
	Research : Reports

Appendix B-2 [Table of Contents]

APPENDIX B-2
Definition of Extended Certificate of Registration/Nurse Practitioner Canadian Jurisdictions

"Extended Certificate"/ "Nurse Practitioner" Legislation/Regulation

The Public Health Act was amended in section 21 in 1996 to allow registered nurses to provide extended health services as permitted by the regulations.
Sect. 1 of the regulations says that extended practice nurses must be employed by a regional health authority, a provincial health board or the Department.
Sect. 3 says that ministerial approval is required before an extended practice nurse is employed other than by the Department.
Sect. 4 says that an employment agreement must exist which sets out the specifics of what services will be provided by an extended practice nurse.
Sect. 5 gives the scope of the services which may be provided:
(a) diagnoses and treatment of common disorders affecting the health of adults and children;
(b) referral;
(c) emergency services
It is not clear if the powers listed in a, b and c are intended to allow for prescribing of drugs but the Pharmaceutical Profession Act regulations were enacted in 1998 to permit prescribing for Extended Practice nurses if authorized by the Public Health Act regulations.
ALBERTA
Legislation:
(1) Nursing Profession Act, SA 1983, Chap. N-10.1
(2) Public Health Act, SA 1984, Chap. P-27.1
(3) Pharmaceutical Profession Act, SA 1988, Chap. P-7.1
Regulations:-
(1) General Regulation, Alberta Reg. 454/83
(1) Nursing Profession Extended Practice Roster Regulation, Alberta Reg.16/99 (expiry date - January 31, 2004)
(2) Registered Nurse Providing Extended Health Services Regulation, Alberta Reg. 224/96 (expiry date - June 30, 2001)
(3) Prescription of Drugs By Authorized Practitioners Regulation, Alberta Reg. 83/98 (expiry date - August 31, 2002)

s. 5.1 In the course of engaging in the practice of nursing, a member who is a registered nurse and who holds an extended certificate of registration in accordance with the regulations is authorized, subject the terms and conditions and limitations imposed on his or her certificate of registration, to perform the following acts in addition to those the member is authorized to perform in section 4
1.1 Communicating to a patient or his representative a diagnosis made by the member identifying as the cause of the patient's symptoms, a disease or disorder that can be identified from
i. the patient's medical history
ii. the findings of a comprehensive medical examination
iii. the results of any laboratory tests or other tests and investigations that the member is authorized to order and perform
2. Ordering the application of a form of energy prescribed by the regulations under this Act
3. Prescribing a drug designated in the regulations
4. Administering, by injection or inhalation, a drug that the member may prescribe under paragraph 3
5.2 A member is not authorized to communicate a diagnosis under paragraph 1 of subsection (1) unless the member has complied with the prescribes standards of practice respecting consultation with members of other health professions.
ONTARIO
Expanded Nursing Services for Patients Act, SO 1997, c.9 (amendment to Nursing Act)

" nurse practitioner" means a registered nurse who meets the requirements for licensure by the ARNN for practice as a nurse practitioner within the primary health care model
NP to establish collaborative relationship with primary care physician and other health professionals for purposes of consultation

NP to consult with primary care physician but, when not available, may consult with specialist physician

NP shall consult with a primary health care physician in circumstances specified in Regs/ in urgent and emergent circumstances as outlined in Regs./ when chronic illness or injury destabilizes in circumstances specified in Regs and regarding annual reassessment of Pt. with a chronic condition

NP can expect to encounter illnesses and injuries as listed in Sch. A of Regs.

NP can order diagnostic tests as outline in Sch B of Regs/ tests not listed but required for monitoring Pt's chronic illness or injury ordered by NP after consultation with Primary care physician and requisition to reference physician's name

NP may prescribed and administer drugs as listed in Sch C (non-narcotics)

NP may prescribe over the counter medication to access drug plan for Pt.

