College programs and services reflect and are grounded in self-regulation principles which include but are not limited to: 

  • Promoting good nursing practice, 
  • Preventing poor nursing practice and 
  • Intervening when practice is unacceptable. 

The College promotes good practice by setting standards for nursing education programs, defining entry-level competencies, setting licensure requirements, promoting evidence based nursing, recognizing nursing role models, establishing professional practice standards and adopting a code of ethics. The College promotes prevent poor practice by identifying potential risks to client and public safety and offering programs and services to assist nurses to manage or mitigate these risks. This includes providing practice consultations, implementing a continuing competence program, developing resources to support practice and influencing administrative and government policy development that affects the practice of nurses. 

Resource Links: 

2. Practises in accordance with the standards of practice for nurse practitioners.  

Objectives 

The nurse practitioner will: 

  • Define the term “standard of practice”  
  • Define the minimal professional practice expectations for nurse practitioners  

SYNOPSIS OF INFORMATION 

Standard of practice “means the minimal professional practice expectations for a registrant of a particular designation in a setting or role, approved by the Board”. A registrant shall comply with this Act, the regulations, by-laws, code of ethics and standards of practice. 

The College sets the practice standards for registered nurses and nurse practitioners to support the delivery of safe, competent, compassionate and ethical care. Nurse practitioners care for various client populations in a variety of practice settings. 

The Nurse Practitioner Standards of Practice outlines the professional and legal obligations and accountabilities of nurse practitioners and provides a common understanding of nurse practitioner practice expectations in Nova Scotia. The standards also identify the performance levels that nurse practitioners are required to achieve in practice. 

This document is a complement to the Entry-Level Competencies for Nurse Practitioners in Canada. Competencies are the specific knowledge, skills, abilities and judgment required for a nurse practitioner to practise safely and ethically with a designated client population in a specific role and practice setting. 

NPs must refrain from prescribing pharmacological therapy for themselves or family members, except to intervene in an emergency or to treat a minor/episodic condition when there is no other prescriber available. 
 
As part of their comprehensive assessment of the client’s diagnoses, NPs are required to use available drug information systems to verify history of clients’ prescribed medications, including controlled drugs and substances, when initiating, changing or discontinuing medications. 

RESOURCES 

3.Practise as directed within the Act related to Registration and Licensing

Objectives – the nurse practitioner will: 

  • describe the purpose of the College Register
  • identify the six registers of the College
  • identify the six licensing categories of the College
  • describe the purpose and information contained in the College “Search for a Nurse”
  • identify who is authorized use the designation Nurse, NP, or N.P.
  • identify who may describe their activities as “nursing”
  • identify what is required in order to engage in the practice of nursing
  • describe what is required to provide nursing services by electronic means
  • describe the requirements for provision of nursing services by persons not registered with the College

SYNOPSIS OF INFORMATION 

College Register  

The College Register is available to the public. It contains the following information for each registrant: 

  1. the name of the registrant;
  2. a unique registration number;
  3. the name and location of the education program attended;
  4. graduation date from an education program;
  5. the date of entry in the register
  6. such other information as may be set out in the bylaws.

The Conditional Register must include the conditions or restrictions under which the registrant is registered as well as (a) to (f) above. 

Conditional registers can be used for applicants who do not meet all of the requirements for full registration if the CEO believes that it is consistent with the objects of the College to grant registration subject to conditions and restrictions. Once granted conditional registration, the person is considered a registrant and is there eligible for a licence to practice nursing. 

The College has the following registers: 

  • Licensed Practical Nurses Register;
  • Nurse Practitioner Register
  • Registered Nurses Register 
  • Licensed Practical Nurses Conditional Register; 
  • Nurse Practitioner Conditional Register 
  • Registered Nurse Conditional Register; and 

such other registers as may be prescribed in the regulations. 

The College has the following categories of licence: 

  • licensed practical nurse practising 
  • licensed practical nurse conditional   
  • nurse practitioner practising 
  • nurse practitioner conditional 
  • registered nurse practising 
  • registered nurse conditional; and 

such other categories as may be set out in the regulations. 

Registrants who do not meet all the requirements for a practising licence, or have conditions and/or restrictions on their practice, may be issued a conditional licence under the appropriate register if the CEO believes it is consistent with the objects of the College to do so. Conditional licences impose conditions and/or restrictions on the registrant’s ability to practice nursing.  Once these conditions and/or restrictions are fulfilled, expired or removed, the registrant may qualify for a practicing licence. For example, a new graduate or internationally educated nurse could be on a conditional register and be issued a conditional licence while waiting to pass their relevant registration examination. Another example is a nurse on the register (not the conditional register) who is issued a conditional licence with restrictions on the population for whom they can provide care. 

