I-8, r. 8 - Regulation respecting the classes of specialization of specialized nurse practitioners

Updated to 8 March 2018

This document has official status.

chapter I-8, r. 8

Regulation respecting the classes of specialization of specialized nurse practitioners

Nurses Act

(chapter I-8, ss. 3 and 14, par. f).

Professional Code

(chapter C-26, ss. 93, pars. c and c.1 and 94.1).

O.C. 997-2005; O.C. 85-2018, s. 1.

DIVISION I GENERAL PROVISIONS AND DEFINITIONS

1. The purpose of this Regulation is to regulate the classes of specialization to which members of the Ordre des infirmières et infirmiers du Québec must belong to engage in activities referred to in section 36.1 of the Nurses Act (chapter I-8). It sets out other terms and conditions for the issue, by the board of directors of the Ordre des infirmières et infirmiers, of specialist’s certificates of specialized nurse practitioners.

Its purpose is also to regulate the issue of training cards to specialized nurse practitioner students or attestations of practice to specialized nurse practitioner candidates, and to determine the professional activities they may engage in under certain terms and conditions.

O.C. 997-2005, s. 1; O.C. 79-2014, s. 1; O.C. 85-2018, s. 2.

2. In this Regulation,

(1)  “specialized nurse practitioner student” means a nurse:

(a)  who is registered in a graduate-level training program leading to a degree granting access to a specialist’s certificate of specialized nurse practitioners;

(b)  who is required to take training for the purpose of obtaining equivalence in accordance with the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2);

(1.1)  “specialized nurse practitioner candidate” means a nurse who is eligible to sit the specialty examination corresponding to the class of specialization concerned, as set out in Division III;

(2)  (paragraph revoked).

The costs payable under this Regulation are those prescribed by the board of directors of the Order, pursuant to paragraph 8 of section 86.0.1 of the Professional Code (chapter C-26).

O.C. 997-2005; O.C. 669-2007, s. 1; O.C. 79-2014, s. 2; O.C. 85-2018, ss. 3, 16 and 17.

3. The classes of specialization of specialized nurse practitioners are as follows:

(1)  nurse practitioner specializing in neonatology;

(2)  nurse practitioner specializing in adult care;

(3)  nurse practitioner specializing in pediatric care;

(4)  nurse practitioner specializing in primary care;

(5)  nurse practitioner specializing in mental health.

O.C. 997-2005, s. 3; O.C. 669-2007, s. 2; O.C. 85-2018, s. 4.

4. A specialist’s certificate related to one of the classes of specialization set out in section 3 shall be issued to a nurse who meets the following conditions:

(1)  she holds a diploma recognized by government regulation, pursuant to the first paragraph of section 184 of the Professional Code (chapter C-26), granting access to a specialist’s certificate of specialized nurse practitioners, or has been recognized as possessing equivalence, as set out in Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2);

(2)  if specializing in neonatology, a training certificate in neonatal resuscitation issued by the Canadian Paediatric Society;

(3)  she passes the specialty examination corresponding to the class of specialization concerned, as set out in Division III;

(4)  (paragraph revoked);

(5)  (paragraph revoked).

O.C. 997-2005, s. 4; O.C. 79-2014, s. 3; O.C. 85-2018, ss. 5, 16 and 17.

DIVISION II TRAINING CARDS AND ATTESTATIONS OF PRACTICE

O.C. 997-2005, Div. II; O.C. 79-2014, s. 4.

5. Specialized nurse practitioner students who hold a training card and specialized nurse practitioner candidates who hold an attestation of practice may perform professional acts referred to in the Regulation respecting specialized nurse practitioners (chapter M-9, r. 23.1), provided that she complies with the terms and conditions set out therein.

O.C. 997-2005, s. 5; O.C. 669-2007, s. 3; O.C. 79-2014, s. 5; O.C. 85-2018, s. 6.

§ 1 . — Training cards

O.C. 79-2014, s. 6.

6. A training card shall be issued by the secretary of the Order to a specialized nurse practitioner student who meets the following conditions:

(1)  she is registered in a graduate-level training program leading to a diploma granting access to a specialist’s certificate of specialized nurse practitioners or has been assigned a training site required for the purpose of obtaining equivalence pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2), among those in the list drawn up by the program review subcommittee in accordance with the Regulation respecting the committees on training of the Ordre des infirmières et infirmiers du Québec (chapter I-8, r. 11);

(2)  she pays the required fee for the purpose of obtaining a training card;

(3)  if specializing in neonatology, she holds an attestation of training as set out in subparagraph 2 of section 4.

