In December 2019, a coronavirus emerged in the city of Wuhan, China. Since then, this respiratory virus has been reported in multiple countries, including Canada. On Thursday, Jan. 30, 2020, the World Health Organization (WHO) declared COVID-19 to be a public health emergency of international concern. On March 11, 2020, the WHO declared COVID-19 as a pandemic because of the alarming levels of spread and severity.
Those with COVID-19 may have little to no symptoms. You may not know you have symptoms of COVID-19 because they are similar to a cold or flu. Symptoms of the virus range from mild to severe and may take up to 14 days to appear after exposure to COVID-19. They can include fever, cough, difficulty breathing, pneumonia and kidney failure. In severe cases, infection can lead to death.
NANB’s mandate is regulation for safe, competent, and ethical nursing care—but patient safety is a responsibility we all share. Our role during the novel coronavirus outbreak is to support your ability to provide safe and competent care and help you understand your accountabilities.
If you have questions about your accountabilities when caring for patients affected with the new coronavirus, please contact us. One of our Nurse Consultants can help identify the appropriate standards and guidelines to guide your decision-making and help you understand your accountabilities.
Nurse Practitioners are encouraged to visit the Office of the Chief Medical Officer of Health (Public Health) Coronavirus page for information.
Visit the Registration Information page for information on emergency temporary registration for former nurses or nurse practitioners, and nurses registered in other provinces who wish to assist with the pandemic response.
On March 25, 2020, the provincial government revised the Declaration of a State of Emergency and Mandatory Order under section 12 of the Emergency Measures Act. The revised order clarifies the types of services that are allowed and not allowed for regulated health professionals:
"6. Regulated health professionals are prohibited from providing in-person services except those services they deem essential for the health and wellbeing of their clients. The offering of services is permitted conditional on compliance with all applicable control measures in the NB OCMOH Novel Coronavirus (COVID-19) Guidance for Primary Care Providers in a Community Setting. The regulated health professionals are: audiologists, cardiology technologists, chiropractors, dental hygienists, dental technicians, dentists, denturists, dieticians, licensed counselling therapists, licensed practical nurses, massage therapists, medical laboratory technologists, medical radiation technologists, midwives, nurse practitioners, nurses, occupational therapists, opticians, optometrists, paramedics, pharmacists, pharmacy technicians, physicians, physician assistants, physiotherapists, podiatrists, psychologists, respiratory therapists, social workers, speech language therapists."
Under this order, nurses must:
If you are able to offer your services remotely, you can still do so (e.g. telephone, videoconference, etc.) providing you adhere to all standards and guidelines.
If you have questions about where and how you may be able to help, please email HRP3CD19@gnb.ca
Self-employed nurses can assist in other sectors
If your business is prohibited from providing services under this order, you may wish to consider assisting other sectors to respond to the pandemic. More nurses are needed in New Brunswick’s health authorities, nursing homes, extra-mural hospital and telehealth.
Updated information for applicants and students can be found on the Registration Information page.
What are my accountabilities when providing care to a client diagnosed with (or suspected of having) the coronavirus (COVID-19)?
You are accountable for making decisions that are in the best interests of your clients and for protecting them from harm. You are also accountable for protecting clients from infection risks. You can do this by:
We encourage you to work collaboratively with your employer to recognize real or potential threats, review relevant organizational policies, and if needed, develop policies and guidelines specific to your practice setting.
RNs and NPs are expected to understand and apply precautionary measures to minimize the risk of infecting themselves, colleagues, clients and others. To learn more about these topics, refer to the Government of New Brunswick Office of the Chief Medical Officer of Health (Public Health).
Government of New Brunswick
MEMO from Chief Medical Officer of Health
Information related to COVID-19
Dedicated GNB phone line for health care workers and staff for questions about COVID-19 testing: 1-833-475-0724.
COVID-19 - Guidance for Community Settings
Other NB Health Organizations
New Brunswick Pharmacists' Association (April 1, 2020)
Government of Canada
The World Health Organization
International Council of Nurses
Duty of care is the moral, ethical, legal and professional obligation that requires LPNs, RNs and NPs to adhere to a reasonable standard of care while providing, assigning, delegating, supervising, promoting, evaluating or advocating for care. Nursing professionals have a duty to provide care using appropriate safety precautions during a public health crisis, such as the COVID-19 pandemic. This FAQ was designed to help support nursing professionals in meeting their accountabilities regarding the duty of care during the COVID-19 pandemic. If you have further questions, please do not hesitate to contact your regulatory body: ANBLPN or NANB.
When your professional obligation to a client conflicts with your personal obligations, you have an accountability to demonstrate leadership and determine the best possible solution while still making decisions in the client’s best interest. Refusing assignments or choosing to discontinue care is an ethical dilemma without one clear answer.
Ultimately, you do have the right to refuse assignments that you believe will subject you or your clients to an unacceptable level of risk. But you also have a professional accountability to advocate for practice settings that minimize risk to both you and your clients. Advocating for quality practice settings is one of the many ways RNs and NPs are leaders in client care.