The conditional licence is rescinded or cancelled by the College on the date the: 

  • conditional licence expires; 
  • College receives notification the conditional licence holder has failed the NP examination for the first time; 
  • conditional licence holder becomes licensed as an NP with the College; or conditional licence is suspended or revoked under the professional conduct process 

A conditional licence may be issued to applicants who are eligible to write the NP exam or have written the NP examination and are awaiting the results. The College registration policy indicates however if an individual fails the NP exam, the conditional licence is no longer valid. The CEO/Registrar may impose specific conditions or restrictions on an NP license if they are necessary in the interest of the public.  

Candidates shall have a maximum of three (3) opportunities to pass the nurse practitioner (NP) examination. The first writing of the exam shall be at the earliest reasonable opportunity following eligibility to write. In the event the candidates do not pass the first write, candidates shall have a maximum of two (2) further opportunities to pass the examination in the twenty-four (24) month period immediately following their first writing of the applicable examination. 

“Search for a Nurse” is found on the College website and includes the name and registration number of all nurses who are registered and licensed to practice in Nova Scotia. 

Use of NP Designation 

No person shall engage in the practice of a nurse practitioner or take or use the designation "Nurse Practitioner", "NP", or "N.P.", or any derivation or abbreviation thereof either alone or in combination with other words, letters or descriptions 
to imply that the person is registered or licensed under this Act unless the person: 

  • is a registrant and holds a licence as a nurse practitioner; or  
  • Is otherwise authorized to practice as a nurse practitioner or to use the relevant designation in accordance with this Act, the Regulations and the Bylaws.  

Who can describe their Activities as ‘Nursing?’ 

No person shall take or use the description "nurse" or any derivation or abbreviation thereof to imply that the person is entitled to engage in the practice of nursing or shall describe the person’s activities as "nursing" unless the person:  

  1. is a registrant and holds a licence in one of the nursing designations; 
  2. is permitted to engage in the practice of nursing or use the relevant description as otherwise provided in the Act, the Regulations or the Bylaws; or 
  3. on the coming into force of this Act, is a person whose name appears on the Certified Graduate Nurses List, maintained by the former College of Registered Nurses of Nova Scotia, naming persons who graduated from a nursing education program but who did not meet the requirements to qualify as a registered nurse. 

What is Required to Engage in the Practice of Nursing in Nova Scotia 

A person, other than a registrant, who is seeking to practise in Nova Scotia and intends to practise for a limited time and purpose in Nova Scotia or is a student enrolled in a nursing program other than an approved education program, shall apply to the College and must: 

  1. meet the criteria approved by the College; 
  2. agree to such terms, conditions or restrictions as may be imposed; and 
  3. receive approval from before engaging in the practice of nursing. 

A person other than a registrant or person specified above may engage in the practice of nursing in Nova Scotia if: 

  1. the person is a student enrolled in an approved education program and is authorized by the administrators of that program to engage in practice as part of such program; or  
  2. the person is permitted to engage in practice as otherwise provided in this Act, the regulations or the by-laws; or 
  3. the person is exempt from the Act in the following circumstances: 
    1. the private care of a person without remuneration; 
    2. the furnishing of first aid or emergency assistance if such aid or assistance is given without hire, gain or hope of reward; 
    3. employees from engaging in a lawful strike; 
    4. the practice of a profession or performance of a function authorized under an enactment of the Province by a person authorized under that enactment, if the person does not describe the person's practice as "nursing" or use a word of similar meaning, or does not use any of the designations or titles protected under this Act or the regulations; 
    5. the practice by registrants of acts approved for practice under the Medical Act; 
    6. the carrying out of delegated tasks constituting part of the practice of nursing by a person under the supervision of a registrant; 
    7. provision of services for compensation, other than the provision of nursing services, at a place that is subject to or providing a service under the Children and Family Services Act, the Day Care Act, the Homemakers' Services Act, the Homes for Special Care Act or the Social Assistance Act; or 
    8. the provision of services as may be prescribed by the regulations. 

Provision of Nursing Services by Electronic Means  

A registrant in Nova Scotia who is engaged in practice by electronic means with clients outside of the province is deemed to be practising in the province.  

A person, other than a registrant, who resides outside of the province and who engages in practice by electronic means with clients within the province is deemed not to be practising in the province. 

Provision of Nursing Services by Persons Not Registered with the College 

Nothing in the Act prohibits the practice of the profession in the province or the recovery of fees or compensation for professional services rendered by a person registered in another country, state, territory or province and whose engagement requires that person to accompany and temporarily care for a client during the period of the engagement, if that person does not represent or hold himself or herself out as a person registered under the Nursing Act. 

NOTE: If a nurse registered in Nova Scotia wishes to provide nursing service outside of the province, they should contact the regulatory body in the jurisdiction where they are planning to work to determine the requirements for registration and licensure. 

