I-8, r. 2 - Regulation respecting the professional activities which may be performed by persons other than nurses

Updated to 12 May 2016

This document has official status.

chapter I-8, r. 2

Regulation respecting the professional activities which may be performed by persons other than nurses

Nurses Act

(chapter I-8, s. 3).

Professional Code

(chapter C-26, s. 94, par. h).

DIVISION I GENERAL

1. The purpose of this Regulation is to determine the professional activities that nurses may perform that may be carried out by the following persons:

(1)  a nursing student, namely, a person registered in a program of studies leading to a diploma giving access to the permit of the Ordre des infirmières et infirmiers du Québec, determined by regulation of the Government made under the first paragraph of section 184 of the Professional Code (chapter C-26);

(2)  a nursing extern, namely, a person who, up to 12 months ago, successfully completed the first 2 years of the college studies program, at least 34 credits of the university studies program of the Université de Montréal, at least 38 credits of the university studies program of the Université du Québec à Trois-Rivières, at least 36 credits of the university studies program of the Université de Sherbrooke or at least 60 credits of another university studies program leading to a diploma giving access to the permit of the Order;

(3)  a person eligible by equivalence, namely, a person registered in a program of studies or a period of additional training required for the purpose of obtaining equivalent training;

(4)  a candidate for the profession of nursing, namely, a person who holds a diploma giving access to the permit of the Order or for whom the Order has recognized an equivalence of a diploma or training.

For the purposes of this Regulation, a care unit means a care unit that is not extended over several sites.

O.C. 551-2010, s. 1; O.C. 332-2016, s. 1.

2. Any person performing professional activities under this Regulation must perform them in compliance with the ethical obligations applicable to members of the Order.

O.C. 551-2010, s. 2.

DIVISION II NURSING STUDENT

3. A nursing student may carry out the professional activities that nurses may perform that are required to complete the program of study in which she is registered, with the exception of the adjustment of the therapeutic nursing plan, when the following conditions have been met:

(1)  she performs them as part of the program of study;

(2)  she performs them under the supervision of a nurse who supervises the training period and who is present in the care unit concerned in order to rapidly intervene.

O.C. 551-2010, s. 3.

4. The nursing student shall record her interventions in the patient’s record with her signature, followed by “student n.”. If her signature cannot be clearly identified, she shall write her name in block letters after it.

O.C. 551-2010, s. 4.

DIVISION III NURSING EXTERN

5. A nursing extern may carry out the professional activities that nurses may perform that are listed in Schedule I in a general and specialized hospital centre, in a residential and long-term care centre and in a rehabilitation centre for persons with physical disabilities, operated by a public institution or a private institution under agreement within the meaning of the Act respecting health services and social services (chapter S-4.2) or the Act respecting health services and social services for Cree Native persons (chapter S-5), when the following conditions have been met:

(1)  the director of nursing of the institution is in charge of the nursing externship and identifies, for each nursing extern, a nurse to whom she may refer throughout her nursing externship so as to facilitate her integration into the clinical environment and the consolidation of her knowledge;

(2)  the institution provides an integration program lasting at least 3 weeks; the program shall make it possible for the nursing extern to become familiar with the institution’s policies and directives, to perfect the knowledge and skills necessary to perform the activities provided for in Schedule I, according to the care methods to be applied for that purpose, and, under the supervision of a nurse, to demonstrate her ability to perform them;

(3)  the institution has rules of care that are issued by the director of nursing.

However, a nursing extern may not perform these activities in the following places and sectors of activity: intensive care, the coronary care unit, the operating suite, the recovery room, the intermediate care unit, the delivery room, neonatology and short-term psychiatric units and services.

For the purposes of this Division, a nursing externship corresponds to the period during which the nursing extern performs the activities provided for in the first paragraph.

O.C. 551-2010, s. 5; O.C. 332-2016, s. 2.

6. To perform the activities provided for in section 5, a nursing extern must comply with the following conditions:

(1)  she must provide the Order with an attestation, issued by an educational institution, that she is a nursing extern;

(2)  she must provide the Order with an attestation, issued by an institution referred to in section 5, that it retained her services;

(3)  she must successfully complete the integration program provided for in subparagraph 2 of the first paragraph of section 5;

(4)  she performs these activities:

(a)  under the conditions provided for in Schedule I;

(b)  under the supervision of a nurse who is in charge of the patient and who is present in the care unit concerned in order to intervene immediately;

(c)  with a patient whose state of health is not in a critical phase or does not require frequent adjustments;

(d)  from 15 May to 31 August and from 15 December to 20 January.

O.C. 551-2010, s. 6.

