Provincial Council Meeting - College and Association of Registered
Transcription
Provincial Council Meeting - College and Association of Registered
Provincial Council Late Package June 2-3, 2016 Record of Decisions Agenda Item 4.1.1 Provincial Council Meeting March 10-11, 2016 CARNA Provincial Office In Attendance Provincial Council Shannon Spenceley Jerry Macdonald Alison Landreville Amie Kerber Andria Marin Christine Davies Derrick Cleaver Doug Romaniuk Elaine Andrews President President-elect Edmonton/West Central Calgary/West Calgary/West Edmonton/West Public Member Public Member Elva Hammarstrand George Epp Jeannie Hare Marlene Pedrick Penny Kwasny Tracy Humphrey Tyler Burley Wendy Carey Mary-Anne Robinson Observers Diane Woodward Eyituoyo Abati Heidi Gould Jennifer Cory Nichole Marks Paul McCaskill Edmonton/West Calgary Northeast Northeast Edmonton/West Central CARNA Staff Barb Perry Carolyn Trumper Cathy Giblin Duane Wysynski Gwendolyn Parsons Jane Morgan Jeanette Machtemes Heather Wasylenki Karen McKay Margaret Ward-Jack Margareth Mauro Meagan LaRiviere Robin Cooper Roxanne Ferrier Samantha Sterling Samy Antonious Sarah Zieminek Regional Coordinator Edmonton/West Director, Professional Practice Support Registrar/Director, Quality Assurance Director, Business Intelligence Conduct Counsel, Professional Conduct Assistant to the Registrar/Director, Quality Assurance Director, Corporate Services Regional Coordinator, Central Regional Coordinator, Northwest Senior Advisor, Public Affairs, Communications NEPAB Consultant Senior Manager, Professional Development & Knowledge Policy and Practice Consultant RN Consultant, Registration Services Board Secretary Controller, Corporate Services Executive Office Assistant Central Public Member Northeast Public Member South Northwest Calgary/West Edmonton/West CEO CARNA Provincial Council Record of Decisions – March 10-11, 2016 1. Call to Order The President called the meeting to order at 1:00 p.m., on Thursday, March 10, 2016 and welcomed the Councillors, observers and staff in attendance. 1.1 Notice of Audio Recording Attendees were advised that the audio recording of the meeting would be used solely for the purposes of ensuring the accuracy of the meeting record and that it would be erased upon approval of the meeting record. 1.2 Self-Introductions Provincial Councillors, observers and staff were introduced. 2. Declaration of Conflict of Interest No conflict of interest was declared at this time. 3. Adoption of Agenda 3.1 Call for Removal of Items from Consent Agenda There were no items removed from the Consent Agenda. 3.2 Order of Agenda Items The order of the agenda was not changed. 3.3 Adoption of Agenda and Acceptance of Consent Agenda Items MOTION 1: That the agenda be adopted, as amended. Moved by Alison Landreville and seconded. ADOPTED 4. Adoption of Record of Decisions 4.1 Provincial Council Meeting Record of Decisions 4.1.1 Provincial Council – September 24-25, 2015 It was noted that in the Record of Decisions, Pat Shackleford should be identified as being from the South region and not Edmonton/West. MOTION 2: That the Record of Decisions of the September 24-25, 2015 Provincial Council meeting be adopted, as amended. Moved by Alison Landreville and seconded. ADOPTED 4.1.2 Provincial Council – December 11, 2015 It was noted that in the Record of Decisions, Motion 15 should have the sentence “Moved by Penny Kwasny, Chair of Appointments Committee on behalf of the Appointments Committee” removed. MOTION 3: That the Record of Decisions of the December 11, 2015 Provincial Council meeting be adopted, as amended. Moved by Elva Hammarstrand and seconded. ADOPTED CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 2 of 10 5. Generative Discussion 5.1 ENDS: Guest Richard Stringham, Senior Consultant, Governance Coach In continuation from the December 2015 ENDS workshop, Richard Stringham facilitated the prioritization of ENDS policies among Council members. The result was presented under agenda item 9.1.1. The meeting adjourned for a break at 3:15 p.m. and reconvened at 3:30 p.m. 5.2 Nursing Education Programs External Review: Guest Bruce Matthews, Consultant, Simplifico Inc. Bruce Matthews provided a high level summary of Simplifico’s project objectives in performing a comprehensive review of the regulatory process, including governance, structure, process and outcomes. His final report will identify stakeholder engagement methodologies, findings, recommendations and an implementation plan. 5.3 Nursing Standards Development and Review Process: Carolyn Trumper, Director, Professional Practice Support, CARNA Carolyn Trumper presented an approach to increase the transparency and collaboration on the Executive Limitation 15: Development of Nursing Standards, Guidelines and Position Statements policy. The engagement strategy identifies four phases including Inform, Direction, Draft, and Approve that coincide with Provincial Council meetings. 6. Scanning 6.1 President’s Report In addition to her written report, the Shannon Spenceley provided four opportunities, three challenges, two insightful quotes and one strategic process, and responded to questions from members of Council. 6.2 Chief Executive Officer’s Report In addition to the CEO written report, Mary-Anne Robinson provided an Environmental Scan which included updates on CARNA activities, nursing issues, the NCLEX-RN exam and physician-assisted dying. The meeting adjourned for a break at 10:45 a.m. and reconvened at 10:55 a.m. 6.3 Provincial Councillors’ Reports Councillors highlighted issues raised in their written regional reports. 7. Monitoring 7.1 Operational Plan Report MOTION 4: That Provincial Council accepts the Operational Plan Report for October 2015 to January 2016. Moved by Alison Landreville and seconded. ADOPTED CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 3 of 10 7.2 CEO Expense Claim Process MOTION 5: That Provincial Council tables the review of the CEO Expense Claim Process to the June 2016 Provincial Council meeting. Moved by George Epp and seconded. ADOPTED 7.3 Regular Policy Review & Council Compliance 7.3.1 GP 7 Council Member’s Code of Conduct Provincial Council reviewed GP 7 and made no changes. 7.3.2 GP 7A Council Member’s Code of Conduct – Complaint Process Provincial Council reviewed GP 7A and made no changes. 