O.C. 997-2005, s. 6; O.C. 669-2007, ss. 4, 17 and 18; O.C. 79-2014, s. 7; O.C. 85-2018, ss. 16 and 17.

7. The training card shall indicate the name of the specialized nurse practitioner student and, as applicable, the educational institution where she is enrolled or the site where she is serving her clinical training period.

The card is valid for a period of 12 months and is renewable. It expires on the date when the specialized nurse practitioner student is no longer enrolled in the graduate-level training program leading to a degree granting access to a specialist’s certificate of specialized nurse practitioners, or has completed the clinical training period for the purpose of obtaining equivalence pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2).

O.C. 997-2005, s. 7; O.C. 79-2014, s. 8; O.C. 85-2018, ss. 16 and 17.

§ 2 . — Attestation of practice

O.C. 79-2014, s. 9.

7.1. An attestation of practice shall be issued by the secretary of the Order to a specialized nurse practitioner candidate who:

(1)  holds a diploma recognized by government regulation, pursuant to the first paragraph of section 184 of the Professional Code (chapter C-26), granting access to a specialist’s certificate of specialized nurse practitioners, or has been recognized as possessing equivalence, pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2);

(2)  if specializing in neonatology, holds the training certificate as set out in paragraph 2 of section 4;

(3)  must provide the Order with an attestation, issued by an institution, that it has retained her services;

(4)  pays the required fee for the purpose of obtaining an attestation of practice.

O.C. 79-2014, s. 9; I.N. 2014-04-01; O.C. 85-2018, ss. 16 and 17.

7.2. The attestation of practice shall indicate the name of the specialized nurse practitioner candidate, the class of specialty in question and the name of the institution that has retained her services.

The attestation is valid for a period of 12 months and is renewable. It expires on the date when the specialized nurse practitioner candidate is no longer eligible to sit the specialty examination, in accordance with Division III.

O.C. 79-2014, s. 9.

DIVISION III SPECIALTY EXAMINATION

§ 1 . — Eligibility

8. Nurses who meet the conditions set out in paragraphs 1 and 2 of section 4 shall be eligible to sit the specialty examination.

O.C. 997-2005, s. 8.

9. Nurses eligible to sit the specialty examination must sit the first session of the examination following the date on which they obtain their diploma or the date on which they are granted diploma or training equivalence, pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2).

If the nurse fails an examination, she shall sit the examination at the session following the session in which she failed.

O.C. 997-2005, s. 9; O.C. 669-2007, s. 5; O.C. 79-2014, s. 10; O.C. 85-2018, ss. 9 and 16.

9.1. The obligation provided in the first paragraph of section 9 does not apply to a nurse who has been recognized as possessing equivalence pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste de l’Ordre des infirmières et infirmiers du Québec pour l’exercice des activités visées à l’article 36.1 de la Loi sur les infirmières et les infirmiers fewer than 90 days preceding the date on which the specialty examination is held.

This nurse must sit the examination session following the one for which she would have had to register pursuant to the first paragraph of section 9.

O.C. 79-2014, s. 10.

9.2. The obligation provided in the first or second paragraph of section 9 or the one provided in the second paragraph of section 9.1 does not apply to a nurse who demonstrates to the Order that she did not sit the examination within the time period allowed because of a health problem, childbirth, the death of her father, mother, child or spouse, or unavoidable circumstances.

This nurse must sit the session of the examination following the date on which her incapacity ends.

O.C. 79-2014, s. 10.

9.3. Nurses eligible to sit the specialty examination must pass it within 3 years from the first examination session following the date on which they obtain their diploma or the date on which they are granted diploma or training equivalence pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2).

However, a person who demonstrates to the Order that she did not pass the examination within the time period allowed because of a health problem, childbirth, the death of her father, mother, child or spouse, or unavoidable circumstances shall have an additional time period determined by the Order. This period may not exceed 4 years from the first examination session following the date on which she obtained her diploma or the date of the decision by the Order granting her diploma equivalence or training equivalence pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste de l’Ordre des infirmières et infirmiers du Québec pour l’exercice des activités visées à l’article 36.1 de la Loi sur les infirmières et les infirmiers.

O.C. 79-2014, s. 10; O.C. 85-2018, s. 10 and 16.