7. The nursing extern shall record her interventions in the patient’s record with her signature, followed by “nurs. ext.”. If her signature cannot be clearly identified, she shall write her name in block letters after it.

O.C. 551-2010, s. 7.

DIVISION IV PERSON ELIGIBLE BY EQUIVALENCE

8. A person eligible by equivalence may carry out the professional activities that nurses may perform that are required to complete the program of studies or the additional training required for the purpose of obtaining equivalence training, with the exception of the adjustment of the therapeutic nursing plan, when the following conditions have been met:

(1)  she performs them as part of the program of studies or additional training;

(2)  she performs them under the supervision of a nurse who is present in the care unit concerned in order to rapidly intervene.

O.C. 551-2010, s. 8.

9. A person eligible by equivalence shall record her interventions in the patient’s record with her signature, followed by “p.el.eq., nurs.”. If her signature cannot be clearly identified, she shall write her name in block letters after it.

O.C. 551-2010, s. 9.

DIVISION V CANDIDATE TO THE PROFESSION OF NURSING

10. A candidate for the profession of nursing may carry out all the professional activities that nurses may perform, with the exception of:

(1)  activities involving a person about to give birth;

(2)  activities involving a client whose state of health is in a critical phase or who requires frequent adjustments;

(3)  community health activities;

(4)  initiating diagnostic and therapeutic measures, according to a prescription;

(5)  initiating diagnostic measures for the purpose of a screening operation under the Public Health Act (chapter S-2.2);

(6)  determining the treatment plan for wounds and alterations of the skin and integuments;

(7)  performing vaccinations as part of a vaccination operation under the Public Health Act;

(8)  making decisions as to the use of restraint measures;

(9)  making decisions as to the use of isolation measures under the Act respecting health services and social services (chapter S-4.2) and the Act respecting health services and social services for Cree Native persons (chapter S-5);

(10)  assessing a child not yet admissible to preschool education who shows signs of developmental delay, in order to determine the rehabilitation and adjustment services required;

(11)  adjusting the therapeutic nursing plan for the activities described in paragraphs 1 to 10.

A candidate for the profession of nursing may, despite the exception provided in paragraph 7, take part in the vaccination procedure forming part of a vaccination operation under the Public Health Act.

In addition, the exceptions provided in paragraphs 2, 3 and 10 do not apply to a candidate for the nursing profession who holds a university diploma or for whom the Order has recognized an equivalence to this diploma.

O.C. 551-2010, s. 10; O.C. 332-2016, s. 3.

11. To perform the professional activities provided in section 10, the candidate for the profession of nursing, who holds a registration certificate, shall comply with the following conditions:

(1)  she holds an attestation, issued by the Order, that:

(a)  she has a diploma giving access to the permit of the Order or she has been granted diploma or training equivalence;

(b)  she has informed the Order of the address of her main residence and the contact information for her employer;

(2)  she performs these activities for a centre operated by a public institution or a private institution under agreement within the meaning of the Act respecting health services and social services (chapter S-4.2) or the Act respecting health services and social services for Cree Native persons (chapter S-5) when the following conditions are met:

(a)  the institution has appointed a Director of Nursing, who assumes responsibility for the candidate’s performance of the activities;

(b)  the institution has rules of care that are issued by the director of nursing;

(c)  the director of nursing identifies, for each candidate, a nurse to whom she may refer throughout the performance of her activities so as to facilitate her integration into the clinical environment and the consolidation of her knowledge;

(d)  the institution provides an integration program making it possible for the candidate to become familiar with the institution’s policies and directives, to consolidate the knowledge and skills necessary to carry out these activities and to demonstrate her ability to perform them;

(3)  she has successfully completed the integration program referred to in subparagraph d of paragraph 2;

(4)  she performs these activities under the supervision of a nurse who is present in the care unit concerned in order to intervene immediately or to respond rapidly to the candidate’s request. In community health, she performs these activities under the supervision of a nurse.

O.C. 551-2010, s. 11; O.C. 332-2016, s. 4.

12. A candidate for the profession of nursing shall record her interventions in the patient’s record with her signature, followed by “CPN”. If her signature cannot be clearly identified, she shall write her name in block letters after it.

O.C. 551-2010, s. 12.

13. A candidate for the profession of nursing is authorized to perform the professional activities provided for in section 10 until the first of the following occurs:

(1)  she does not pass the professional examination by the time limit provided for in the Regulation respecting the terms and conditions for the issue of permits by the Ordre des infirmières et infirmiers du Québec (chapter I-8, r. 13);

(2)  she fails the professional examination 3 times;

(3)  more than 30 days elapse after the date on which the permit of the Order is issued;

(4)  more than 4 years elapse after the first professional examination session that follows the date on which she obtained her diploma giving access to the permit of the Order or the date of the decision of the Order to recognize her equivalent diploma or training for the purposes of issuing a permit.