7.3.3 GP 8 Membership Complaint Policy Provincial Council reviewed GP 8 and made no changes. 7.3.4 GP 9 Safe Disclosure – Financial Whistleblowing MOTION 6: That Provincial Council tables the review of the GP 9 Safe Disclosure policy to the June 2016 Provincial Council Meeting. Moved by George Epp and seconded. ADOPTED 7.3.5 GP 14 Council Committees MOTION 7: That Provincial Council directs the Chair of the Leadership Review Committee to review the terms of reference and determine whether amendments are needed related to Council-CEO policy review and to report back at the June 2016 Provincial Council meeting. Moved by Jerry Macdonald and seconded. ADOPTED 7.3.6 GP 14A Council Committees – Performance Management of Members of Regulatory Committees Council reviewed GP 14A and made no changes. 7.3.7 GP 14B Council Committees – Complaints About the Conduct of Regulatory Committees, Members or CARNA Staff Supporting Regulatory Committees Council reviewed GP 14B and made no changes. 7.3.8 Potential Policy Gaps (Note: GP 4 Bylaw Review Process) MOTION 8: That Provincial Council tables the review of the GP 4 Bylaw Review Process to the June 2016 Provincial Council meeting. Moved by Wendy Carey and seconded. ADOPTED 7.3.9 GP 16B Specialty Practice Groups MOTION 9: That the minimum membership requirement for the membership of the specialty practice group be removed. Moved by Jeannie Hare and seconded. ADOPTED CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 4 of 10 7.4 Council-CEO Relationship Policy Review 7.4.1 Appointment to LRC MOTION 10: That Provincial Council appoints Penny Kwasny to the Leadership Review Committee until the expiry of her term on council. Moved by Elva Hammarstrand and seconded. ADOPTED 7.5 CEO Compliance Reporting and Review 7.5.1 EL 5 Tangible Assets Protection 7.5.2 EL 12 Information Management 7.5.3 EL 14 Public Relations 7.5.4 EL 15 Development of Nursing Standards, Guidelines and Position Statements MOTION 11: That Provincial Council adopts the compliance reports for EL 5, 12, 14 and 15. Moved by Amie Kerber and seconded. ADOPTED The meeting adjourned for lunch at 12:00 p.m. and reconvened at 12:30 p.m. 8. Ownership Linkage 8.1 Open Forum Heidi Gould – Northeast Re: Primary Health Care. Would like to hear more from CARNA regarding its vision and the role of RNs Diane Woodward – Edmonton/West Provided feedback regarding the difficulty of meeting CARNA registration renewal deadlines. July and August are particularly busy months in terms of workload, continuing competency requirements and registration. She proposed for CARNA to consider moving the renewal process later into the fall. Nichole Marks – Edmonton/West Graduate student working towards her Master’s degree in the faculty of nursing at the University of Alberta. Completing her leadership practicum at CARNA and has been tasked with reviewing the Truth & Reconciliation Commission from a regulatory lens. She voiced support for the Provincial Council’s work in revising the ENDS statements and how it links with Canada’s indigenous population. 7. Monitoring (Cont.) 7.6 Regulatory Committee Presentations 7.6.1 Complaints, Hearings and Appeals Georgann Wilkin, Complaints Director The Complaints Director presented an update on the Complaints, Hearings and Appeals Committees’ activities. 7.6.2 Competence Committee Ashley Hyde, Competence Committee CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 5 of 10 The Vice-Chair of the Competence Committee presented an update on the Committee’s activities. 9. CARNA Mandate: Decision Items 9.1 Fiduciary 9.1.1 Finalizing ENDS Statements (CEO) Council drafted a revised version of the ENDS policies as follows: CARNA exists so that: The Alberta public is assured of safe, competent, ethical nursing care and excellence in nursing practice by an effectively regulated, advancing, and progressive profession at a cost that demonstrates responsible stewardship of resources. This is further interpreted as: 1. RNs provide safe, ethical, competent care. 1.1. There is a balanced and evidence-informed regulatory framework. 1.2. The scope of practice and competencies reflect the evolving needs of the population. 1.2.1. RNs are safe and competent prescribers. 1.2.2. RNs demonstrate leadership in their clinical practice. 2. CARNA’s regulatory practices support increased harmonization across Canada. 2.1. Nurses experience consistent registration requirements in Canada. 3. Members have sufficient opportunities to acquire and enhance competencies. 3.1. Members will develop competencies to effectively use information/emerging technology in their practice. 3.2. Members have the resources, tools and support necessary to demonstrate leadership in their professional practice. Members have the knowledge and ability to adapt to and function in 3.3. changing models of care. 3.4. Members have access to educational resources necessary to enact primary health care principles in their practice and to articulate the value of doing so to decision-makers. 4. The unique contribution of Registered Nurses and Nurse Practitioners to the health of the people, communities, and populations we serve, is fully realized in all aspects of the design and delivery of health care services in Alberta. 4.1. RNs are an integral part of health related decision-making at the provincial level, particularly in the areas of: • Primary health care • Seniors Care • Mental health and addictions Chronic disease management • • Electronic health records and new technologies 5. CARNA is a strong, collaborative advocate in promoting the health of indigenous peoples and addressing indigenous health issues within Alberta. MOTION 12: That the Provincial Council adopts the ENDS Statements, as amended for direction to CARNA from 2017-2021 fiscal years. Moved by Christine Davies and seconded. ADOPTED CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 6 of 10 9.1.2 Financial Monitoring Report MOTION 13: That the Provincial Council adopts the Financial Monitoring report for the first quarter, October 1– December 31, 2015. Moved by Alison Landreville and seconded. ADOPTED 9.1.3 Pension Governance Regulations 9.1.3.1 CARNA Pension Plan Governance Policy MOTION 14: That Provincial Council adopts the CARNA Pension Plan Governance Policy. Moved by Alison Landreville and seconded. ADOPTED 9.1.3.2 CARNA Pension Plan Statement of Investment