Resource Links: 

4. Practise as directed within the Act related to Professional Conduct 

Objective – the nurse practitioner will: 

  • identify regulatory committees that relate to the professional conduct of registered nurses 

SYNOPSIS OF INFORMATION 

The College is required to establish regulatory committees to carry out the essential functions related to its regulatory mandate. The regulatory committees related to professional conduct are Complaints Committee, Professional Conduct Committee, Fitness to Practice Committee and Reinstatement Committee. All committees include at least one public representative, at least one registrant from each designation regulated by the College and such other number of registrants and public representatives as the Board determines. Each committee has a different minimum number of members and composition of public representatives and nursing designations. 

Complaints Committee: The Committee considers complaints and other matters that have been referred to them.  The Committee considers and/or disposes of complaints, refers matters to the Fitness to Practice process when appropriate, provides direction regarding investigations, reviews decisions made by the CEO when requested by complainants, considers outcomes of proposed settlement agreements, determines whether to impose an interim suspension of a nurse’s licence, or their ability to obtain a licence, impose conditions or restrictions on a licence and recommends suspension of a licence when required. 

Professional Conduct Committee: The Committee considers, and where necessary amends, Notices of Hearings including dates for hearings if required, pre-hearing conferences to address procedural matters, and processes for hearings. The Committee may order a respondent to submit to a health examination, audit or competence assessment, or produce records and documents. If allegations are proven against a respondent, the Committee has the authority to impose costs and direct the CEO regarding publication of the decision.  

Fitness to Practise Committee: This Committee determines if a registrant meets the eligibility criteria for the fitness to practice process and approves any terms and conditions laid out for the process. The Committee may also convene a hearing to consider a registrant’s progress or consider their removal from the process. When requested by a registrant, the Committee reviews requests for return to practice or for removal or changes to any licensure terms/conditions and may grant the request, vary the terms/conditions or deny the request for return to practice. The committee retains jurisdiction until terms and conditions are met or the matter has been referred back to the CEO.    

Reinstatement Committee:  The Committee reviews applications for reinstatement of registration and licence following revocation, arranges for and conducts hearings to review reinstatement applications.  After considering the evidence presented, the Committee determines if applications will be accepted, accepted with restrictions and/or conditions or rejected as well as determining manner of publication of the decision and assess any costs to be paid by the applicant.  

5. Practices as directed within the Act related to custodianship of client records 

Objectives – the nurse practitioner will: 

  • explain RN and NP accountability for client records when self-employed nurses leave their practice 

SYNOPSIS OF INFORMATION 

NPs and RNs who are self-employed must be aware of the regulatory requirements to make adequate provisions for client records. Where adequate provision has not been made for the protection of the client’s interests, the College may request the court to appoint a custodian to take possession of the client records in the case where the registrant:  

  1. dies, disappears, is imprisoned, leaves the Province or surrenders the person’s licence to practise; 
  2. is struck off the Register or is the subject of a suspension of licence; 
  3. has had a licensing sanction imposed; or 
  4. neglects their practice 

6. Practise in a manner consistent with the Act governing nursing practice 

Objectives – the nurse practitioner will: 

  • define the terms competencies and competent  
  • define the terms caution  

SYNOPSIS OF INFORMATION 

According to the Act: 

Competencies means the knowledge, skills and judgment required to practise safely and ethically 

Competence means the ability to integrate and apply competencies in a designated role and practice setting 

Caution means a determination by the Complaints Committee that a registrant may have breached the standards of professional ethics or practice but in circumstances that do not constitute professional misconduct, conduct unbecoming the profession, incompetence or incapacity. 

7. Practise as directed within in the Act related to record of hours  

Objective – the nurse practitioner will: 

  • define currency of practice 
  • state why a valid record of hours must be kept  

SYNOPSIS OF INFORMATION 

Currency of practice requirements” means those requirements set out in the by-laws that a registrant must meet to establish the registrant is current in practice 
 
The College requires RNs to maintain their record of practice hours from at least the previous 5 years and NPs, the previous 2 years.  The College may at any time conduct an audit of records kept to ensure the validity of data that is recorded on applications to the College respecting hours worked in the designated practices. 

8. Practise as directed related to Professional Conduct 

Objective – the nurse practitioner will: 

  • describe the sanctions that can be applied to a nurse’s licence through the professional conduct process 

SYNOPSIS OF INFORMATION 

Professional Conduct Process: Sanctions 

Once an investigation is complete and the nurse has had an opportunity to respond to the allegations, the matter will be reviewed to determine whether it should be forwarded to a committee for further action or decision. There are three primary committees involved in the professional conduct process: Complaints Committee, the Fitness to Practice Committee and the Professional Conduct Committee. These committees are made up of at least one public representative and at least one registrant from each designation regulated by the College.  

