Happy Nursing Week 2017


Happy Nursing Week

National Nursing Week provides an opportunity to reflect on the important contributions Canadian nurses make to health care and to their patients. On behalf of all of us at the Canadian Nurses Protective Society (CNPS), thank you for making a difference.

We invite you to follow us on social media or visit this page to see our daily posts this week. During Nursing Week, we will be featuring several Ask a Lawyer articles, inspiring nurse stories and videos.

Facebook imageLinkedIn imageTwitter image

 

Monday, May 8

Watch a video message from the CNPS President, Mary Ellen Gurnham

 

Ask a lawyer: Social media

Question:  A nurse working in primary care receives a “friend” request on her Facebook site from someone with a familiar-sounding name. The picture accompanying the request is of a lakeside sunset, so she cannot tell who sent the request. Because the name sounds familiar, she accepts the request. After going through the requestor’s profile, she realizes the “friend” is a patient. The next day, she receives a message from the patient commenting on photos the nurse had posted of her and her friends drinking margaritas on the beach in Mexico. What should she do?

Answer:  Professional practice standards regarding confidentiality, therapeutic boundaries and professional image are engaged when nurses use social media in connection with their professional activities. Many institutions and health authorities have policies regarding social media and patient privacy and the failure to abide by these governing standards and policies can lead to serious legal consequences.

Even where there is no clear policy prohibiting the practice, nurses should consider declining “friend” requests from current or former patients, as communicating with clients through social media sites may extend the scope of professional responsibility. The fact that information in electronic form is easily distributed, archived, and downloaded leaves little control over who sees the information posted on social media sites. In addition, accepting a “friend” request from a patient can adversely affect the nurse-patient therapeutic relationship. Nurses who allow patients to access their entire profile allow them to access information beyond what would normally be shared in a professional nurse-patient relationship.

With respect to the content posted on this nurse’s personal social media page, nurses are reminded that postings to social media sites are generally permanent records that cannot easily be deleted. There exists anecdotal evidence that an increasing number of employers check social networking profiles of current and prospective employees looking for information that could be interpreted as reflecting negatively on the organization or as misconduct or inappropriate behaviour on the part of employees.

If a patient does request you as a “friend” on a social networking site, a polite message responding that it is not your practice to establish online relationships with patients is appropriate. In this case, the nurse could simply send a similar message to the patient indicating that the “friend” request was accepted in error and “unfriend” the patient.

For more information, see our CNPS infoLAW on Social Media.

Back to top

Tuesday, May 9

"If not you, then who?" Julie Fraser, CNPS Board member from British Columbia, shares why nurses should get involved in nursing organizations.

 

Ask a lawyer: Mature minor

Question:  I am a nurse practitioner and my patient Jane is a 15-year old female who requires IV antibiotics for a foot infection. Jane lives away from home, attends school and is otherwise in good health. Is she capable of consenting to treatment, or must I obtain parental consent?

Answer: The issue of consent is complex and will vary across Canadian jurisdictions.

A key component of obtaining valid consent is that the person providing it must be capable of consenting. Canadian law generally[1] reflects that the capacity to make a decision is not tied strictly to age but is a function of maturity and ability of the patient to understand the nature of the decision to make and consequences of accepting or declining treatment.[2] This is known as the Common Law Mature Minor Doctrine.

The manner in which this assessment is to be undertaken and what criteria may be used to deem a minor a mature minor are not prescribed. One appropriate option to test the understanding of a young patient is the “teach-back” technique. This involves asking the patient to re-phrase and summarize what the practitioner has told them about the medical situation, the risks of treatment options and the intended results.

Factual circumstances may also be taken into consideration. In Jane’s case, such factors may include the following:

  • she has presented herself for treatment,
  • she wishes to undertake the appropriate treatment,
  • the infection may be easily treatable,
  • the treatment is minimally invasive, and
  • she is generally living a life independent from her parents.

Even if you deem Jane to be a mature minor, you would use your professional judgement to determine whether it would be appropriate to encourage her to choose to involve a parent. For example, Jane may wish to involve her parents in the decision-making process as part of making appropriate arrangements for follow-up care.

For your protection, it is essential to document the assessment of your patient and note the factors you have considered in reaching your opinion as to whether Jane has sufficient maturity to provide consent for IV treatment of her infection. Given the increased risks of obtaining consent from a minor, if you decide to deem Jane a mature minor, it is advisable that you have the written consent witnessed.