Policies and Procedures (SIPP) MOTION 15: That Provincial Council adopts the CARNA Pension Plan Statement of Investment Policies and Procedures. Moved by Alison Landreville and seconded. ADOPTED 9.1.3.3 CARNA Pension Plan Funding Policy MOTION 16: That Provincial Council adopts the CARNA Pension Plan Funding Policy. Moved by Alison Landreville and seconded. ADOPTED 9.1.4 Appointment of Pension Expert to Finance, Audit and Pension Committee MOTION 17: That Provincial Council agrees to seek a pension expert for appointment to the Finance, Audit and Pension Committee. Moved by Jerry Macdonald and seconded. ADOPTED 9.1.5 Annual Member Registration Fee Review MOTION 18: That the Provincial Council does not approve an RN fee increase other than the Alberta CPI inflationary adjustment and directs the CEO to draw down net assets to meet budget requirements. Moved by Derrick Cleaver and seconded. ADOPTED 9.2 Policy Development and Review 9.2.1 Ratification of Changes to Bylaw 8.1 re President Running for PresidentElect (was re-posted in November for 60 days. Needs ratification.) MOTION 19: That Provincial Council ratifies the proposed changes to CARNA Bylaw 8.1. Moved by Christine Davies and seconded. ADOPTED 9.2.2 2016 CARNA AGM Resolutions No resolutions were received. CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 7 of 10 9.2.3 RN Entry Level Exam – Policy on Number of Eligible Write Attempts MOTION 20: That the Provincial Council tables the RN Entry Level Exam: Policy on Number of Eligible Write attempts to the June 2016 Provincial Council meeting. Moved by Alison Landreville and seconded. ADOPTED 9.3 Council Administration 9.3.1 Provincial Council 2017 Meeting Schedule MOTION 21: That Provincial Council approves the 2017 Provincial Council meeting schedule as presented, with the addition of a council meeting day on March 8, 2017. Moved by Alison Landreville and seconded. ADOPTED 9.3.2 2016 Teller Appointments A ballot was distributed and Council indicated their choices for the position of Election Teller and Alternate Teller. MOTION 22: That Provincial Council appoints Jacqueline Alston-Warnica as Teller and Camille Rudolf as Alternate Teller for the 2016 CARNA elections. Moved by Amie Kerber and seconded. ADOPTED The meeting adjourned for a break at 2:30 p.m. and reconvened at 2:50 p.m. 9.4 Policy Influence 9.4.1 CNA Biennial Meeting Delegates The following Provincial Councillors had their names drawn to attend the CNA Biennial meeting as voting delegates: 1. Alison Landreville 2. Christine Davies 3. Penny Kwasny 4. Andria Marin Additional voting delegates include Amie Kerber (chosen as observer at the December 11, 2015 Council meeting), Shannon Spenceley, Jerry Macdonald and Mary-Anne Robinson. MOTION 23: That Provincial Council approves Alison Landreville, Christine Davies, Penny Kwasny and Andria Marin as voting delegates to the 2016 CNA Biennial meeting. Moved by unanimous consent. ADOPTED 9.4.2 CNA Annual Meeting Resolutions At its December 11, 2015 meeting, Provincial Council passed a motion that it would not develop potential resolutions but consider resolutions generated from member response to the newsletter’s call for resolutions or at the CARNA annual general meeting. No resolutions were submitted by members. CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 8 of 10 9.4.3 CNA Public Member Nomination No further action was recommended by Provincial Council at this time. 10. Consent Items 10.1 Governance Committee Reports 10.1.1 Leadership Review Committee 10.1.2 Provincial Executive Committee 10.1.3 Nominations Committee 10.1.4 Finance, Audit and Pension Committee 10.1.5 Centennial Steering Committee 10.2 10.3 10.4 CARNA Specialty Practice Groups – Quarterly Reports CARNA Educational Advisory Committees Annual Reports Other Reports 10.4.1 Summary of Observer Feedback: September 24-25, 2015 Provincial Council Meeting 10.4.2 Observer Feedback: November 23-24, 2015 CNA Board Meeting 11. Council Executive Session Motions The following motions were passed at the Council Executive Session held on March 10, 2016: MOTION 1: That Provincial Council approves the draft letter as presented be sent to the CCRNR President. Moved by George Epp and seconded. ADOPTED MOTION 2: That if no satisfactory response to the letter is received from CCRNR within two weeks of it being transmitted electronically, an urgent teleconference of Council will be convened to decide on next steps. Moved by George Epp and seconded. ADOPTED MOTION 3: That Provincial Council authorizes the President and the Chair of LRC to obtain independent legal advice with respect to the CEO's employment contract. Moved by Jerry Macdonald and seconded. ADOPTED These decisions are hereby read into the Provincial Council Record of Decisions. 12. Next Meeting Date/Agenda The next meeting of Provincial Council will be June 2-3, 2016. 13. Adjournment The President declared the meeting adjourned at 4:00 p.m. CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 9 of 10 Council Self Evaluation (Council and CEO only) This discussion was held in camera. Minutes Prepared by: Minutes Approved by: ______________________________ Samantha Sterling, Board Secretary ______________________________ Shannon Spenceley, President CARNA Provincial Council Record of Decisions – March 10-11, 2016 Page 10 of 10 Agenda Item 6.3.1 Appendix B CARNA: Good Practice in Bylaw Review Contents 1. A Hierarchy of Board Documents............................................................................................................ 1 2. Considerations in Reviewing Bylaws........................................................................................................ 2 Framework for the Review...................................................................................................................... 2 Review Cycle............................................................................................................................................ 3 Using a Working Group …………………………………………………………………………………………………………………….. 4 Using Legal counsel…………………………………………………………………………………………………………………………… 4 3. Governing Process Policy: Bylaws Review Working Group Terms of Reference[DRAFT ONLY].............. 