Clients who receive professional foot care services are often those who make up our most vulnerable population (e.g., elderly, diabetics) and therefore they are more susceptible to developing severe complications if they were to contract COVID-19. RNs practice foot care in a variety of settings such as hospitals, long term care facilities, community clinics and in client’s homes. As such, it is the responsibility of all foot care nursing professionals to break the chain of infection when possible.
The population of New Brunswick is being directed to adhere to social distancing practices and to only provide services that are essential by our leading public health officials. In keeping with the Declaration of a State of Emergency and Mandatory Order, NANB recommends to all self-employed RNs and NPs to provide in-person services that are deemed essential for the health and wellbeing of their clients. Please refer to the section on this webpage called Impact of State of Emergency on Self-Employed Nurses for more information.
The Association of New Brunswick Licensed Practical Nurses granted permission to adapt content from Memo: Foot Care and the COVID-19 Pandemic.
RNs and NPs are accountable for their actions and inactions at all times. They make decisions based on an analysis of all the data at hand, the needs of the client, employer policy, their duty to provide care and their obligation to protect themselves and their families.
An unreasonable burden may exist in rare situations, such as public health emergencies, where the RN or NP is unable to provide safe care and meet professional standards of practice because of unreasonable expectations, lack of resources or ongoing threats to personal safety.
Refusing to provide care or withdrawing from care may be appropriate in very specific circumstances. Before withdrawing from care, you must fully consider the risk and impact to clients. Additionally, you must first attempt several other strategies to improve the safety of the situation, such as working with your employer to obtain the appropriate PPE and isolation spaces.
Consider the following when contemplating withdrawing from care:
If I decide to withdraw from care, could I be accused of abandonment?
Abandonment occurs when an RN or an NP has engaged with a client or has accepted an assignment and then discontinues care without:
While you have the right to refuse to work in situations where you cannot manage or reasonably mitigate the risk, it is equally important to note that you are accountable to take every reasonable action to prevent withdrawal from care and abandoning clients.
For more information on abandonment, you can refer to Fact Sheet: Abandonment. RNs and NPs should review relevant organizational policies and guidelines related to staffing and workload. If needed, you should advocate for and develop policies and guidelines driven by patient interest and safety. You can also refer to this document: Practicing with Limited Resources: A Guide for RNs and NPs.
The Nova Scotia College of Nursing granted permission to adapt content from Practice Scenario: Withdrawing from Care – Unreasonable Burden.
Temporary re-assignment is a legitimate employer practice to ensure they can meet the needs of the clients they serve every day. You and your employer have an accountability to ensure clients are receiving safe and competent care. While in this unusual circumstance of a public health emergency RNs, NPs and employers are accountable to work together to make the best decisions based on the information at hand, fully recognizing that the evolving situation may result in a different decision at a different time.
RNs and NPs Accountabilities
As a RN or NP, you must ensure you have the knowledge, skills and judgement, and the appropriate authority before performing any activity or procedure. There are elements of nursing knowledge and entry-level competencies that apply to all client groups and practice. While you may not be able to carry a full client assignment in the unfamiliar setting, there are many things you can do competently within your individual scope of practice to support the care area. Recognize that in some cases your assignment may be to assist regular staff as they care for clients rather than caring for clients independently. This may be the case for an acute care RN re-assigned to an ICU, for example.
If you are assigned to an area that you are not familiar with, consider:
Your employer has an obligation to:
RNs and NPs are accountable to legislation, the Code of Ethics, standards and employer policies. Here are a few key elements to keep in mind during the coronavirus outbreak:
RNs and NPs are accountable for:
RNs and NPs are accountable for:
Historically and currently, nurses provide care to those in need, even when providing care puts their own health and life at risk. Nurses also encounter personal risk when providing care for those with a known or unknown communicable or infectious disease. However, disasters and communicable disease outbreaks call for extraordinary effort from all health-care personnel, including nurses. (p. 38)
The Code states: “During a natural or human-made disaster, including a communicable disease outbreak, nurses provide care using appropriate safety precautions in accordance with legislation, regulations and guidelines provided by government, regulatory bodies, employers, unions and professional associations (A9)”. (p. 38)
Nurses carefully consider their professional role, their duty to provide care and other competing obligations to their own health, to family and to friends. (p. 39)
For more information on Ethical Considerations for Nurses in a Natural or Human-Made Disaster, Communicable Disease Outbreak or Pandemic, please consult pages 38-40 of the Code of Ethics.
RNs and NPs have the responsibility to ensure they practise safely and competently at all times, including the use of safe and effective IPC measures. To do so, RNs and NPs are expected to be aware of applicable legislation, NANB standards, best practices and organizational policies related to IPC and to advocate for quality practice environments.
The College of Nurses of Ontario granted permission to NANB to adapt content from the Novel Coronavirus (COVID-19) section of their website: https://www.cno.org/en/trending-topics/novel-coronavirus/.