M-9, r. 12.001 - Regulation respecting certain professional activities that may be engaged in by a nurse

Updated to 12 July 2018

This document has official status.

chapter M-9, r. 12.001

Regulation respecting certain professional activities that may be engaged in by a nurse

Medical Act

(chapter M-9, s. 19, 1st par. subpar. b).

DIVISION I PURPOSE

1. The purpose of this Regulation is to determine, among the professional activities that may be engaged in by physicians, those that may be engaged in by a nurse under certain prescribed conditions.

O.C. 839-2015, s. 1.

DIVISION II WOUND CARE

2. A nurse may, as part of the activity reserved to nurses to determine the treatment plan for wounds and alterations of the skin and teguments and to provide the required care and treatment,

(1)  prescribe the following laboratory analyses:

(a)  prealbumin and albumin;

(b)  wound culture;

(2)  prescribe the following products, medications and dressings associated with the treatment of wounds and alterations of the skin and teguments:

(a)  products creating a skin barrier;

(b)  topical medications, except sulfadiazine and those associated with dermatological or oncological treatment;

(c)  dressings.

Before prescribing an analysis, the nurse must make sure that a recent result for that analysis is not otherwise available for the patient.

Before prescribing products, medications or dressings to a patient with comorbidity factors, the nurse must obtain the medical assessment of the patient’s health condition.

The nurse must communicate to the attending physician or specialized nurse practitioner who is responsible for the follow-up of the patient’s condition the result of the laboratory analyses prescribed and the names of the dressings, products or medications prescribed.

O.C. 839-2015, s. 2.

3. The nurse must consult a physician or team of professionals dedicated to wound care when the wound has not responded favourably within the normal or expected time for the care given.

The nurse must refer the patient to a physician when the signs and symptoms suggest a deterioration in the patient’s general condition.

O.C. 839-2015, s. 3.

DIVISION III PUBLIC HEALTH

4. Under the national public health program made pursuant to the Public Health Act (chapter S-2.2), a nurse may

(1)  prescribe hormonal contraception, an IUD or emergency oral contraception, according to the national protocol developed as part of an activity under the program;

(2)  prescribe a perinatal vitamin supplement and folic acid;

(3)  prescribe a medication for the treatment of pediculosis;

(4)  prescribe a drug for smoking cessation except for varenicline and bupropion;

(5)  prescribe a medication for the treatment of a gonococcal infection or a Chlamydia trachomatis infection in an asymptomatic person with a positive test result from screening and prescribe control tests, according to the national protocol developed as part of an activity under the program;

(6)  prescribe a drug for the treatment of a gonococcal infection or a Chlamydia trachomatis infection in an asymptomatic person identified as a sexual partner of a person presenting either of those infections and prescribe control tests, according to the national protocol developed as part of an activity under the program.

O.C. 839-2015, s. 4.

DIVISION IV COMMON HEALTH ISSUES

5. A nurse may engage in the following professional activities:

(1)  prescribe a medication for the treatment of nausea and vomiting in pregnant women, except for incoercible vomiting;

(2)  prescribe topical medication for the treatment of a fungal infection (candida) of the skin or mucosa of a baby and a nursing mother.

O.C. 839-2015, s. 5.

DIVISION V PRESCRIPTION WRITING STANDARDS

6. A nurse engages in the activities provided for in sections 2, 4 and 5 in accordance with the provisions applicable to individual prescriptions provided for in the Règlement sur les normes relatives aux ordonnances faites par un médecin (chapter M-9, r. 25).

O.C. 839-2015, s. 6.

DIVISION VI NURSES AFFECTED

7. To engage in the activities referred to in this Regulation, a nurse must meet one of the following conditions:

(1)  be the holder of a diploma referred to in the first paragraph of section 1.17 of the Regulation respecting the diplomas issued by designated educational institutions which give access to permits or specialist’s certificates of professional orders (chapter C-26, r. 2);

(2)  be the holder of a bachelor’s degree by accumulation of certificates, including at least 2 certificates in nursing care, and have successfully completed at least 45 hours of university-level training in wound care on the elements provided for in Schedule I;

(3)  be the holder of a diplôme d’État for a program of studies completed in France and have obtained his or her permit pursuant to the Règlement sur la délivrance d’un permis de l’Ordre des infirmières et infirmiers du Québec pour donner effet à l’arrangement conclu par l’Ordre en vertu de l’Entente entre le Québec et la France en matière de reconnaissance mutuelle des qualifications professionnelles (chapter I-8, r. 13.1);

(4)  have obtained his or her permit pursuant to the Règlement sur les autorisations légales d’exercer la profession d’infirmière ou d’infirmier hors du Québec qui donnent ouverture au permis de l’Ordre des infirmières et infirmiers du Québec (chapter I-8, r. 7);

(5)  be the holder of a university-level diploma in nursing care awarded by an educational institution situated outside Québec including at least 45 hours of training in community health and 45 hours of training in wound care on the elements provided for in Schedule I.

O.C. 839-2015, s. 7; O.C. 764-2018, s. 1.

8. The nurse must also hold an attestation issued by the Ordre des infirmières et infirmiers du Québec attesting to the successful completion of 2 hours of training in the following:

(1)  ethical considerations;

(2)  the procedure for prescribing analyses, products, medications and dressings related to the treatment of wounds and alterations of the skin and teguments and for prescribing medications for public health and for common health issues:

(a)  the prescription decision-making process;

(b)  writing a prescription;

(c)  follow-up with the physician or specialized nurse practitioner;

(d)  record-keeping.

O.C. 839-2015, s. 8.

DIVISION VII TRANSITIONAL AND FINAL

9. Despite section 7, a nurse who holds a diploma of college studies in nursing care and who, on 30 June 2017, according to a collective prescription, engaged in activities referred to in section 2 may continue to engage in those activities if the director of nursing care or, where the nurse practises elsewhere than in a centre operated by an institution 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), one of the signatory physicians of the collective prescription attests in writing that the nurse has applied one or more collective prescriptions in connection with the activities referred to in section 2.

O.C. 839-2015, s. 9; O.C. 764-2018, s. 2.

10. Despite section 7, a nurse who holds a diploma of college studies in nursing care and who, on 30 June 2017, according to a collective prescription, engaged in activities referred to in section 4 may continue to engage in those activities if the director of nursing care or, where the nurse practises elsewhere than in a centre operated by an institution 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), one of the signatory physicians of the collective prescription attests in writing that the nurse has applied one or more collective prescriptions in connection with the activities referred to in section 4.

O.C. 839-2015, s. 10; O.C. 764-2018, s. 3.

11. A nurse referred to in section 9 or 10 must have obtained the attestation of training required by section 8 before 12 July 2018.

O.C. 839-2015, s. 11; O.C. 764-2018, s. 4.

12. (Omitted).

O.C. 839-2015, s. 12.

SCHEDULE I

(s. 7, pars. 2 and 5; s. 9, par. 3)

UNIVERSITY-LEVEL TRAINING IN WOUND CARE

i. anatomo-physiology of wounds and of alterations of the skin and teguments;

ii. wound assessment;

iii. wound classification;

iv. classification and indication of the products, topical medications and dressings;

v. debridement.

The training must be recognized by the Ordre des infirmières et infirmiers du Québec and may have been acquired as part of a university diploma in nursing or from a trainer who is a member of the Ordre des infirmières et infirmiers du Québec.

O.C. 839-2015, Sch. I.

REFERENCES

O.C. 839-2015, 2015 G.O. 2, 2750

O.C. 764-2018, 2018 G.O. 2, 2722