5 1. A Hierarchy of Board Documents Before beginning the process of bylaw review, it is helpful to appreciate the function of bylaws. There is a hierarchy of governance documents that, in the case of CARNA, begins with the Health Professions Act which brings into being a corporation that in law is considered an “artificial person” if you will, and which is 1 authorized to regulate the nursing profession. Legislation also permits the College to be an Association of members. Bylaws then state the conditions e.g. number of directors, eligibility, quorum, elections, meetings, etc. which are necessary to consider that the ‘corporation/artificial person’ has spoken. Bylaws enable the corporation to have a voice which is empowered to command action over the College’s resources in fulfilling the College’s mandates which is done through the Council’s pronouncements. Given that the Council is using Policy Governance, these pronouncements take the form of Ends, Executive Limitations, Governance Process and Council‐CEO Relationship policies. Bylaws sit between the Act and Council’s policies. You can imagine these documents as a hierarchical chain with the Act at the top, below which is the Council’s bylaws, and below this, the Council’s policies. Each document in the hierarchy is governed by the higher document. This means by that Council cannot do anything in policy which is in conflict with its bylaws and cannot do anything in its bylaws which is in conflict with applicable legislation. (This recalls the principle of policy sizes in which a policy statement is contained by the next higher level of a policy.) Bylaw review then can be considered as the Council acting consistently with a Governance Process policy on Governing Style which begins by stating, “[Council] will govern lawfully with an emphasis on 1 Alberta Health Professions Act, Part 1.1, Section 2 ‐College established: A college is a corporation that (a) is created or continued in a schedule to this Act, (b) consists of its regulated members and other members, and (c) has the capacity and, subject to this Act, the rights, powers and privileges of a natural person. 1|Page Agenda Item 6.3.1 Appendix B outward vision…” While I am aware that the wording of CARNA Council’s policy differs from this phrasing (from the template policies that The Governance Coach offers as starting points), Council nevertheless remains legally responsible to ensure that its policies governing its process and the management of the Council/Association are consistent with CARNA bylaws. In order to govern ‘lawfully’, Council also needs to ensure CARNA’s bylaws are consistent with current and applicable legislation. These last two points draw attention to the importance of every Council member being familiar with the College/Association’s bylaws. Given that bylaws set out the rules by which the Association/College is empowered to conduct itself in pursuit of its mandate, it follows that Council should be interested in the transparency, clarity, currency and appropriateness of these rules. For all of these reasons, it is good practice for Council to conduct regular reviews of the CARNA bylaws and respond to the need for amendments – whether to improved effectiveness, efficiency, clarity, appropriateness, transparency, etc. from time to time and, to conduct reviews prompted by an external prompt, such as the upcoming revision of the HPA which may compel specific amendments and/or timelines for bylaw revision. Legislated changes, such as those set out in the Canada Non‐profit Corporations Act, 2009, can also provide the occasion for more comprehensive review. 2. Considerations in Reviewing Bylaws Once the Council decides to engage in bylaw review, what is good practice? Interestingly, there is not an overabundance of guidance to be found. However, there is some learning to be had from the literature and the bylaw revisions I helped to complete with national organizations who were required to submit bylaws to achieve continuance under the new Canada Non‐profit Corporation Act. Framework for the Review A good place to start is with careful reading of the current bylaws looking for the following: o Bylaws that don’t match what the College/Associations does or needs: If you haven’t reviewed your bylaws in a while, you can be surprised by differences in what the bylaws say you should do and what you actually do. In addition, bylaws may no longer fit your current context. Consider what has changed since your bylaws were written or most recently comprehensively reviewed: do your bylaws fit the context? o Unnecessary duplication: Bylaws often address situations that are not covered in legislation; this is truer when the legislation has been in place for several years. However, if sections of the Act establishing the College are duplicated in the bylaws, this may not be necessary. Remember that the College must always act consistently with the higher authority document. Sometimes an organization chooses to duplicate the legislation so that its governing body does not need to refer to two documents. This is a choice but a review can help the Council ensure it is making an informed choice. o Conflicting or confusing information: Carefully reading the bylaws in their totality often reveals unintentionally conflicting sections. It also sometimes highlights sections or phraseology that are confusing to the reader. Look for these and try to find ways to eliminate sections that conflict with 2|Page Agenda Item 6.3.1 Appendix B each other. You will need to determine which of the conflicting sections takes precedence before considering how to eliminate a conflict. o Balancing precision and simplicity: Bylaws often start from legal templates. While the law is gradually adopting the use of plain language, bylaws may have been written before the movement started. It is possible to simplify language, however remember that precision is as important in legal documents. Simple and precise bylaws causes the fewest problems with interpretation. o Clarity: Similar to above, read your bylaws for clarity of intent. Can all members of Council read a section and take away the same meaning? Or are sections vague and open to many interpretations. Does the ordering of the sections support or detract from clarity. Try testing for clarity with someone not familiar with your organization. o Unnecessary inefficiencies: Do your bylaws create rules that are unnecessarily complicated? Do they require more steps