If a complaint is not disposed of by staff, it is typically referred to the Complaints Committee. The Complaints Committee has the ability to resolve complaints in a variety of ways, but in more serious cases, the Complaints Committee will refer the allegations to the Professional Conduct Committee for a hearing.  The Professional Conduct Committee will receive the evidence and determine whether the allegations against the nurse are true, and if so, whether proven facts amount to a finding of misconduct, incompetence, incapacity and/or conduct unbecoming. If the Professional Conduct  

Committee makes one or more of these findings, it must then decide on the appropriate penalty, such as a licensing sanction. Potential licensing sanctions include:  

  • a reprimand  
  • a suspension  
  • conditions or restrictions  
  • imposition of a fine  
  • revocation  

9. Practises as directed within the legislated regulatory committees 

Objectives 

The nurse practitioner will: 

  • identify the regulatory committees that relate to nurse practitioners and their practice 

SYNOPSIS OF INFORMATION 

According to the Nursing Act, the College is required to establish regulatory committees to carry out the essential functions related to its regulatory mandate. The regulatory committees specifically related to nurse practitioners are the Education Program Approval Committee, Registration and Licensing Committee and the Practice Review Committee.  

The Education Program Approval Committee is made up of at least one public representative and such other members of registrants and public representatives as the Board determines. The Education Program Approval Committee: 

  • advises and makes recommendations to the Board with respect to 
  • establishing standards for education programs1 offered in the Province to meet in order to become approved education programs, 
  • establishing standards for re-entry programs, 
  • approving or conditionally approving education programs in the Province as approved education programs or re-entry programs for the purpose of this Act, and 
  • denying or withdrawing approval of approved education programs and re-entry programs that do not meet the standards approved by the Board; 
  • ensures that approved education programs and re-entry programs are assessed for compliance with Board standards at times approved by Board; and 
  • performs such other functions as directed by the Board. 

The Registration and Licensing Committee is made up of at least on public representative, at least one registrant from each designation regulated by the College and such other number of registrants and public representatives as the Board determines.  The Committee is responsible for: 

  • General registration and renewal matters 
  • Review registration, license and renewal matters referred to it by the CEO and make decisions on such matters  
  • Nurse practitioners requesting changes in client population: 
  • Upon referral from the CEO, determine whether a nurse practitioner is approved to practise with a different client population; and 

The Committee may require a nurse practitioner to complete a competence assessment and bridging education before determining whether the nurse practitioner is approved to practise with a different client population. 

Nurse practitioners are required to report to the College if they wish to change their NP client population. “Change of client population” is defined as moving from the client group for which the NP was formerly educated and has passed the exam to a client group for which they have not been educated or passed the exam.  For example, moving from Adult or Pediatrics to Family/All Ages is considered a change of client population as there may be gaps in education across the lifespan. NPs who wish to provide care to a client population for which have not completed education or an approved licensure exam (e.g. adult or pediatrics moving to Family/All Ages) will be required to report this change to the Registration and Licensing Committee.  This committee will review the application and may determine what, if any, additional education and/or exam is required in order for the NP to move to the new client population. 

The Practice Review Committee is made up of at least on public representative, at least one registrant from each designation regulated by the College and such other number of registrants and public representatives as the Board determines.  The Committee: 

  • Oversees the conduct of practice reviews 
  • Refers registrants for practice reviews  
  • Select reviewers in accordance with criteria approved by the Committee 
  • Conducts practice reviews in accordance with the regulations, including disclosure of information necessary to fully conduct the review 
  • Requires registrants to undergo competence assessments if deemed necessary  
  • Reviews reports from practice reviews and set out observations and conclusions in writing to the registrant, including any requirements for remediation or recommendations for improvement, or both 
  • Oversees any remediation that is required for a registrant who has undergone a practice review, and 
  • Liaises with the CEO when needed. 

(1) competency 

1.  Practises in a manner consistent with the Adoption Information Act that directly governs nursing practice.  

Objectives 

The nurse practitioner will: 

  • define the purpose of the Adoption Information Act 
  • identify the compelling circumstances that would allow disclosure under the Act  

SYNOPSIS OF INFORMATION 

The purpose of the Adoption Information Act is to: 

  1. establish the criteria by which  
    1. persons who are adopted and of the age of majority may have access to information concerning their birth families,  
    2. birth parents and adoptive parents of adopted persons may have access to information concerning their children, and  
    3. relatives and other persons may, in special circumstances, have access to information concerning the birth family of adopted persons; 
  2. establish controls for adoptive parents over access by adopted persons under the age of majority to information concerning their birth families;  
  3. provide for the circumstances under which reunions of persons separated as a consequence of adoption will be facilitated; and  
  4. establish an appeal procedure for applications made pursuant to this Act.  

