COVID-19 Resources for Nurses

Alberta Relaunch Guidelines for Self-Employed Nurses

As part of Order 16 regulators were asked to create guidelines for self-employed healthcare practitioners during Alberta’s Relaunch. The College of Licensed Practical Nurses of Alberta (CLPNA), the College and Association of Registered Nurses of Alberta (CARNA), and the College of Registered Psychiatric Nurses of Alberta (CRPNA) developed The Guidelines for Self-Employed Nurses during Alberta’s Relaunch Strategy.

Guidance for the relaunch of self-employed practice

CARNA is developing guidelines to align with the three-phase relaunch strategy announced by the Government of Alberta on April 30, 2020. This strategy allows for a phased reopening of many areas of the economy and includes medical and health-care procedures.

The Chief Medical Officer of Health published an amendment to Order 7. This order, allows non-essential health services to resume, prescribes that colleges need to initially follow existing guidelines, and expects colleges to develop guidelines specific to their professions. Appendix A to Record of Decision – CMOH Order 16-2020 is Workplace Guidance for Community Health Care Settings that is to be used until CARNA posts their specific guidelines. CARNA guidelines will be provided as soon as possible.

View full Orders and guidelines.

CARNA’s new module Ethical Decision Making: A Framework will help you learn about making ethical decisions during a pandemic using the Canadian Nurses Association Code of Ethics for Registered Nurses (2017) values and responsibility statements to guide the process. Access the module under the Practice Advice tab below.

Removal of legislative barriers to NP practice in continuing care

Ministerial Order 6/2020 modifies the Nursing Homes General Regulation and the Nursing Homes Operation Regulation to enable nurse practitioners and other regulated health professionals to work to their full scopes of practice in nursing homes during the COVID-19 pandemic. Changes will remain in effect until August 14, unless the order is terminated earlier or the public health emergency is reduced or extended.

Nurse practitioners, as autonomous and independent health professionals, provide essential health services and have the competencies to conduct a comprehensive health assessment, diagnose health/illness conditions, and treat and manage acute and chronic illness within a holistic model of care. They order and interpret screening and diagnostic tests, perform procedures and prescribe medications and therapeutic interventions.

What better time to refresh your Infection Prevention and Control skills! Our Infection Prevention and Control – 2020 course is the newest version and includes the Alberta Health Reusable & Single-Use Medical Devices Standards, Infection Prevention and Control Standards, and Guidelines for Medication and Vaccine Injection Safety. Learn more by signing into MyCARNA and earn your certificate of completion today!

Dr. Deena Hinshaw announced that all workers in continuing care and designated supportive living facilities must only work at one site.

Any staff or residents who display any symptoms at continuing care facilities are being tested.

Staff in these facilities who need to be within two metres of others during their work are required to wear face masks during their shift.

Enhanced cleaning and disinfection requirements, and mandatory outbreak protocols have now been implemented to protect staff and residents at these facilities.

In the weeks since the first case in Alberta, the provincial lab has increased its capacity for testing to meet the demand. Eligibility requirements for testing have been expanded to ensure access to testing.

Anyone in Alberta who has a fever, cough, shortness of breath, runny nose or a sore throat is eligible to be tested.

Yesterday, Premier Jason Kenney addressed all Albertans about the future of the COVID-19 pandemic in our province. Statistics for COVID-19 in our province as of today show the steady increase of cases.

Alberta Health has projected the two scenarios below:

Probable: Alberta will hit the peak of infections in mid-May. From the beginning of the outbreak to the end of summer, we could see as many as 800,000 total infections, and between 400 and 3,100 deaths.

Elevated: This more serious but less likely scenario, would see infections peak at the beginning of May, with as many as 1 million total infections, and between 500 and 6,600 deaths.

Alberta’s strategy to defeat the Coronavirus is to push down the peak of infections as much as possible, while pulling up the capacity of our health-care system to cope with the demand.

The Premier encourages us all to rigorously follow these infection prevention and control measures:

• Wash your hands frequently for at least twenty seconds with warm, soapy water.
• Sneeze or cough into your elbow or arm.
• When you can, stay home.
• Try to stay at least six feet away from other people outside your home.
• Wear a covering over your nose and mouth if you are going into a crowded area.

Stay at home for two weeks if you are sick, or have returned from outside the country.

We cannot thank our registrants and other health-care workers enough for their continued dedication to the care of Albertans. The more we do to stop the pandemic now, the faster we can restart our economy, and pave a path to recovery.

Instead of the usual newsletter this month, we would like to use this space to acknowledge all of the nurses of Alberta.

To all of the nurses serving patients, residents and families, as well as those that support through research, education and administration in all practice settings, thank you.

You are responding to this unprecedented event with compassion, skill and integrity. We know that you are being asked to do more than ever before. There are no easy answers to many of the issues; however, we are confident that patients can count on your best professional judgement.

A pandemic situation calls for extraordinary effort from all health-care personnel. In the midst of all this, you are providing and will continue to provide safe, competent, compassionate and ethical care to your fellow Albertans. We know that nurses are experienced in dealing with challenging health issues, including infected patients, on a daily basis. But this unprecedented time requires agility, creativity and innovative options. You possess these qualities and you will be called upon in the weeks and months ahead to continue displaying them.