than are needed to meet legislation of good practice? Do they provide too many options? Identify areas where you might be able to simplify the rules without compromising the intent. It is possible that too much detail can limit future options. A common example – though not applicable here – is a set of bylaws that specifies the committees that a board will establish. As the organization evolves, some of these committees are unnecessary or redundant but changing bylaws can be difficult. How much clearer and permissive is a bylaw that simply states a board will, from time to time, establish committees as it determines are necessary. o Consistency with Policy Governance principles: The most common inconsistencies found in bylaws are the assignment of the chief executive officer role to the president or chair, the requirement for the board to have committees that are operational in nature, the assignment of roles to officers that the board has delegated to the CEO, description of the Chair’s role that includes supervision of the CEO, etc. You can also check if there are bylaws that are inconsistent with Council policies. If that is the case, you need to decide which might require amendments. o Bylaws consistency with the reasons for the review: There are different reasons to undertake a bylaws review. For CARNA, the changes in the Health Professions Act, may be a primary motivator. Amendments to the Act may require amendments in the lower authority document, the bylaws. Review can be motivated by a desired change in governing structure, terms of office, eligibility for office, etc. Whatever the reason, it is important to look at all sections to maintain coherence in the document. Council can use the same framework whether it chooses to focus on the bylaws as a whole or only on specific sections. Review Cycle There is no standard for frequency of review. However, it is good practice to not ignore your bylaws. There is not always work to be done with bylaws, but being proactive and making this task part of your annual agenda plan is good practice. If there has been a recent comprehensive review, then Council might want to check over the following year if the new bylaws are meeting the intended objectives or whether, in the implementation, problems such as lack of clarity have been discovered. Otherwise, Council could choose to: o Keep track through the year of possible changes to be considered, and then when there is a sufficient number or items of sufficient importance, the review of possible changes and options to address the needed change could be assigned to an ad hoc committee of Council. o Schedule a review of specific sections over three or four years. As with all of Council’s jobs, making them part of the annual agenda plan ensures that Council does not overlook this work. 3|Page Agenda Item 6.3.1 Appendix B Using a Working Group Given its size, having Council as a whole conduct bylaws review is unlikely to be efficient. Using a working group to assist Council with this work makes sense. However, it is important that the working group not make decisions on behalf of Council. This compromises the principle of holism in which Council as a whole should make decisions. You will notice how this is addressed in the draft terms of reference. Using Legal Counsel It is good practice to ensure your bylaws are well‐crafted, defensible and consistent with legislation. Legal counsel provides this assurance. However, it is not necessary to have a lawyer involved throughout the entire process of bylaws review. Once Council has determined what it wants the bylaws to say, it can have a legal review as a final stage. An exception to this may be if the impending changes in the HPA require significant changes; in this case, it may help to have legal counsel provide an opinion about the sections of the bylaws that will need to be amended along with the rationale. References: Shaping Up Your Bylaws, John Carver, from Board Leadership No. 20, July‐Aug. 1995. The Art of Trusteeship: The Nonprofit Board Member’s Guide to Effective Governance, Candace Widmer and Susan Houchin (Jossey‐Bass, 2000). 4|Page Agenda Item 6.3.1 Appendix B 3. Governing Process Policy: Bylaws Review Working Group Terms of Reference [DRAFT ONLY] The Bylaws Review Working Group enhances the Council’s responsibility to ensure its bylaws are appropriate to governing lawfully, effectively and efficiently. Working Group Products 1. The Working Group products are to support the Council’s responsibility for governing lawfully, never to decide for Council, unless explicitly stated below. 1.1. For consideration of Council, a plan for a regular cycle of bylaw review. 1.2. An opinion for Council on aspects of the bylaws that might be improved, the rationale for improvements, and options for amendments. 1.3. Current information for the board on significant developments that affect the bylaws of the College/Association. 1.4. Options for Council decision, to address desired bylaw amendments. 1.5. For Council, at its request, education about impact of legislative change on CARNA bylaws, options for bylaw changes, or requested topic. 1.6. A transparent process of bylaw review that enhances public‐and member‐owners’ confidence in the organization’s legal framework. Working Group Authority 2. The Working Group’s authority enables it to assist the Council in its work, while not interfering with board holism. 2.1. The Working Group cannot change or contravene Council policies, or instruct the CEO or any other staff member, other than to request information required in the conduct of its duties. 2.2 The Working Group may not spend or commit organization funds, other than those specifically allocated by the board. 2.3 The Working Group may use staff resource time normal for administrative support around meetings. 2.4 The Working Group may meet independently with the organization’s legal counsel. Working Group Composition and Tenure 3. The Working Group’s composition shall enable it to function effectively and efficiently. 3.1. The Committee shall be composed of _____________ 3.2. The _____ shall serve as Committee Chairman. OR The Committee shall appoint a Chair from among its members. 