CNPS beneficiaries can call 1-844-4MY-CNPS (1-844-469-2677) to discuss specific questions regarding obtaining consent from minors with a CNPS legal advisor.


[1] Two exceptions are New Brunswick and Quebec. New Brunswick’s Medical Consent of Minors Act states that minors 16 years or older have the right to consent or refuse treatment as if they had reached the age of majority. If younger than 16 years, the patient may provide valid consent if the attending physician, nurse practitioner or nurse believe that the young patient is capable of making such a decision. In Quebec, the Civil Code provides that a youth 14 years and older can consent to care. However, parental or guardian authority is also required if the patient is seeking care that is not medically required and that carries a health risk. Exceptions exist in all jurisdictions for emerging health situations.

[2] For further information, please see Consent to Treatment: The Role of the Nurse, infoLAW Vol. 3, No 2, December 1994.

Back to top

Inspiring Nurse: Maike van Niekerk

Maike van Niekerk

After losing her mother to cancer, Maike van Niekerk was inspired to help others undergoing cancer treatment. While studying for her Bachelor of Science in Nursing at Dalhousie University, Maike started a charity, Katrin’s Karepackage, to help cancer patients pay for the travel costs associated with treatment.

To launch the charity, Maike biked more than 1,000 kilometres across Newfoundland to symbolize the long distances some patients need to travel to access treatment. To publicize the charity, Maike ran seven consecutive marathons across Newfoundland the next year, and to date, has raised more than $110,000 for cancer patients.

To say that Maike is an exceptional young woman is an understatement. Named as one of Canada’s Top 20 Under 20, she continues to volunteer for numerous charities, and has earned several scholarships and awards for her academic and humanitarian accomplishments. In the fall of 2017, this inspiring nurse will continue her studies as a Rhodes Scholar at Oxford University with the goal of improving the psychological well-being of patients.

“I told my mother, ‘I will never stop fighting in your memory.’ And I haven’t.”

Back to top

 

Wednesday, May 10

Inspiring Nurse: Janet Weber, NP

Janet WeberNurse practitioner Janet Weber led a successful effort to improve access to primary health-care services in rural New Brunswick. A Nursing Officer in the Canadian Armed Forces for more than two decades, Janet served on bases across Canada and in Bosnia.

After retiring in 2007, Janet returned to her native province where she began working as a civilian NP at Canadian Forces Base (CFB) Gagetown. She was surprised to discover that members of the Canadian Armed Forces received health-care services, but their families did not. Lengthy waiting lists to see a family doctor, for everything from cancer treatments to prenatal care, prompted Janet to act.

Janet, who had enrolled in a Master of Nursing program, began focusing some of her studies on advocating for better health care for CFB Gagetown families. “One of my courses involved proposal writing, so I got right to work.”

Janet began petitioning the regional health authority, the province and the Government of Canada to act. Her advocacy and proposal writing eventually paid off. After five years, a small clinic opened at the Oromocto Hospital. Two years later, a larger clinic opened to serve the Oromocto community, and included two full-time nurse practitioners, a registered nurse, a social worker and a part-time dietician.

“This is home for me now,” she says, “and it’s great to feel that I’ve helped to make a difference in my community.”

Back to top

Ask a Lawyer: Parent’s Request for Minor’s Health Records

Question:  I am a nurse who is employed at a primary care clinic. I have recently become aware that the parents of a 10-year-old patient have divorced. The father is now requesting a copy of the child’s health records. Is he entitled to receive a copy of the records? What should I do?

Answer: The father’s ability to receive a copy of the child’s records will generally depend on whether the child has the capacity to consent to the management of their health information.[1] If the child is capable of managing their own personal health information, the child generally must provide consent before a copy of the health records is released. Furthermore, it is important to note that the father’s ability to receive a copy of the child’s health records will also depend on whether there is legal authority, such as a court order or subpoena authorizing the release, that allows its release without the consent of a child who has the capacity to manage health information.[2]

If the child is incapable of consenting to the management of their health information, the father’s access will depend on whether he has custodial or access rights to the child. If he has custodial rights, he generally has full access rights to the child’s personal health information and is entitled to a copy of the child’s health record. Alternatively, if the father has access rights, then his right to receive a copy of the records will depend on the governing privacy legislation, the legislation governing access parents’ rights and any relevant court order or agreement regarding access or custody. In some situations, you may want to confirm the parent’s access rights by requesting a copy of any relevant court order or agreement regarding access or custody.