The legislation defines the specific information available to the adopted person, birth parent, birth sibling or relatives through application to the Director.   

Application by adopted person  

An adopted person may apply to the Director for disclosure of  

  1. the adopted person's birth name;  
  2. the name of the adopted person's birth mother;  
  3. the name of the adopted person's birth father;  
  4. where there are adopted birth siblings of an adopted person, the birth names of those persons;  
  5. where there are adopted birth siblings of an adopted person, the adoptive names of those persons.  

Application by birth parent  

A birth parent may apply to the Director for disclosure of the adoptive name of an adopted person of whom the birth parent is a birth parent.  

Application by birth sibling  

A birth sibling, with the written consent of a birth parent, may apply to the Director for disclosure of the adoptive name of an adopted person of whom the birth sibling is a birth sibling, where: 

  1. the birth parent whose consent is required pursuant to subsection (1) is deceased;  
  2. the birth sibling provides evidence to the Director that the birth sibling has conducted a reasonable search to locate the birth parent whose consent is required pursuant to subsection (1), and has failed to locate the birth parent; or  
  3. the regulations prescribe that the consent required pursuant to subsection (1) may be dispensed with,  

the Director may dispense with such consent.  

Application by relative  

Where an adopted person has died, a relative of the adopted person may apply to the Director for disclosure of  

  1. the adopted person's birth name;  
  2. the name of the adopted person's birth mother;  
  3. the name of the adopted person's birth father;  
  4. where there are adopted birth siblings of an adopted person, the birth names of those persons; or  
  5. where there are adopted birth siblings of an adopted person, the adoptive names of those persons.  

Where a birth parent of an adopted person has died, a relative of the birth parent may apply to the Director for disclosure of the adoptive name of the adopted person whose birth parent is deceased.  

A relative who applies pursuant to subsection (1) or (2) shall submit, with the application, proof of death of the adopted person or birth parent, as the case may be.  

RESOURCE LINKS 

Reporting of Notifiable Diseases and Condition Regulations   (1) competency 

1.  Practises in a manner consistent with the Reporting of Notifiable Diseases and Condition Regulations that directly governs nursing practice  

Objectives 

The nurse practitioner will: 

  • identify diseases that must be reported to Public Health 

SYNOPSIS OF INFORMATION 

In the Health Protection Act, under Notifiable Diseases or Conditions, a registered nurse who has reasonable grounds to believe that a person has or may have a notifiable disease or condition must report that belief to a medical officer of health.   

A physician, a registered nurse licensed pursuant to the Registered Nurses Act or a medical laboratory technologist licensed pursuant to the Medical Laboratory Technology Act who has reasonable and probable grounds to believe that a person 

  1. has or may have a notifiable disease or condition; or 
  2. has had a notifiable disease or condition, 

shall forthwith report that belief to a medical officer 

A physician, registered nurse licensed pursuant to the Registered Nurses Act or an administrator of an institution who believes that an illness is serious and is occurring at a higher rate than is normal, shall forthwith report that belief to a medical officer. 

Diseases that must be reported can be found in A Guide to the Health Protection Act & Regulations in Appendix A.  The list of guidance documents related to the Health Protection Act and Regulations can be found in Appendix B. 

RESOURCE LINKS 

(1) competency 

1.  Practises in a manner consistent with the Hospital Act that directly governs NP practice  

Objectives 

The nurse practitioner will: 

  • Identify who has admitting and discharge privileges 

SYNOPSIS OF INFORMATION 

To improve efficiencies in client flow through the health care system, revisions to the regulations under the Nova Scotia Hospitals Act authorizes nurse practitioners (NPs) to discharge clients from any hospital setting. These settings may include but are not limited to inpatient units, day surgery and/or interventional radiology units, emergency departments and collaborative emergency centers (CECs). The revised regulations do not change the Hospitals Act in relation to admission, which only authorizes physicians, midwives and dentists to admit clients to health care facilities.  

According to the Hospitals Act, NPs are not authorized to admit clients to hospitals. 

RESOURCE LINKS 

(1) competency 

1. Practises in a manner that is consistent with the Homes for Special Care Act 

Objectives 

The nurse practitioner will: 

  • Identify the role of NPs when residents are admitted to long term care facilities and homes for special care 

SYNOPSIS OF INFORMATION 

Admission to long term care facilities or homes for special care is not defined in the same manner as under the Hospital Act.   

Nursing homes are intended for medically-stable individuals who required more nursing care than can be provided in their home. Residential care facilities provide individuals with personal care, supervision and accommodation in a safe and supportive environment when nursing home care is not required. 