9.4. For the application of section 9.2 and the second paragraph of section 9.3, a nurse who cannot sit the examination because of a health problem, childbirth or a death must provide the Order with a medical certificate, a birth certificate or a death certificate.

O.C. 79-2014, s. 10.

§ 2 . — Specialty Examination

10. The specialty examination shall cover the theoretical and clinical aspects of the class of specialization concerned. In particular, it shall assess, in various clinical situations, the assimilation and application of knowledge and skills acquired by the nurse, for the purpose of determining if she is able to practice independently as a specialized nurse practitioner in the class of specialization concerned.

O.C. 997-2005, s. 10; O.C. 85-2018, s. 11.

11. For all the classes of specialization or for each of them, an examination committee shall be formed by the Order’s board of directors. At least one member of the committee must be a physician.

O.C. 997-2005, s. 11; O.C. 79-2014, s. 11; I.N. 2014-04-01; O.C. 85-2018, s. 12.

12. The examination committee shall determine the orientations related to the development of the content of the specialty examination, approve the content of the specialty examination before each examination session, administer the examination and determine whether or not a nurse has passed the specialty examination.

The committee may retain the services of any person whose expertise is necessary to achieve its mandate.

O.C. 997-2005, s. 12; O.C. 85-2018, s. 13.

13. Examination sessions shall be held at least once per year, on the date and at the time and location determined by the board of directors of the Order.

O.C. 997-2005, s. 13.

14. To sit the specialty examination, a nurse must register at least 2 months prior to the date set for the examination session and pay the required fees.

O.C. 997-2005, s. 14.

15. A nurse may sit the specialty examination in French or English.

O.C. 997-2005, s. 15.

16. The board of directors of the Order shall send the nurse her examination results in writing.

O.C. 997-2005, s. 16.

17. Registration under false pretenses, fraud, plagiarism, participation in fraud or plagiarism or attempted fraud or plagiarism with respect to a specialty examination shall result in failure of the specialty examination, by decision of the board of directors of the Order. Within 15 days of its decision, the board of directors must notify the nurse of this decision in writing.

A nurse who fails the specialty examination for one of the reasons set out in the first paragraph may request a review of the decision rendered by the board of directors of the Order, provided that she files a written request with the Order secretary within 30 days of receipt of such decision.

At its first regular meeting following the date on which the request for review was received, the board of directors of the Order must examine this request. It must, before rendering a decision, allow the nurse to submit her comments at this meeting.

A nurse who wishes to attend the meeting in order to be heard must notify the secretary of the Order at least 5 days before the scheduled meeting date. The nurse may, however, submit her comments in writing to the secretary at any time before the scheduled meeting date.

The decision of the board of directors of the Order shall be final and must be sent to the nurse by registered mail within 30 days following the date of the meeting.

O.C. 997-2005, s. 17.

18. A nurse who fails the specialty examination may resit the examination twice.

The provisions of sections 10 to 17 regarding the specialty examination shall apply to the supplemental examination.

O.C. 997-2005, s. 18; O.C. 79-2014, s. 12.

§ 3 . — Request for review

19. A nurse who fails the specialty examination may request a review of the examination committee’s decision by the review committee if she believes that the cause of her failure involved a factor related to the examination procedure.

She must submit this request within 30 days following the date on which the examination results were received, and pay the required fees.

O.C. 997-2005, s. 19.

20. The review committee shall be composed of 3 members appointed by the board of directors of the Order.

O.C. 997-2005, s. 20; O.C. 79-2014, s. 13.

21. Review committee decisions shall be rendered by a majority of members.

O.C. 997-2005, s. 21.

22. Within 60 days of receipt of the request for review, the review committee may render one or several of the following decisions:

(1)  refuse the request for review;

(2)  cancel the nurse’s specialty examination and authorize her to sit a new specialty examination, at no additional cost, on a date set by the secretary of the Order, which will not be considered a supplemental examination within the meaning of section 18, and, as required, recommend that the composition of the examination committee for that examination be changed.

The board of directors of the Order shall notify the nurse, in writing, of the review committee’s decision, and this decision shall be final.

O.C. 997-2005, s. 22; O.C. 85-2018, s. 14.

DIVISION III.1 CONDITIONS OF PRACTICE

O.C. 85-2018, s. 15.