NEWFOUNDLAND
Newfoundland Regulation 65/98 Nurse Practitioner Primary Health Care Regulations

s. 2 (2) In accordance with any requirements set out in the regulations, a registered nurse my do any of the following in the course of engaging in the practice of nursing:
(a) order and receive reports of screening and diagnostic tests designated in the regulations;
(b) prescribe drugs designated in the regulations;
(c) perform minor surgical and invasive procedures designated in the regulations.
MANITOBA
Registered Nurses Act
S.M. 1999, c. 36
( Not yet proclaimed-awaiting regulations)

"Extended Certificate"/ "Nurse Practitioner"	Legislation/Regulation
The Public Health Act was amended in section 21 in 1996 to allow registered nurses to provide extended health services as permitted by the regulations. Sect. 1 of the regulations says that extended practice nurses must be employed by a regional health authority, a provincial health board or the Department. Sect. 3 says that ministerial approval is required before an extended practice nurse is employed other than by the Department. Sect. 4 says that an employment agreement must exist which sets out the specifics of what services will be provided by an extended practice nurse. Sect. 5 gives the scope of the services which may be provided: (a) diagnoses and treatment of common disorders affecting the health of adults and children; (b) referral; (c) emergency services It is not clear if the powers listed in a, b and c are intended to allow for prescribing of drugs but the Pharmaceutical Profession Act regulations were enacted in 1998 to permit prescribing for Extended Practice nurses if authorized by the Public Health Act regulations.	ALBERTA Legislation: (1) Nursing Profession Act, SA 1983, Chap. N-10.1 (2) Public Health Act, SA 1984, Chap. P-27.1 (3) Pharmaceutical Profession Act, SA 1988, Chap. P-7.1 Regulations:- (1) General Regulation, Alberta Reg. 454/83 (1) Nursing Profession Extended Practice Roster Regulation, Alberta Reg.16/99 (expiry date - January 31, 2004) (2) Registered Nurse Providing Extended Health Services Regulation, Alberta Reg. 224/96 (expiry date - June 30, 2001) (3) Prescription of Drugs By Authorized Practitioners Regulation, Alberta Reg. 83/98 (expiry date - August 31, 2002)
s. 5.1 In the course of engaging in the practice of nursing, a member who is a registered nurse and who holds an extended certificate of registration in accordance with the regulations is authorized, subject the terms and conditions and limitations imposed on his or her certificate of registration, to perform the following acts in addition to those the member is authorized to perform in section 4 1.1 Communicating to a patient or his representative a diagnosis made by the member identifying as the cause of the patient's symptoms, a disease or disorder that can be identified from i. the patient's medical history ii. the findings of a comprehensive medical examination iii. the results of any laboratory tests or other tests and investigations that the member is authorized to order and perform 2. Ordering the application of a form of energy prescribed by the regulations under this Act 3. Prescribing a drug designated in the regulations 4. Administering, by injection or inhalation, a drug that the member may prescribe under paragraph 3 5.2 A member is not authorized to communicate a diagnosis under paragraph 1 of subsection (1) unless the member has complied with the prescribes standards of practice respecting consultation with members of other health professions.	ONTARIO Expanded Nursing Services for Patients Act, SO 1997, c.9 (amendment to Nursing Act)
" nurse practitioner" means a registered nurse who meets the requirements for licensure by the ARNN for practice as a nurse practitioner within the primary health care model NP to establish collaborative relationship with primary care physician and other health professionals for purposes of consultation NP to consult with primary care physician but, when not available, may consult with specialist physician NP shall consult with a primary health care physician in circumstances specified in Regs/ in urgent and emergent circumstances as outlined in Regs./ when chronic illness or injury destabilizes in circumstances specified in Regs and regarding annual reassessment of Pt. with a chronic condition NP can expect to encounter illnesses and injuries as listed in Sch. A of Regs. NP can order diagnostic tests as outline in Sch B of Regs/ tests not listed but required for monitoring Pt's chronic illness or injury ordered by NP after consultation with Primary care physician and requisition to reference physician's name NP may prescribed and administer drugs as listed in Sch C (non-narcotics) NP may prescribe over the counter medication to access drug plan for Pt.	NEWFOUNDLAND Newfoundland Regulation 65/98 Nurse Practitioner Primary Health Care Regulations
s. 2 (2) In accordance with any requirements set out in the regulations, a registered nurse my do any of the following in the course of engaging in the practice of nursing: (a) order and receive reports of screening and diagnostic tests designated in the regulations; (b) prescribe drugs designated in the regulations; (c) perform minor surgical and invasive procedures designated in the regulations.	MANITOBA Registered Nurses Act S.M. 1999, c. 36 ( Not yet proclaimed-awaiting regulations)