Long term care facilities are not considered hospitals under the Hospitals Act and are fall under the jurisdiction of the Homes for Special Care Act.  NPs may participate in any phase of the process required as part of the application to long term care, including the completion of Medical Status Reports. Decisions regarding placement into a long term care facility are made based on an assessment carried out by Continuing Care assessors and are approved by the administrator or medical director of the facility.  

Nurse practitioners may complete the initial assessment and orders for care (e.g. diet, medication, activities, treatments, etc.) when a new resident arrives at a long term care facility. Nurse practitioners are also able to provide ongoing primary care to residents.  In addition, the Homes for Special Care Regulations states that each resident must be seen once every 6 months by a physician.   

Long term care beds may be located in an acute care hospital. NPs need to be aware whether these beds are “licensed” (meaning designated) as acute care or long term care beds. NPs must not be involved with the admission process for individuals being placed in acute care beds, because in doing so, they will violate section 8 of the Hospitals Act. 

RESOURCE LINKS: 

(1) competency

1. Practises in a manner that is consistent with the Motor Vehicles Act

Objectives 

The nurse practitioner will: 

  • State the health care professional who can complete a driver’s medical examination report for the Registry ofMotor Vehicles.
  • State the health care professionals who can inform the Registry of Motor Vehicles that a person is unsafe to drivea motor vehicle.

SYNOPSIS OF INFORMATION 

In accordance with the Motor Vehicles Act, only a qualified medical practitioner or a qualified registered psychologist may complete a driver’s medical examination report.  In addition, only a qualified medical practitioner can determine if a person can be exempt from wearing a seat belt or child restraint for medical reasons. The Motor Vehicle Act has been amended to define NPs as qualified medical providers who are able to report to the Registrar of Motor Vehicles when a client is unsafe to drive a motor vehicle and extend indemnification for NPs who report an unsafe driver. 

Note for all Acts: NPs are not considered to be medical practitioners under any Act.  A "qualified medical practitioner" means a member under the Medical Act. 

RESOURCE LINKS 

(1) competency

1. Practises in a manner consistent with the Personal Health Information Act that directly governs NP practice

Objectives  

The nurse practitioner will be able to: 

  • Explain when a custodian may collect, use or disclose information without the consent of the individual
  • Explain when a custodian may not collect, use or disclose personal health information about an individual
  • Identify that an agent of the custodian must notify the custodian if personal health information is stolen, lost oraccessed by unauthorized persons
  • State when a custodian may disclose personal health information about an individual collected in the province to a person outside the province  
  •  Identify when a person may request access to a record of information  

SYNOPSIS OF INFORMATION 

Agent and custodian are defined in the Personal Health Information Act.  Essentially, an agent is the person who “acts for or on behalf of the custodian in respect of personal health information for the purposes of the custodian”; for example, an NP (agent) acting on behalf of the health authority (custodian) by whom they are employed.  

A custodian is an individual or organization that has custody of personal health information as part of their powers or duties.  Custodians can include: 

  • a regulated health professional or a person who operates a group practice of regulated health professionals,  
  • the Minister,  
  • the Minister of Health Promotion and Protection, 
  • a district health authority under the Health Authorities Act, 
  • the Izaak Walton Killam Health Centre, 
  • the Review Board under the Involuntary Psychiatric Treatment Act, 
  • a pharmacy licensed under the Pharmacy Act, 
  • a continuing-care facility licensed by the Minister under the Homes for Special Care Act or a continuing-care facility approved by the Minister, 
  • Canadian Blood Services, 
  • any other individual or organization or class of individual or class of organization as prescribed by regulation as a custodian; 

A custodian can disclose personal health information about an individual without the consent of the individual when it does not: 

  • require the custodian to disclose it unless required to do so by law; 
  • relieve the custodian from a legal requirement to disclose the information; and 
  • prevent the custodian from obtaining the individual's consent for the disclosure or giving notice to the individual of the disclosure.  

A custodian cannot collect, use or disclose personal health information about an individual unless:  

  • the custodian has the individual's consent under this Act and the collection, use or disclosure is reasonably necessary for a lawful purpose; or 
  • the collection, use or disclosure is permitted or required by this Act. 

An agent (e.g. NP) of a custodian (e.g. health facility) must notify the health facility at the first reasonable opportunity if a client’s personal health information in their custody is stolen, lost or accessed by unauthorized persons.   

A custodian may use personal health information about an individual without the individual's consent for a number of purposes, including but not limited to: 

  • planning or delivering programs or services;  
  • ensuring quality or standards of care;  
  • when the information is limited to the individual's name and contact information;  
  • processing, monitoring, verifying or reimbursing claims for payment for the provision of health care;  
  • research conducted by the custodian, in accordance with Sections 52 to 60 of the Act  

A custodian may disclose personal health information about an individual to another custodian involved in that individual's health care if it is deemed reasonably necessary for the provision of health care to the individual.  