3.3. Members shall be appointed for a [?] year term. 5|Page Decision Document Agenda Item 10.2.3 Policy on Nurse Practitioners Ordering Radiation Therapy June 2-3, 2016 Submitted by: Mary-Anne Robinson, Chief Executive Officer 1. Decision Required Policy Direction: ☒ or Enable Policy: ☐ Does Provincial Council wish to withdraw its policy direction to authorize Nurses Practitioners (NP) to order radiation therapy in the revisions to the Registered Nurses Profession Regulation? 2. Issue Statement In June 2007, Provincial Council approved in principle amending the Registered Nurses Profession Regulation to authorize NPs to order radiation therapy and subsequently reaffirmed this policy direction in May 2011 following the receipt of mixed feedback from stakeholders to our proposed policies to revise the Registered Nurses Profession Regulation. On May 28, 2015 Alberta Health initiated a consultation on the proposed amendments to the Registered Nurses Profession Regulation. Included in the information letter requesting feedback from stakeholders was that prescribing radiation therapy would be a new practice area for NPs and that ordering radiation therapy in oncology would not be practised by NPs until such time as there is an initiative to implement this and the standards of practice are developed in consultation with other stakeholders including radiation oncology. CARNA’s intent is that NPs would adjust or adapt the radiation treatment plan in accordance with the standard of practice. In May 2016 Alberta Health informed CARNA that stakeholders’ comments indicated strong opposition to the expansion of the scope of practice for NPs to order ionizing radiation in radiation therapy, particularly in oncology. Concerns focus primarily on the lack of clarity surrounding the need and rationale for practitioners other than radiation oncologists to prescribe radiation treatment, and the absence of training programs for NPs in radiation therapy. The May 25, 2016 letter from Alberta Health officially informed CARNA of this opposition from stakeholders. Alberta Health acknowledged the college’s prerogative and authority to make proposals for changes to their regulation and standards of practice, however, they requested that CARNA’s council reconsider its proposal to expand the NP scope of practice to authorize NPs to perform the following services at this time: order any form of ionizing radiation in radiation therapy, and Page 1 of 8 order any form of ionizing radiation in radiation therapy in oncology in accordance with standards of practice for radiation therapy adopted by the (CARNA) council 3. Important Deadlines CARNA is steadily moving forward with changes to the Registered Nurses Profession Regulation with anticipated changes to be completed and sent to the legislative planner in May and subsequently sent to a legislative drafter. Alberta Health is working with CARNA towards a proclamation date for our regulation in November 2016. 4. Framing the Issue 4.1 History: 2006 A request was received in 2006 from the Cross Cancer Institute to enable oncology specialist nurse practitioners (NPs) to order radiation therapy. It was suggested that the radiation oncologist would do the new patient consultation and develop the treatment plan and the NP would see the patient in follow up and initiate changes to the radiation therapy as required. There was recognition that significant education would be required to prepare NPs for this responsibility. 2007 In an early initial consultation in 2007, 61.7% of respondents supported the proposal to authorize NPs to order radiation therapy but indicated that this should be done with strict guidelines and in consultation with the radiation oncologists. The College of Physicians and Surgeons of Alberta (CPSA) supported the initiative in accordance with care pathways and defined parameters for medical consultation. In June 2007, Provincial Council approved in principle amending the Registered Nurses Profession Regulation to authorize NPs to order radiation therapy. 2010 Alberta Health initiated a stakeholder consultation in September 2010 on all of CARNA’s proposed policies to revise the Registered Nurses Profession Regulation. Included in the consultation was the proposal to authorize NPs to order radiation therapy. The stakeholder response to NPs ordering radiation at that time was mixed with some stakeholders supportive in principle while others were opposed to NPs ordering radiation therapy. The human resource situation had also changed and there was an oversupply of radiation oncologists in Alberta and across Canada. See comments from stakeholders below: The Alberta College of Medical Diagnostic and Therapeutic Technologist stated: “NPs ordering radiation may be appropriate with established and informed clinical pathways.” Alberta Health Services (AHS) responded by stating: “AHS is supportive in principle but state that they have a lack of knowledge as to competency requirements to safely prescribe radiation therapy. One suggestion was that more education in chemistry, physics and principles of radiotherapy is needed to obtain specific certifications necessary to attain competence.” Page 2 of 8 CPSA was supportive of the changes to restricted activities authorizations that CARNA was proposing and did not comment specifically on NPs ordering radiation. The Alberta Medical Association (AMA) stated that “radiation oncologists, who currently prescribe all radiation therapy in the province, are not supportive of prescribing rights for NPs. Prescribing radiation requires extensive clinical oncology knowledge as well as anatomical/radiological and radiotherapy planning skills, plus other basic science background which is beyond the training and experience of NPs. Steps to improve efficiency, such as the ability to stop a course of palliative radiation or recommend a break in treatment could be done under direct supervision of the prescribing radiation oncologist.” In follow up to the feedback that opposed NPs ordering radiation therapy, CARNA had further discussion with specific stakeholders. CARNA staff met with: the Director of Radiation Oncology and NPs from the Cross Cancer Institute (CCI) NP members of the Nursing Advisory Committee at the Tom Baker Cancer Clinic in Calgary In 2010 the Director of Radiation Oncology at CCI stated that a number of years ago they were having difficulty recruiting a radiation oncologist and when an NP suggested the idea of NPs being able to prescribe radiation