I would describe my current role as a Nurse Case Manager as patient support based. I am the primary point of contact for physicians, nurses and patients. I coordinate and manage all aspects required in order to obtain prescription drug coverage for patients and assist a patient in their journey on treatment. I coordinate clinic appointments and drug deliveries within timelines. I proactively offer counseling, advocacy and assistance for patients. I also complete adherence checks and report any adverse events.

The CNO Scope of Practice provides outlines of the legislated scope of nursing practice for nurses. The activities that a nurse has authority to perform while adhering to the Nursing Act and the RHPA.

An example of how a nurse could use the standard to help make patient care decisions in this type of role would be by following the key concept of Competence. My role doesn’t involve hands on physical care of patients. It is a teaching and educating role. I must ensure that the information I am giving patients and their families is factual, and evidence based. I must have the knowledge to be able to answer questions and discuss their treatment plan in full detail and provide ongoing support. I must be accountable for the information and resources that I am providing and ensure that patients fully understand how to administer their treatment.

In explaining my role as a nurse, the environment in which this practice occurs is identified as a retirement residence providing support that enhances the activities of daily living and wellbeing. As a nurse in this environment, my role is to oversee the general wellbeing of the community of residents , staff, and visitors onsite. This not only includes the supervision of proper administration of medications but also the wellness status of the individual resident. As the population in this community is experiencing advancing stages of dementia, providing the individual with support with coping with their awareness of diminishing cognition, compassionate care in situations where the resident is experiencing episodes of sundowning, or misunderstanding of their actual capabilities versus their perceived ability. This involves aspects of positive reinforcement of the individual’s mental health status. Monitoring and assessing ongoing critical conditions and reporting adverse effects and implement redeeming interventions including contact with the tending physician and family as necessary. Finally, to assist where needed when working with the intra & inter-professional teams in order to ensure a safe, harmonious home setting for all residents building confidence with their families that their loved-one is in the right facility.
As a new nurse, the Scope of Practice is a life-line resource. The grey areas that come up during the typical day that need to be clarified because my willingness to learn new skills and grow into an expert nurse could be misguided. Reflecting on the adage, ignorance is bliss, in nursing it could cost someone’s life and my license to practice. So, walking the straight and narrow line of adherence is important to me. I have experienced frustration and resistance from experienced nurses who may not be as compliant which I find a challenge, but I persist in ensuring that all persons are safe in all aspects that a nurse is responsible. I want to be able to go to sleep knowing I did my best. The scope of practice and the entry to practice competencies combine to support who I am as a nurse and guides how my practice evolves.

I would describe my role as an RPN working for a family doctors office for a family health team. I started in 2009 mainly bringing patients back to rooms for the doctors or NP, doing vital signs and assessment of what they came in to see their doctor for and setting up the right equipment for the visit. I also administered any vaccines needed and ran flu vaccine clinics every fall.
Over the years my role has expanded with more tasks such as staple/suture removal, ear syringing, strep throat assessment, urinary tract infection assessment, wound care, diabetic visits with the patients and prenatal care on top of bringing patients to rooms as I has started out doing.
My role is always expanding and I enjoy learning new ways to help the doctors and NP’s provide the best possible care to the patients in our community.

How a nurse would use the CNO practise standard in my current role would for example be when we implemented the nurses seeing patients to assess for UTI’s or strep throat we had a clear directive made up for the nurses to look over and follow that had been signed by our MD’s of the office. The nurses were also to observe at least three UTI’s and strep throat encounters with either the MD’s or NP and then have three of each signed off by an MD observing us perform the assessments. In our directive we can not prescribe so we do the assessment and present to the MD we are working with with the assessment and they will send the Rx if needed to the pharmacy for us.

My role is a nurse practitioner and leader. I help patients through their health and wellness journey.

As a leader, I help the people I work with through their career journey. I work with a group of RPNs, that we have trained and mentored to optimize their scope of practice. We use the Scope of Practice document routinely, using the 3 levels – authority, context and competence. I help our nursing team (nurse practitioner and RPNs) navigate scope of practice and help them work well together. We have developed directives for RPNs to work under also. I’ve seen our team grow and mature. It is wonderful to see how my team works with each other and how much they are helping the patients.