A custodian may disclose personal health information about an individual collected in Nova Scotia to a person outside Nova Scotia for a number of reasons, including disclosure to a regulated health professional to meet the functions of another jurisdiction's prescription monitoring program.  

A person can ask to examine or obtain a copy of their personal health record by:  

  • making a request in writing to the custodian;  
  • specifying the subject-matter of the requested record; and  
  • paying any required fees. 

A custodian may refuse to grant access to an individual's personal health information if: 

  • the record is subject to a legal privilege; 
  • another Act of the Province or of the Parliament of Canada or a court order prohibits disclosure; 
  • the information in the record was collected or created primarily for the purpose of ensuring quality or standards of care; 
  • the information in the record was collected or created in anticipation of or for use in a proceeding, and the proceeding, together with all appeals or processes resulting from it, have not been concluded; 
  • the information was collected as the result of an investigation of an individual receiving or attempting to receive a service or benefit for which he/she was not entitled, and the investigation has not been concluded; 
  • granting the access could result in a risk of serious harm to the treatment or recovery of the individual or their mental or physical health;  
  • granting the access could result in a risk of serious harm to the mental or physical health of another individual;  
  • granting the access could lead to the identification of a person who provided information in the record to the custodian in circumstances in which confidentiality was reasonably expected; or 
  • granting access could result in the release of another individual's personal health information. 

RESOURCE LINKS 

(1) competency   

1. Prescribes drugs according to the Prescription Monitoring Act and its regulations  

Objectives 

The nurse practitioner will be able to: 

  • Identify drugs that fall under the designation of monitored drugs  
  • Identifies that a prescriber must be registered with the Prescription Monitoring Program in order to prescribe monitored drugs  
  • State the objects of the prescription monitoring program  
  • State when the Administrator of the Prescription Monitoring Program may file a complaint with a licensing body  
  • Identify situations when a prescription form does not have to be used when prescribing a monitored drug  

SYNOPSIS OF INFORMATION 

According to the Prescription Monitoring Regulations, a "registrant" is a prescriber, pharmacist or pharmacy who is registered with the Program.  In order to prescribe controlled drugs and substances in Nova Scotia, the NP must be registered with the Prescription Monitoring Program (PMP). 

The Prescription Monitoring Act defines "monitored drugs" as those drugs designated by the regulations as being subject to the Program.   

A list of controlled drugs and substances can be found in the Controlled Drugs and Substances Act or any successor legislation and are designated as being subject to the Nova Scotia Prescription Monitoring Program, except testosterone, when dispensed as a compound for topical application for local effect.  

The mandate of the Nova Scotia Prescription Monitoring Program is to promote the appropriate use of monitored drugs and the reduction of the abuse or misuse of monitored drugs.  The Nova Scotia Prescription Monitoring Board, which is responsible for operating the Prescription Monitoring Program, interprets this legislative mandate as including a mission to: 

  • educate prescribers, dispensers and the general public on the appropriate use of monitored drugs; 
  • collaborate and develop working partnerships with other key organizations in order to achieve the Program’s objectives; and 
  • proactively share information in a timely and responsive manner to allow others to do their part in achieving the Program’s objectives. 

The Prescription Monitoring Program administrator may communicate or file a complaint with authorities when the administrator has reason to believe that: 

  • an offence has been committed contrary to the Controlled Drugs and Substances Act or the Criminal Code (Canada) or successor legislation, or 
  • a member of that licensing authority may be practising in a manner that is inconsistent with the objects of the Program. 

A prescriber must only prescribe a monitored drug in the manner approved by the Board and by using a prescription form. However, a prescriber does not have to use a prescription form if the prescription is for one of the following:  

  • a person in a nursing home, as defined in the Homes for Special Care Act;  
  • a person in a home for the aged that is subject to the Homes for Special Care Act;  
  • a person who is prescribed a monitored drug while an in-patient, as defined in the Hospital Insurance Regulations made under the Health Services and Insurance Act;  
  • an inmate in a federal correctional centre or penitentiary.  

Nurse practitioners should become familiar with the Nova Scotia Prescription Monitoring Program policies and resources (see links below). 

RESOURCES 

(1) competency

1. Practices in a manner consistent with the Vital Statistics and Chapter 494: Timely Medical Certificate Act and itsregulations that directly governs NP practice

Objectives 

The nurse practitioner will: 

  • sign death certificates as outlined in the Vital Statistics Act
  • cite the circumstances under which a NP can complete the certificate of death

SYNOPSIS OF INFORMATION 

In Nova Scotia, nurse practitioners can enact their authority to complete a Medical Certificate of Death when they:  

  • Hold an active practice license with the College of Registered Nurses of Nova Scotia
  • Completed the approved Medial Certificate of Death education
  • Received a registration number from vital statistics.

