News

Coronavirus (COVID-19)

2 March 2020

About Coronavirus (COVID-19)

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.

To learn more about the virus, visit the WHO’s info page and the government of Canada's FAQ page

NANB’s Role

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.

Emergency Temporary Registration

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.

Impact of State of Emergency on Self-Employed Nurses

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:

  • use their discretion to determine if their service is urgent and essential
  • follow the directives provided by their employer and the NB Office of the Chief Medical Officer of Health (OCMOH) to protect themselves, their workplaces and their clients/patients.

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. 

Impact of COVID-19 on application and exam process

Updated information for applicants and students can be found on the Registration Information page.

Impact of COVID-19 on Nursing Education Programs

Memo: Effect of COVID-19 pandemic on nursing education programs, faculty, and students

Nurse Practitioner Prescribing during COVID-19

FAQs for RNs and NPs

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:

  • applying hand hygiene principles
  • choosing appropriate measures to prevent and control infection transmission such as wearing personal protective equipment (PPE)
  • understanding your workplace’s organizational policies about infection prevention and control
  • participating in any training or education sessions on infection prevention and control
  • consulting NANB’s Infection Prevention and Control Fact Sheet
  • working with your employer to develop new policies as needed
  • using sources of evidence to inform your practice (consult “Important Resources” section a little further on this page)

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).

FAQs for Applicants and Students

FAQs – Impact of COVID-19 on Applicants and Students

Important Resources

Government of New Brunswick

MEMO from Chief Medical Officer of Health

Information related to COVID-19

General information

Dedicated GNB phone line for health care workers and staff for questions about COVID-19 testing:   1-833-475-0724.

Form/Tool

Self Monitor

Self Isolation

COVID-19 - Guidance for Community Settings

Other NB Health Organizations

New Brunswick Pharmacists' Association (April 1, 2020)

Government of Canada

CNPS

CNA 

The World Health Organization

International Council of Nurses

COVID-19 & DUTY OF CARE

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.

FAQ- COVID-19 & DUTY OF CARE

Can I refuse to work with an infected client?

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. 

Can I continue providing foot care services as a self-employed RN during the COVID-19 pandemic?

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.

Can I refuse to provide care or withdraw from care because the healthcare settings are running low on isolation spaces and personal protective equipment (PPE)?

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: 

  • What is the risk to the client if I withdraw from care?
  • Is the care I am providing directly preventing harm to the client?
  • Does the benefit of the care I am providing outweigh my risk of harm?  
  • What can I do to minimize my risk?
  • What can I do to minimize the risk to the client if I withdraw 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:

  • negotiating a mutually acceptable withdrawal of service with the client; or
  • arranging for suitable, or replacement services; or
  • allowing the employer a reasonable opportunity for alternative or replacement services to be provided.

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.

What should I consider if I am re-assigned to an unfamiliar practice setting during the COVID-19 outbreak?

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:

  • Asking for a brief orientation to the new practice setting.
  • Performing activities you are competent to do. For example, providing basic care to free up RNs and NPs with expertise to provide more complex or practice area specific care.
  • Your learning needs specific to the new practice setting. Are there ways to address them?
  • Discussing your competency and expected responsibilities with your employer.
  • Seeking advice and collaborating with the health care team to uphold safe client care and working together with other health care experts to improve your clients’ care.

Employer Accountabilities

Your employer has an obligation to:

  • Provide staffing and resources and to ensure that RNs and NPs are supported to work within their role and scope of practice. 
  • Arrange for support for RNs and NPs re-assigned to unfamiliar practice settings.
  • Assist RNs and NPs in understanding their expectations when providing care in an unfamiliar practice setting.
  • Consider the competencies and qualifications of RNs and NPs or other care providers when making client assignments.

Part of content comes from Nova Scotia College of Nursing Practice Scenario: Re-deployed Nurses and College of Nurses of Ontario COVID-19 Information for nurses.    

Your Accountabilities

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:

Standards of Practice for RNs

RNs and NPs are accountable for:

  • practicing safely, competently, compassionately, and ethically and are accountable to the client, public, employer and profession
  • practising using evidence-informed knowledge, skill and judgement
  • contributing to and promoting measures that optimize positive client health outcomes at the individual, organizational and system level
  • establishing professional relationships and demonstrating leadership to deliver quality nursing and health care services

Standards for the Therapeutic Nurse-Client Relationship

RNs and NPs are accountable for:

  • using a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain and terminate the nurse-client relationship
  • ensuring that all professional behaviours and actions meet client’s therapeutic needs

Code of Ethics for RNs   

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.

Fact Sheet: Infection Prevention and Control (IPC) 

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.

Acknowledgement

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/.