therapy he was receptive to the idea at that time. Since then, however, the human resource situation has changed and they now have an oversupply of radiation oncologists in Alberta and across Canada. From the Director’s perspective, when the knowledge and skills of various providers who could be involved in the ordering of radiation is examined, the radiation therapist has the technical background for the complexities of ordering radiation therapy – the interpretation of images, the complex calculations, physics involved, etc. The education of radiation therapists across Canada is moving to baccalaureate preparation and a Master’s Program has been developed at the University of Toronto. A Master’s program for radiation therapists was in the process of development at the University of Alberta. NPs being able to stop treatment or recommend that treatment that has been stopped be re-started, is supported by the radiation oncologists but prescriptive authority is not necessary for that kind of decision making. From the director’s perspective there would need to be a compelling reason to go forward with NP ordering of radiation therapy at this time for it to be supported by the radiation oncologists. Several of the NPs stated that the prescribing of radiation therapy would require significant additional education and that their roles as NPs in radiation oncology were supported and valued without this authorization. They also felt that if there was an NP who was willing to take the additional education that is needed they did not want to have barriers in place that would prevent them from being able to order radiation therapy. When the Master’s program for radiation therapists is available in Alberta there may be opportunity for NPs to do additional course work through them. While there may be a need in the future, NPs stated that now may not be the time to push this forward. NPs do not order radiation therapy in any other Canadian jurisdiction. Page 3 of 8 2011 Due to the mixed feedback from stakeholders on the proposed policies that included authorizing NPs to order radiation therapy in the amendments to the Registered Nurses Profession Regulation this policy question was brought to Council for reconsideration in May 2011. In May 2011, Provincial Council approved that CARNA continue to move forward with authorizing Nurse Practitioners to order radiation therapy in the revisions to the Registered Nurses Profession Regulation. 4.2 Opposition to Authorization for NPs to Order Ionizing Radiation Continues: 2015 In late May 2015 Alberta Health initiated a stakeholder consultation on the Registered Nurses Profession Amendment Regulation. The information letter sent to all stakeholders as part of this consultation stated that CARNA is proposing that NPs be authorized to order radiation therapy and that ordering radiation therapy in oncology will not be practiced by NPs until such time as there is an initiative to implement this and the standards of practice are developed in consultation with other stakeholder including radiation oncology. CARNA’s intent is that NPs would adjust or adapt the radiation treatment plan in accordance with the standards of practice. Alberta Health sent CARNA the feedback from stakeholders on our regulation in November 2015 and a subsequent face to face meeting was held with Alberta Health staff to discuss the feedback. Alberta Health staff commented that it appears the stakeholders are unclear on the need for practitioners other than radiation oncologists to perform this activity and asked if CARNA would reconsider their policy direction based on the strong opposition that was identified in the feedback. The stakeholder feedback in strong opposition to NPs being authorized to order radiation therapy included the following: NPs do not have the skills, knowledge or training to order ionizing radiation in radiation therapy in oncology highly trained physicians do not prescribe therapeutic ionizing radiation in radiation therapy in oncology radiation oncologist do not make the decision to sue radiation therapy in isolation – is often group decision involving specialists in chemotherapy, radiation oncology and surgery CARNA responded to Alberta Health stating that ordering radiation therapy in oncology will not be practiced by NPs until such time as there is an initiative to implement this and the standards of practice are developed in consultation with other stakeholder including radiation oncology. In November 2015 CARNA conducted a survey seeking feedback on the revised Restricted Activities: Standards for Regulated Members. CARNA also sent the standards to Alberta Health as required by the Health Professions Act. This document includes the restricted activities authorized for RNs and NPs. Page 4 of 8 Feedback Received The total number of responses to the CARNA survey was 129 and there was no feedback or comments on the authorization of NPs in ordering ionizing radiation in radiation therapy in oncology in accordance with the standards of practice for radiation therapy. CARNA meet with Alberta Health in March and unofficial feedback on the standards document was shared. There continues to be a concern among stakeholders regarding the authorization of NPs in ordering ionizing radiation in radiation therapy. We have not received official feedback on this standard from Alberta Health as of this date. 2016 In May 2016 Alberta Health informed CARNA that stakeholders’ comments indicated strong opposition to the expansion of the scope of practice for NPs to order ionizing radiation in radiation therapy, particularly in oncology. Concerns focus primarily on the lack of clarity surrounding the need and rationale for practitioners other than radiation oncologists to prescribe radiation treatment and the absence of training programs for NPs in radiation therapy. The May 25, 2016 letter from Alberta Health (Appendix A) officially informed CARNA of this opposition from stakeholders. Alberta Health acknowledged the college’s prerogative and authority to make proposals for changes to their regulation and standards of practice however, they requested that CARNA’s council reconsider its proposal to expand the NP scope of practice to authorize NPs to perform the following services at this time: order any form of ionizing radiation in radiation therapy, and order any