O.C. 551-2010, s. 13.

DIVISION VI TRANSITIONAL AND FINAL PROVISIONS

14. This Regulation replaces the Regulation respecting the professional activities which may be performed by persons other than nurses (O.C. 849-97, 97-05-25) and the Regulation respecting the professional acts that may be performed by a nursing extern on certain terms and conditions (O.C. 512-2000, 2000-04-19).

O.C. 551-2010, s. 14.

15. A candidate for the profession of nursing who carried out the professional activities provided for in the Regulation respecting the professional activities which may be performed by persons other than nurses (O.C. 849-97, 97-06-25) shall have eight weeks as of 22 July 2010 in which to obtain from the Order the attestation referred in paragraph 1 of section 11 of this Regulation.

O.C. 551-2010, s. 15.

16. (Omitted).

O.C. 551-2010, s. 16.

SCHEDULE I

(s. 5)

PROFESSIONAL ACTIVITIES THAT MAY BE PERFORMED BY A NURSING EXTERN

(1) Apply the following invasive measures for the maintenance of therapeutic equipment:

(1.1) irrigate a nasogastric tube;

(1.2) irrigate a nasoduodenal tube;

(1.3) irrigate a gastrostomy tube;

(1.4) irrigate a jejunostomy tube;

(1.5) maintain an indwelling urinary drainage system;

(1.6) give tracheostomy care.

(2) Take the following samples, according to a prescription:

(2.1) blood;

(2.2) urine;

(2.3) stool;

(2.4) wound exsudate;

(2.5) tracheal secretions;

(2.6) gastric secretions;

(2.7) vaginal secretions.

(3) Provide care and treatment related to the wounds and alterations of the skin and integuments, according to a prescription or according to the nursing treatment plan, in the following cases:

(3.1) do an aseptic dressing, including a drain or packing;

(3.2) apply a dressing to prevent and treat pressure lesions (stages 1 and 2);

(3.3) remove staples and sutures;

(3.4) provide intestinal stomy care (colostomy, ileostomy);

(3.5) provide care around the periphery of a gastrostomy, jejunostomy, cystostomy and nephrostomy tube.

(4) Check neurological, neurovascular and vital signs.

(5) Mix substances to complete the preparation of a medication, according to a prescription.

(6) Administer, according to the indicated route, the following medication or substances, when they are prescribed and, in the case of PRN medication, when the patient’s state has been assessed by a nurse beforehand:

(6.1) oxygen, via the respiratory tract;

(6.2) a medication or substance other than a serum, a medication related to a research protocol, a substance related to allergy tests or a subcutaneous anesthetic substance:

(6.2.1) by oral and sublingual route;

(6.2.2) by nasogastric and gastrostomy tube if the tube is in place;

(6.2.3) by nasal, ophthalmic and otic route;

(6.2.4) by topical route;

(6.2.5) by vaginal and rectal route;

(6.2.6) by intradermal, subcutaneous and intramuscular route, after verification by a nurse;

(6.2.7) by respiratory tract;

(6.3) a drug or other controlled substance, by oral, rectal, intradermal, transdermal, subcutaneous and intra-muscular route, after verification by a nurse.

(7) Take part in the vaccination procedure forming part of a vaccination operation under the Public Health Act (chapter S-2.2).

(8) Provide the following medical treatments, according to a prescription:

(8.1) install a nasogastric tube;

(8.2) perform a gastric residue;

(8.3) administer enteric feeding;

(8.4) perform aspiration of nasopharyngeal secretions;

(8.5) install, change or remove a urinary catheter;

(8.6) perform a bladder catheterization;

(8.7) monitor an irrigation of the bladder;

(8.8) give an enema;

(8.9) give a colostomy enema;

(8.10) install a butterfly needle for an intermittent subcutaneous injection or for a perfusion by subcutaneous route;

(8.11) install a short peripheral intravenous catheter measuring less than 7.5 cm;

(8.12) administer an intravenous solution without additives, using a short peripheral intravenous catheter measuring less than 7.5 cm, when the solution has been checked beforehand by a nurse;

(8.13) install and irrigate with an isotonic solution a short, intermittent injection, peripheral intravenous catheter measuring less than 7.5 cm.

O.C. 551-2010, Sch. I; O.C. 332-2016, s. 5.

SCHEDULE II

(s. 10)

(Revoked).

O.C. 551-2010, Sch. II; O.C. 332-2016, s. 6.

REFERENCES

O.C. 551-2010, 2010 G.O. 2, 1906

O.C. 332-2016, 2016 G.O. 2, 1835