During these challenging times, we are doing our best to support you. This includes updating our website with COVID-19 resources and extended Practice Consultation support. One of our ongoing priorities has been to reinstate and register as many nurses as possible. We will stay open (virtually) during the upcoming Easter weekend to help reinstate as many nurses as we can. Please check nurses.ab.ca regularly for the latest information.

There are many affected Albertans and regrettably a number of deaths due to the virus. We join all Albertans in extending our heartfelt gratitude for all you are doing. Please remember to take some time to care for yourself and your colleagues.

Stay safe and be well.

Dennie Hycha, President

Joy Peacock, CEO

April 2, 2020

April 1, 2020

A new question and answer about self-employed practice has been added to the section below Answering Your Questions.

As a regulated member who is self-employed you are responsible for developing an approach to the COVID-19 pandemic appropriate to the nature of your practice and the population served. During this time of a declared state of public health emergency regulated members who are self-employed need to evaluate their services based on the Government of Alberta’s public health orders to only provide critical, urgent, or emergency care.

March 23, 2020

Alberta Health and health-care employers in Alberta are recommending Contact and Droplet Precautions in addition to Routine Practices for health care employees involved in the care of suspected or confirmed cases of COVID-19. As nurses, you need to know how to properly don, use, and doff PPE in a manner that prevents self-contamination or contamination of others. Follow your employer policies on infection prevention and control.

March 20, 2020

CARNA supports Nurse Practitioners (NPs) in having the capacity to provide quality client care during this pandemic through virtual care. Nurse practitioners and their employer have an accountability to ensure clients are receiving safe and competent care. While in the midst of this pandemic, nurse practitioners 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.

CARNA supports the use of virtual care platforms that are recommended and supported by the employer. We recognize that in highly challenging circumstances an NP may need to depart from established procedures in order to care for clients and people using health-care services. It is reasonable that if the employer is supporting temporary use of unregulated communication technologies based on the principle of matching intervention to need, then CARNA would also support this use as the Practice Standards for Regulated Members state that the RN and NP follow policies relevant to their practice setting.

March 19, 2020

Effective Friday, March 20, 2020 the Edmonton office of the College and Association of Registered Nurses of Alberta (CARNA) is closing its doors to walk-in visitors without appointments as part of ‘social distancing’. CARNA has implemented this measure to minimize the risk of transmission and ensure the continuity of critical services.

CARNA remains open for business with staff available by email or phone during regular business hours.

The Registration call centre is open and available by phone or email to answer your questions. Call 780.451.0043 (toll free 1.800.252.9392) ext. 548 or email registration@nurses.ab.ca.

Policy and Practice Consultants are working extended hours and weekends to be available by phone and email to address your practice questions. Call 780.451.0043 (toll free 1.800.252.9392) ext. 504 or email practice@nurses.ab.ca.

Hearing Tribunals and other business functions as appropriate will be conducted virtually. We thank you for your patience as workflow and logistical changes are made. CARNA will monitor the situation carefully and adjust as appropriate.

We will communicate any changes via our website, social media, and emails to registrants and stakeholders.

March 17, 2020

Former registrants who wish to assist with the COVID-19 pandemic are asked to contact their previous employer, the Talent Acquisition & Recognition team of Covenant Health at careers@covenanthealth.ca or AHS at careers@ahs.ca to inform them of their availability. Employers will send a list of names to CARNA and we will reach out to those who are identified on the Alberta Health or the health care provider organizations list to begin the process of reinstating practice permits for the pandemic response.

If you are contacted by CARNA you will be required to complete an application and meet all eligibility requirements before being assessed.

In the meantime, please ensure that your contact information is updated in your MyCARNA profile.

March 16, 2020

Return to practice permits will be issued to retired/associate/former registrants at the request of health-care provider organizations or in the event Government requests extra staff for pandemic response. This request must come through the employers. Please ensure your contact information is up-to-date in your MyCARNA. Please ensure your contact information is up-to-date in your MyCARNA.

Each application will be expedited and assessed to ensure eligibility requirements are met. These permits will be in effect until 30 September 2020 and with the condition "Permit issued for Pandemic response".

Can I refuse to care for someone who may be infected if I feel I may be at risk?

During a pandemic, RNs and NPs provide care using appropriate safety precautions. They have a duty to provide care. A duty to provide care refers to a nurse’s professional obligation to provide clients receiving care with safe, competent, compassionate and ethical care. We know that nurses are experienced in dealing with challenging health issues, including infected patients, on a daily basis. A pandemic situation calls for extraordinary effort from all health-care personnel.

As part of planning preparations, it’s our responsibility to make sure you’re aware that the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses (2017) and CARNA’s Practice Standards for Regulated Members continue to apply. Pages 38-40 of the Code of Ethics explain what you should do to make sure people’s individual needs are recognized, assessed and responded to without undue delay.

It’s also important that you’re supported to take account of your own safety and wellbeing. Your employer is there to help by managing resources effectively and dealing with risk so that the quality of care or service you provide for people can be maintained.