22.1. Before engaging in the professional activities referred to in section 36.1 of the Nurses Act (chapter I-8), a nurse who holds a specialist’s certificate of specialized nurse practitioner must provide to the secretary of the Order, not later than 1 April of each year and on the prescribed form, a statement that contains

(1)  the nurse’s class of specialization;

(2)  the name and membership number of the partner physicians with whom the nurse has signed a partnership agreement under the Regulation respecting specialized nurse practitioners (chapter M-9, r. 23.1);

(3)  the name, address and telephone number of the institution, clinic, dispensary or any other place where the nurse practises under the partnership agreement; and

(4)  the area of care where the nurse engages in the professional activities referred to in section 36.1 of the Nurses Act.

O.C. 85-2018, s. 15.

22.2. A nurse who holds a specialist’s certificate of specialized nurse practitioner must report to the secretary of the Order in writing any change in the information referred to in paragraphs 2 to 4 of section 22.1.

The change must be reported within 30 days of its occurrence, except if it concerns the area of care referred to in paragraph 4 of section 22.1. In the latter case, the nurse must report the new area of care at least 30 days before engaging in the professional activities referred to in section 36.1 of the Nurses Act (chapter I-8) in that area and establish that the nurse has updated the nurse’s knowledge to practise in that area.

O.C. 85-2018, s. 15.

DIVISION III.2 ADVISORY COMMITTEE ON THE PRACTICE OF SPECIALIZED NURSE PRACTITIONERS

O.C. 85-2018, s. 15.

22.3. An advisory committee on the practice of specialized nurse practitioners is established.

The committee’s mandate is to

(1)  examine generally the quality of the clinical practice of specialized nurse practitioners in the various classes of specialization, in particular with respect to

(a)  the quality of the prescription;

(b)  the quality of interventions; and

(c)  the quality of interprofessional collaboration;

(2)  recommend new clinical practices or improvements to respond to scientific developments and new conclusive data;

(3)  make recommendations to the board of directors of the Collège des médecins du Québec and to the board of directors of the Ordre des infirmières et infirmiers du Québec on the terms and conditions of practice of specialized nurse practitioners and on the amendments to be made to the regulations involving specialized nurse practitioners; and

(4)  analyze any issue related to the practice of specialized nurse practitioners and formulate opinions.

O.C. 85-2018, s. 15.

22.4. The committee is composed of the following 11 members:

(1)  1 representative of the College;

(2)  1 representative of the Order;

(3)  1 partner physician in acute care appointed by the College;

(4)  1 partner physician in primary care appointed by the College;

(5)  1 nurse practitioner specialized in primary care appointed by the Order;

(6)  1 nurse practitioner specialized in neonatology appointed by the Order;

(7)  1 nurse practitioner specialized in adult care appointed by the Order;

(8)  1 nurse practitioner specialized in pediatric care appointed by the Order;

(9)  1 nurse practitioner specialized in mental health appointed by the Order;

(10)  1 specialized nurse practitioner appointed by the Order with teaching responsibilities in a university training program for the practice of specialized nurse practitioners;

(11)  1 representative of the Direction nationale des soins et services infirmiers of the Ministère de la Santé et des Services sociaux.

The committee may retain the services of any person deemed necessary to achieve its mandate.

O.C. 85-2018, s. 15.

22.5. The quorum of the committee is 6 members, including 3 specialized nurse practitioners, 1 partner physician and the representatives of both orders.

O.C. 85-2018, s. 15.

22.6. The members of the committee are appointed for a 3-year term and remain in office until they are re-appointed or replaced.

O.C. 85-2018, s. 15.

DIVISION IV

(Revoked)

O.C. 997-2005, Div. IV; O.C. 79-2014, s. 14.

§§ 1.  — 

(Revoked)

O.C. 997-2005, Ssd. 1; O.C. 79-2014, s. 14.

23. (Revoked).

O.C. 997-2005, s. 23; O.C. 669-2007, s. 6; O.C. 79-2014, s. 14.

23.1. (Revoked).

O.C. 669-2007, s. 7; O.C. 79-2014, s. 14.

24. (Revoked).

O.C. 997-2005, s. 24; O.C. 669-2007, s. 8; O.C. 79-2014, s. 14.

§ 2 . —

(Revoked)

D. 997-2005, Sd. 2; O.C. 79-2014, s. 14.

25. (Revoked).

O.C. 997-2005, s. 25; O.C. 669-2007, s. 9; O.C. 79-2014, s. 14.

26. (Revoked).

O.C. 997-2005, s. 26; O.C. 669-2007, s. 10; O.C. 79-2014, s. 14.