If you receive a request to release copies of personal health records, consider whether you are the best person to handle the request. Typically, health-care institutions are considered the custodians or trustees of personal health records, and an employee nurse is considered an affiliate. The affiliate must comply with the custodian or trustee’s policies and procedures, which are based on privacy law, regarding the disclosure of personal health information. Many health-care institutions have privacy departments or designated individuals who are responsible for managing requests for access to personal health information. In situations where there is no employer policy in place, or the policy does not identify who is authorized to respond to these requests, seek direction from your employer about how best to proceed. Document the request and your actions in the patient’s health record.

CNPS beneficiaries can call 1-844-4MY-CNPS (1-844-469-2677) to speak with a CNPS legal advisor about specific requests for the release of a child’s health records to a custodial or access parent.


[1] CNPS beneficiaries can contact the CNPS for more information on a minor’s ability to consent to the release of their own personal health information.

[2] Please see Confidentiality of Health Information (October 2008, Revision of September 1993).

Back to top

Thursday, May 11

Inspiring Nurse: Courtney Bercan

Courtney BercanAt the age of 19, Courtney Bercan was inspired to become a registered nurse when she heard about Doctors Without Borders—the independent agency that delivers emergency medical and humanitarian relief.  After becoming a nurse, Courtney worked in several northern British Columbia communities with limited diagnostic equipment and support. Although these challenges helped her become more resourceful and autonomous, nothing could prepare her for the challenges she would face during her overseas missions with Doctors Without Borders.

For her first mission, Courtney worked in the Democratic Republic of Congo, where she supported a medical team treating children with severe illnesses. Her second assignment involved four months on an aid ship that rescued migrants making the perilous journey across the Mediterranean Sea to Europe.

“I find it humbling to treat people in such dire situations. I know that if I wasn’t lucky to be born where I was, I could be in their shoes. By helping, I feel that I can make a positive contribution to society. It’s not easy work, but it’s an honour to be able to do it.”

Back to top

 

Ask a Lawyer: EMR Independent Practice

Question:  I have an independent foot-care practice and have been using paper charting but am considering starting to chart in a Word document on my laptop. Is this appropriate?

Answer: In every Canadian province or territory, there is legislation to protect the privacy of personal health information (PHI). These laws create obligations as to how the PHI that is normally found in health records can be collected, used and disclosed. These laws also provide guidelines for storing and securing such information.

Usually, this legislation requires the appointment of a “custodian” or “trustee” that has the responsibility to ensure that all the requirements of the privacy legislation are met. For nurses who are employees of a health-care organization, their employer typically takes on that role. However, nurses in independent practice are often considered the legal custodians of the health information and must ensure that the manner in which they collect and store patients’ PHI follows applicable privacy legislation.

In privacy laws, the specific requirements dealing with the storage and security of PHI vary between jurisdictions. However, as a general guideline, the custodian must ensure that the PHI is secure regardless of whether paper or electronic records are used. This may include putting in place a number of safeguards to prevent improper access to PHI. As for electronic records, privacy standards typically require the encryption of electronic files and communications to ensure the security of PHI in the possession of the custodian. Encryption is a process of encoding a message or information in such a way that only authorized parties can access it. Implementing password protection on computers is another minimum safeguard.

In certain jurisdictions, there are additional requirements regarding the electronic storage of PHI. For example, some jurisdictions require that electronic records have the ability to be audited or to create a record of user activity. Because of these requirements, word processing applications like Microsoft Word may not be appropriate. As a nurse in independent practice, you should ensure that your electronic record-keeping follows your regulatory body's standards and all relevant legislation.  

CNPS beneficiaries can call 1-844-4MY-CNPS (1-844-469-2677) to discuss privacy issues with a CNPS legal advisor.

Back to top

 

Friday, May 12

"Canadian nurses are the envy of international nurses." Jackie MacLaren, CNPS Board member, talks about the CNPS Advantage.

 

Thank you!

On Florence Nightingale's birthday, we wish all nurses a Happy International Nurses Day! You inspire us every day. Thank you! #YesThisIsNursing

Thank you

 

Upcoming Webinars & Events

Upcoming webinars image

 

September 13, 2017 - L’infirmière, la documentation et le droit (French-language webinar)

 

September 14, 2017 - Legal Risks for New Grads

 

October 11, 2017 - Public Health and Community Nursing and the Law

 

November 8, 2017 - RN Prescribing and Risk Management