What You Need to Know
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.
NANB Is Currently Accepting New Applications for Emergency Temporary Registration
Due to the rising number of COVID-19 infections in New Brunswick, and to support the Province in its COVID-19 relief efforts, NANB is once again opening its Emergency Temporary Registration Process to new applicants.
If you are current in your nursing practice (have practiced a minimum of 1125 hours in the last 5 years), are a former member in good standing with NANB, wish to assist the Province in its COVID-19 relief efforts under an Emergency Temporary Registration, and you have been recruited by the Horizon or Vitalité Health Network, please complete an Application for Emergency Temporary Registration Form and provide evidence that Horizon or Vitalité wishes to hire you to provide Covid 19 support (a job offer) and submit both to email@example.com and copy HRP3CN19@gnb.ca. Once this form and a confirmation of your recruitment are received by NANB, and it is determined that you are eligible for an Emergency Temporary Registration, you will receive a registration certificate via email.
If you have practiced a minimum of 1125 hours in the last 10 years, are a former member in good standing with NANB, and wish to assist the Province in its COVID-19 relief efforts, you may be eligible for a Restricted Emergency Temporary Registration that would restrict your practice to a COVID-19 support role in a vaccination clinic or assessment/testing centre. If you think you qualify for a Restricted Emergency Temporary Registration, please follow the same application process outlined above.
All Emergency Temporary Registrations and Restricted Emergency Temporary Registrations will be valid until May 31st, 2022.
FAQs for RNs & 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)
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).
The College of Nurses of Ontario granted permission to NANB to adapt content from the Novel Coronavirus (COVID-19) section of their website.
Can I refuse to work with a client who tested positive for COVID-19?
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. However, you also have a professional responsibility and accountability to engage proactively with your employer, become informed and access the required education and training to ensure you have all available facts before considering refusal.
Here is a resource that could be helpful in this situation: Fact Sheet: Abandonment
The College of Nurses of Ontario granted permission to NANB to adapt content from the Novel Coronavirus (COVID-19) section of their website.
As a self-employed RN or NP, how can I know if I am following the proper public health measures?
If you are providing nursing services as a self-employed nurse you must comply with the Mandatory Order rules and conditions aimed at reducing the spread of the COVID-19 virus. Everyone, including individuals, employers and businesses, must follow the order to ensure public health. For information how business owners can comply with the Mandatory Order see the following resources:
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 RNs and NPs, you must ensure you have the knowledge, skill and judgement before performing any activity or procedure. There are elements of nursing knowledge and entry-level competencies that apply to all client groups and practice. You must practice within your level of competence; therefore, it is important to assess and communicate any practice limitations. 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 practice area. In some cases, you may need to recognize that your assignment may be to assist regular staff as they care for clients rather than caring for clients independently.
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.
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.
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:
- 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
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
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.
Nurse Practitioner Prescribing during COVID-19
Sending prescriptions to pharmacists by email
- Unsecured email, texting and other digital platforms are generally not acceptable ways to send prescriptions.
- Whenever feasible, NPs should use appropriate channels, such as phone, fax or secure e-prescribing systems.
- We understand this is an unusual time and if these methods of communication are not an option, work with the pharmacist to identify the best way to meet patient needs, such as unsecured email. The pharmacist needs to assure any prescription is valid. Unsecured email cannot be used for drugs listed under the Narcotic Control Regulations.
- Work with your patients to meet their needs and to get informed consent before using unsecured email to send a prescription. If the patient consents to sending this unsecured prescription email, ensure you are only sending it to the pharmacy of the patient’s choosing. For guidance, consult with the Department of Health Prescribing methadone and buprenorphine
- For NPs who treat opioid addiction, the Centre for Addiction and Mental Health has new guidelines for prescribing and managing treatment with methadone and buprenorphine while adhering to social distancing and self-isolation measures. These guidelines “address office visits, remote visits, carry doses and frequency of urine drug testing.”
- We encourage NPs to work with pharmacists and others on the care team who may be impacted by changes to a patient’s treatment regime.
Hydroxychloroquine and azithromycin prescriptions
- All drugs, including hydroxychloroquine and azithromycin, should only be prescribed in alignment with current evidence.
- Until there is supporting evidence, do not prescribe hydroxychloroquine and azithromycin to prevent or treat COVID-19 as this is leading to drug shortages and may compromise care for other patients.