§ 3 . —

(Revoked)

D. 997-2005, Sd. 3; O.C. 79-2014, s. 14.

27. (Revoked).

O.C. 997-2005, s. 27; O.C. 79-2014, s. 14.

28. (Revoked).

O.C. 997-2005, s. 28; O.C. 669-2007, s. 11; O.C. 79-2014, s. 14.

29. (Revoked).

O.C. 997-2005, s. 29; O.C. 669-2007, s. 12; O.C. 79-2014, s. 14.

30. (Revoked).

O.C. 997-2005, s. 30; O.C. 669-2007, s. 13; O.C. 79-2014, s. 14.

31. (Revoked).

O.C. 997-2005, s. 31; O.C. 669-2007, s. 14; O.C. 79-2014, s. 14.

31.1. (Revoked).

O.C. 669-2007, s. 15; O.C. 79-2014, s. 14.

32. (Omitted).

O.C. 997-2005, s. 32.

SCHEDULE I

(Revoked)

O.C. 997-2005; O.C. 669-2007, s. 16; O.C. 79-2014, s. 15.

TRANSITIONAL

2018

(O.C. 85-2018) SECTION 18. A nurse who is registered, before 8 March 2018, in a graduate-level training program leading to a diploma recognized by government regulation pursuant to the first paragraph of section 184 of the Professional Code (chapter C-26) granting access to a specialist’s certificate of nurse practitioner specialized in cardiology or to a specialist’s certificate of nurse practitioner specialized in nephrology is eligible, in accordance with Division III of the Regulation respecting the classes of specialization of specialized nurse practitioners (chapter I-8, r. 8), to sit the specialty examination corresponding to the class of specialization covered by the diploma.

SECTION 19. A nurse who holds, before 8 March 2018, a diploma recognized by government regulation pursuant to the first paragraph of section 184 of the Professional Code (chapter C-26) granting access to a specialist’s certificate of nurse practitioner specialized in cardiology or to a specialist’s certificate of nurse practitioner specialized in nephrology is eligible, in accordance with Division III of the Regulation respecting the classes of specialization of specialized nurse practitioners (chapter I-8, r. 8), to sit the specialty examination corresponding to the class of specialization covered by the nurse’s diploma.

Where a nurse, admitted to the specialty examination under the first paragraph passes the examination, the Order issues the nurse, if the nurse also meets the other conditions prescribed by the regulation, a specialist’s certificate of nurse practitioner specialized in adult care in the place and stead of a specialist’s certificate of nurse practitioner specialized in cardiology or a specialist’s certificate of nurse practitioner specialized in nephrology.

SECTION 20. Specialist’s certificates of nurse practitioners specialized in cardiology and in nephrology issued by the Order before 8 March 2018 become specialist’s certificates of nurse practitioners specialized in adult care.

SECTION 21. A nurse who, on 8 March 2018, holds a specialist’s certificate of specialized nurse practitioners must, within 30 days after that date, provide the secretary of the Order with the statement provided for in section 22.1.

SECTION 22. A nurse who obtained the diploma giving access to the specialist’s certificate in primary care before 1 September 2017 or who, before that date, was registered in a graduate-level training program leading to a diploma giving access to the specialist’s certificate of nurse practitioner specialized in primary care must, to perform the activities referred to in section 36.1 of the Nurses Act in a residential and long-term care centre, undergo training recognized by the Order.

The same applies to a nurse practitioner specialized in primary care who obtained the specialist’s certificate before 8 March 2018 by recognition of an equivalence of diploma or training in accordance with the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2).

The training, which lasts 35 hours, specifically focuses on the elderly and includes the following: advanced clinical evaluation, advanced physiopathology and advanced pharmacology. At least 10 hours focus on the elderly who present behavioural and psychological symptoms of dementia.

SECTION 23. The advisory committee on the practice of specialized nurse practitioners is composed of 9 members until the Order appoints to the committee a nurse practitioner specialized in pediatric care and a nurse practitioner specialized in mental health.

During that period, the quorum of the committee is 5 members, including 2 specialized nurse practitioners, 1 partner physician and the representatives of both orders.

REFERENCES

O.C. 997-2005, 2005 G.O. 2, 4816

O.C. 669-2007, 2007 G.O. 2, 2449

S.Q. 2008, c. 11, s. 212

O.C. 79-2014, 2014 G.O. 2, 396

O.C. 85-2018, 2018 G.O. 2, 685