The Règlement sur certaines activités profesionnelles qui peuvent être exercées par une infirmière et un infirmier (Regulation respecting certain professional activities that may be performed by a nurse) ("Regulation") adopted under the Medical Act (c. M-9), came into force on January 11, 2016.
The Fédération interprofessionnelle de la santé du Québec ("FIQ") and the Collège des médecins du Québec ("CMQ") sponsored the Regulation with the purpose of granting nurses certain competences previously held solely by doctors.
The Regulation permits nurses to, among other things: (i) treat wounds by ordering tests and prescribing products that create a skin barrier; (ii) prescribe certain drugs for contraception, smoking cessation and to treat some sexually transmitted infections; as well as (iii) prescribe drugs for non-intractable nausea and vomiting in pregnant women and for topical treatment of fungal infection of the skin (ss. 2, 4, & 5).
These new activities are meant to better equip nurses to meet patient needs, optimize patient intervention, avoid the fragmentation of services, reduce delays in the delivery of care and thus reduce the risk of negative consequences to patients' health.
Subject to some exceptions, nurses must meet certain criteria set forth in the Regulation in order to perform these new services (ss. 7, 9, & 10). The criteria include, for example: holding a bachelor's degree with a minimum of two (2) certificates in nursing and completing a university training of at least 45 hours in wound care; holding equivalence under the Quebec-France agreement; or having a permit issued by the Ordre des infirmières et infirmiers du Québec ("OIIQ").
Nurses must also obtain a certificate from the OIIQ attesting that they completed a two (2) hour training on the relevant ethical considerations that arise as a result of the new activities, as well as the procedures that must be followed when prescribing tests, products, drugs and bandages, including in writing the prescription, following up with a physician or specialized nurse practitioner and record keeping (ss. 8 & 11).
The Guide explicatif conjoint (PDF - French only) published by the OIIQ and the CMQ states that a committee with members from both organizations will be created in order to assist with the implementation of the Regulation and ensure collaboration between the nurses, nurse practitioners, and other health professionals.
Other legislation, including the Code of ethics of nurses (CQLR c I-8, r 9) was revised to take into consideration increased ethical responsibilities, including, updating and developing professional skills, following the standards of practice, obtaining a patient's free and informed consent, etc.
The Regulation respecting medical specialties (CQLR c M-9, r 26.1) as well as the Règlement sur les normes relatives aux ordonnances faites par un médecin (Regulation respecting the standards for prescriptions made by a physician) (c. M-9, r. 25.1) were also amended to reflect the new activities that nurses may perform.
Provided that nurses meet the requisite criteria and obtain the certification form the OIIQ, they can now perform the new acts.