Nurse practitioners working in all practice settings (hospitals, community, long term care) have the authority to complete Medical Certificates of Death in the following circumstances: 

The death of a person was expected as the result of a diagnosed chronic or acute illness or conditions; and 

There is no reason to believe that the death was a result of any of the circumstances referred to in sections 9-12 of the Nova Scotia Fatality Investigations Act. 

Nurse practitioners are accountable for accurate completion the Registration of Death Form for Nova Scotia including the medical certification of death outlining the date of death, immediate cause of death, antecedent causes of death and other significant conditions contributing to the death to uphold the accuracy of mortality statistics in Nova Scotia and Canada.  

RESOURCES 

(1) competency

1. Practises in a manner consistent with the Workers Compensation Board Act that directly governs NP practice

Objectives 

The nurse practitioner will be able to: 

  • recognize accountability related to completion of the Workers Compensation Board Act

SYNOPSIS OF INFORMATION 

An NP can complete the Physician’s Report 8/10. Please see the Physician’s Report Guide for additional guidance for completion of this form.  To become a WCB service provider, an NP will need to complete the Service Provision Proposal Application form and fax it to the WCB Health Service Department for processing.  

Medical records completed as part of a WCB claim are privileged. This means that every report submitted to the Board or the Appeals Tribunal by a physician, surgeon, hospital official or other health care professional: 

  • is a privileged communication of the person submitting the report; and
  • is not admissible as evidence in any action against the physician, surgeon, hospital official or health careprofessional.

RESOURCES 

(1) competency

1. Practises in a manner consistent with the Adult Capacity and Decision Making Act that directly governs NP practice.

Objectives 

The nurse practitioner will be able to: 

  • recognize accountability under the Adult Capacity and Decision Making Act

SYNOPSIS OF INFORMATION 

The Adult Capacity and Decision-making Act and Regulations applies to adults who may not be able to make some decisions for themselves because of learning disabilities, mental health problems, brain injuries, etc. and allows another person to make some important decisions for the individual. 

The Act and Regulations came into effect on December 28, 2017 and replaced the Incompetent Persons Act. This legislation extends the authority to complete capacity assessments to healthcare professionals other than physicians including nurse practitioners (NPs) and registered nurses (RNs) who have completed education mandated by the Public Trustee’s Office. 

The purpose of the Adult Capacity and Decision Making Act is to: 

  1. recognize that adults may experience an impairment of their capacity; 
  2. provide a fair and respectful legal framework for protecting the safety and security of adults whose capacity is impaired and who may be made vulnerable thereby; 
  3. promote the dignity, autonomy, independence, social inclusion and freedom of decision-making of adults who are the subject of this legislation; and 
  4. ensure that the least restrictive and least intrusive supports and interventions are considered before an application is made or a representation order is granted under this Act. 

Under this Act, “capacity” is defined as an individual’s ability, with or without support, to understand information relevant to making a decision, appreciate the reasonably foreseeable consequences of making or not making a decision including, for greater certainty, the reasonably foreseeable consequences of the decision to be made.  For healthcare professionals, capacity refers to an individual’s ability to make decisions about their personal care, including but not limited to, health care, nutrition and hydration, shelter or residence, hygiene, safety, comfort, recreation, social activities, support services and finances. 

There is additional legislation that addresses assessment of capacity:  

  • Hospitals Act addresses the assessment of capacity in a hospital setting.  
  • Involuntary Psychiatric Treatment Act addresses issues of capacity assessment in psychiatric settings. 
  • Personal Directives Act allows an individual with capacity to make a personal directive outlining instructions about future personal care decisions to be made on their behalf. Personal directives take effect when an individual lacks the capacity to make a personal care decision but has no effect when the individual still has such capacity. 

An individual may need different levels of capacity depending on the decision required. Decisions that are associated with greater risk require a higher level of capacity. At the most basic level, capacity in relation to day-to-day services refers to the ability of a client to consent to specific activities or treatments. This basic capacity assessment falls within the scope of practice of many healthcare professionals including licensed practical nurses, nurse practitioners and registered nurses. However, when an individual is unable to make decisions beyond day-to-day personal care services, a more formal capacity assessment may be required. A delegate or statutory decision-maker may also make a request to have a capacity assessment completed. 

When a nurse is unable to determine the client’s day-to-day capacity and determine that further assessment is needed, they should consult an authorized healthcare professional who have completed the required education.  Nurses are accountable to be familiar with the legislation that is applicable to their practice setting and to follow agency policies when initiating capacity assessments.  

RESOURCES