- Nurses have an obligation to ensure that their practice and any treatment they prescribe is evidence-informed.
Health Canada exemptions for prescribing controlled substances
- As part of its response to the containment of COVID-19, Health Canada is issuing exemptions for prescriptions of controlled substances under the Controlled Drugs and Substances Act.
- NPs can now temporarily issue verbal orders (for example, over the phone) to extend or refill a prescription to a patient under your treatment.
COVID-19 and 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.
Due to the COVID-19 pandemic I will be providing virtual care to clients. What should I consider and what are my accountabilities when doing this?
As virtual or telenursing care is being required and adopted, NANB supports nurses providing care to clients through technology.
Telenursing may change how you conduct your nursing practice, it does not fundamentally change the nature of nursing practice, or the nursing process that is foundational to the delivery of nursing care. The requirement to meet your standards of practice remains.
If you are providing nursing services using technology, you must:
- Use the nursing process to assess, plan, implement, evaluate, and document nursing care.
- Use effective communication to establish the nurse-client relationships.
- Develop the client’s care plan based on your virtual assessment and evaluation of their history / current health care needs. Ask the client enough questions to ensure that you have relevant and sufficient data to guide your decisions and interventions.
- Collaborate with members of the nursing and care team as needed. This may be required more frequently, when:
- providing care to new clients to help relieve pressures in the health system
- usual data is not available (such as recent assessments, lab or diagnostic results because the client chart is not available, or clients cannot access the health system)
- needs of the client are beyond your individual scope of practice, area of expertise or competence.
- Make care decisions based on the data available to you at the time and in the context in which it is provided.
- Recognize when telenursing is not meeting the needs of the clients and a face-to- face assessment is required.
- Provide services that are consistent with your scope of nursing practice, your individual competencies and your employer’s expectations and policies.
You should be aware of employer policies related to:
- Privacy and confidentiality
- Security and approved type of technology or other required equipment
- IT support
- Informed consent
If you are practising in New Brunswick and providing virtual nursing services using technology to clients outside of New Brunswick, you:
- Must hold a practising licence with NANB
- Are accountable to know what policies or legislation may apply to you in the jurisdiction where your clients reside. Different polices policies and legislation may affect telenursing in other jurisdictions. You may also be required to be licensed in that jurisdiction.
All nurses are accountable for their own actions and for the things they know or reasonably should have known. They are expected to make care decisions based on the data available to them at the time, and in the context in which it is provided.
The Nova Scotia College of Nursing granted permission to adapt content from Practice Scenario: Telenursing or Providing Virtual Care in a Pandemic. / Practice Scenario: NPs Providing Virtual Care for Unfamiliar Clients in a Pandemic.
How can I minimize the risk of errors when communicating or receiving medication orders verbally?
ISMP Canada recommends using written orders, including electronic orders, as preferred practice. However, the current pandemic has increased the need for and frequency of telephone and verbal orders. They suggest safe practices that RNs and NPs can find in the following document: ISMP Canada Safety Bulletin.
What is CNPS’ legal advise during a pandemic?
- Legal Considerations When Nursing in a Pandemic
- Ask a Lawyer: Refusal to wear a mask and mask exemption requests
- Four things to Know about Professional Nursing Services During a Pandemic
- COVID-19: Footcare nursing during the pandemic
- Twelve Things to Consider Before Joining a Virtual Care Practice
- Six Considerations for Independent Practice during a Pandemic
- Case Study: Virtual Care
What are my accountabilities if I am asked to self-isolate?
Fact Sheets and Posters
Other Health Organizations
Other NB Health Organizations
- CADTH- What You Should Know About Drug Treatments for COVID-19
- Sherbrooke University – Moncton Campus, Centre de formation médicale du Nouveau-Brunswick
Canada and Abroad
Government of Canada
- Health Canada Toolkit: COVID-19 and Substance Use (May 4, 2020)
- FAQ-Subsection 56(1) Class Exemption for Patients, Practitioners and Pharmacists Prescribing and Providing Controlled Substances in Canada during the Coronavirus Pandemic (March 23, 2020)
- CDSA Exemption and interpretive guide for controlled substances (March 19, 2020)
- Coronavirus disease (COVID-19)
- COVID-19: What health professionals need to know
- An Advisory Committee (ACS) National Advisory Committee on Immunization (NACI). Recommendations on the use of COVID-19 Vaccine(s)
The World Health Organization