I’m worried that my registration/license is at risk if I need to act outside my normal job. What should I do?

We recognize that in highly challenging circumstances you may need to depart from established procedures in order to care for patients and people using health-care services.

Our regulatory standards are designed to provide a framework for decision-making in a wide range of situations.

In line with the CNA Code of Ethics for Registered Nurses (2017 ) (pages 38-40), use your professional judgement, working with other colleagues across all disciplines to assess risk, find the best way to provide care for people while recognizing and working within the limits of your competence to ensure essential care is provided to clients.

What does the CNA Code of Ethics for Registered Nurses and the Practice Standards for Regulated Members tell me to do in this type of emergency situation?

Some professional standards and behaviours, as set out in the Code, that may be particularly helpful for RNs and NPs to bear in mind at this time include:

• Acting in the best interests of people at all times within the limits of your knowledge and competence
• Understanding you have a professional obligation to ensure that any actions they take do not compromise client safety
• Supporting decisions with evidence-based rationale
• As well as your own safety and fitness to practice, taking account of the safety of others and the availability of other options for providing care
• Using appropriate information and resources that enhance client care and the achievement of desired client outcomes
• Exercising reasonable judgement and setting justifiable priorities in practice
• Integrating infection prevention and control principles, standards and guidelines in providing care and service to protect the health and well-being of clients, staff and the public

You will be expected to do what any reasonable, prudent nurse would do in this same situation and make informed and reasonable decisions based on the context, length and severity of the pandemic situation at this time.

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

All RNs and NPs may be asked to work in an area that they are less familiar with during a pandemic. Temporary re-deployment 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. It is also very important to note that a public health emergency, such as a pandemic, is not a usual circumstance. While in the midst of this pandemic; registered nurses, nurse practitioners 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.

We expect that RNs and NPs are responsible and accountable for the care they provide and must practice to their level of competence. Although there are elements of nursing knowledge and entry-level competencies that cross all client groups and practice, the RN or NP may not be able to do all interventions or carry a full client assignment in the setting to which they will be re-deployed. The RN or NP need to assess and communicate the interventions that they can do competently. The discussion with the manager could include asking for an orientation to the new practice setting, asking questions to understand the expectations of them in this situation, and asking for an identified experienced staff member to be a buddy to answer questions when needed.

I am a former member of CARNA how can I help with the pandemic?

Former members who wish to assist with the COVID-19 pandemic are asked to contact their previous employer, or AHS at careers@ahs.ca, or Covenant at Careers@covenanthealth.ca to inform them of their availability. Employers will send a list of names to CARNA and we will reach out to those who are identified on the Alberta Health or the health care provider organizations list to begin the process of reinstating licenses for the pandemic response.

If you are contacted by CARNA you will be required to complete an application, and meet all eligibility requirements before being assessed.

In the meantime, please ensure that your contact information is updated in your MyCARNA profile.

Nurses like all individuals, can do their part to stop the spread of the virus. Nurses can direct clients and the public to reliable sources for information and must also take a leadership role in reminding others to prevent the spread of the virus by:

• Self-isolating yourself or your family members if feeling sick
• Washing your hands frequently
• Covering coughs and sneezes
• Avoid touching your face

Virtual Care during the COVID-19 pandemic

CARNA supports regulated members in having the capacity to provide quality client care through virtual care during this pandemic. Regulated members and their employer have an accountability to ensure clients are receiving safe and competent care. While in the midst of this pandemic regulated members 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.

CARNA supports the use of virtual care platforms that are recommended and supported by the employer. We recognize that in highly challenging circumstances there may be a departure from established procedures in order to care for clients and people using health-care services. It is reasonable that if the employer is supporting temporary use of unregulated communication technologies based on the principle of matching intervention to need then CARNA would also support this use as the practice standards for regulated members state that the RN and NP follow policies relevant to their practice setting.

Infection, Prevention and Control (IPC)

At this time, it appears the virus is transmitted by larger droplets, like from a cough or sneeze. It is also possible for people to be exposed to the virus from contaminated objects or surfaces by touching these objects or surfaces, then touching their eyes, nose or mouth.

Please review our documents for patients presenting with influenza-like illness:

• Infection, Protection and Control (IPC) Standards
• Guidelines for Hand Hygiene

Alberta Health and health care employers in Alberta are recommending Contact and Droplet Precautions in addition to Routine Practices for health care employees involved in the care of suspected or confirmed cases of COVID-19. As nurses you need to know how to properly don, use, and doff personal protective equipment (PPE) in a manner that prevents self-contamination or contamination of others. Follow your employer policies on infection prevention and control.

General Prevention

There are many common respiratory viruses circulating in Alberta and globally. To help protect against all respiratory illnesses, including the flu and COVID-19, you should:

• use good hygiene practices, such as frequent handwashing
• stay at home and away from others if you are feeling ill
• clean high-touch surfaces

• Canadian Nurses Protective Society (CNPS)
• Legal Considerations When Working in a Pandemic

• Alberta Health: COVID-19
• Alberta Health Services: COVID-19