form of ionizing radiation in radiation therapy in oncology in accordance with standards of practice for radiation therapy adopted by the (CARNA) council 5. Decision Options 5.1 Decision 1: Does Provincial Council wish to withdraw its policy direction to authorize Nurses Practitioners (NP) to order radiation therapy in the revisions to the Registered Nurses Profession Regulation? Option 1 Provincial Council withdraws its policy direction to authorize Nurse Practitioners to order radiation therapy in the revisions to the Registered Nurses Profession Regulation. Implications NPs working in radiation oncology will not be able to order radiation therapy. The decision could be interpreted as supporting the use of the most appropriate provider ordering radiation therapy. The decision responds to stakeholder feedback and opposition. There is no current demand for NPs to be able to order radiation therapy. Page 5 of 8 NPs being able to recommend that treatment that has been stopped be re-started does not require prescriptive authority. This may remove any challenges for moving forward as quickly as possible with the remainder of the proposed amendments to the Regulation. Option 2 Provincial Council continues with its policy direction to authorize Nurse Practitioners to order radiation therapy in the revisions to the Registered Nurses Profession Regulation. Implications NPs will be authorized to order radiation therapy. This decision may impact on moving forward as quickly as possible with the remainder of the proposed amendments to the Regulation. The decision is not supported by radiation oncologists. The decision does not adequately address stakeholder feedback and opposition. Lack of clarity surrounding the need and rationale for practitioners other than radiation oncologists persists. NPs would require significant additional education to attain the competencies to order radiation therapy. There are no education programs for NPs in radiation therapy. Changes to Regulation is a complex legislative process, so this authorization is in place if needed for future implementation. Option 3 Other option as brought forward by Provincial Council. Page 6 of 8 Appendix A Page 7 of 8 Page 8 of 8 Decision Document Agenda Item 10.2.5 CARNA Specialty Practice Group Application Canadian Association for Rural and Remote Nursing – Alberta Chapter (CARRN-AB) June 2-3, 2016 Submitted by: Mary-Anne Robinson, Chief Executive Officer 1. Decision Required Policy Direction: ☐ or Enable Policy: ☒ Does Council wish to recognize the Canadian Association for Rural and Remote Nursing – Alberta Chapter (CARRN-AB) as a CARNA specialty practice group (SPG)? 2. Issue Statement N/A 3. Important Deadlines N/A 4. Background On April 1, 2016 CARNA received a request from CARRN-AB regarding affiliation as a CARNA SPG (Appendix A). The following checklist has been developed based on the criteria included in GP 16B Council Linkage with Other Organizations – Specialty Practice Groups (Appendix B) approved by Council in December 2015. Requirements for Initial Application Proposed organizational structure, including Bylaws and objectives Short and long term goals Evidence that the group will be ongoing Evidence that the group will be self-supporting List of members List of Executive or Officers Evidence of potential membership Evidence the group involves one or more CARNA Regions Objectives are congruent with vision, mission and values of CARNA, and with the positions taken by CARNA If a request for funding is required, the request is to accompany the document For discussion June 2016 CARNA Provincial Council meeting Received () 14 RN/NP 5. Decision Options 5.1 Decision 1: Does Council wish to recognize CARRN-AB as a CARNA SPG? Option 1 Provincial Council recognizes CARRN-AB as a CARNA SPG. Implications Council is satisfied that CARRN-AB meets all the requirements for recognition as a CARNA SPG. Both Provincial Council and CARRN-AB commit to honouring the responsibilities outlined in Council policy. CARRN-AB will be added to the CARNA SPG list and included on the CARNA website. Option 2 Provincial Council does not recognize CARRN-AB as a CARNA SPG. Implications Council may provide rationale for its decision and direction to the CARRN-AB on the possibility of future applications. Option 3 Other option as brought forward by Provincial Council. For discussion June 2016 CARNA Provincial Council meeting Page 2 of 2 SPECIALTY PRACTICE GROUP APPLICATION FORM Appendix A Please complete the following sections: 1. What is the name of your specialty practice group? Canadian Association for Rural and Remote Nursing – Alberta Chapter (CARRN-AB). 2. Please list your SPG contact info (email, phone, mailing address, website, social media, etc.): www.carrn.com [email protected] [email protected] [email protected] [email protected] [email protected] 3. How much financial assistance is requested per the number of RN/NP members in your SPG? 14 CARNA RN/NP members x $14.36 = $201.04. 4. Your Bylaws are attached? (Y/N) Yes. 5. Describe what your short and long term goals are: 1.) By providing rural and remote nurses a network system 2.) To promote and support rural nurses 3.) To provide resources for knowledge and competency 6. Describe how your group will be self-supporting: Group has been self-supporting since inception. 7. A list of member names is attached? (Y/N – at least 50% are RNs/NPs) Yes. 8. List your executive or officers (president must be a RN or NP; at least 50% of executive positions are held by RNs/NPs): President: Deirdre Jackman (RN) Past-President: Jeannie Hare (RN) President Elect: David Razao (RN) Page | 1 SPECIALTY PRACTICE GROUP APPLICATION FORM Treasurer: Natalie Palmer (RN) Membership: Meg McDonaghy (NP) Secretary: Jeannie Hare (RN) 9. Describe how you will maintain or increase membership for your SPG: We have offered students free membership the last few years, this year we offered students a reduced membership fee. We have a brochure we give out at conferences, etc. as well as poster boards. We have also co-participated in planning a conference put on by Saskatchewan rural nurses (Sept, 2015). We offer a fit-bit for early registration (draw). 10. Do you consent to CARNA sending your SPG emails with non-regulatory information? (Y/N) Yes. Page | 2 CARRN Alberta Chapter Membership List 1 2 3 4 5 6 7 8 9 10 11 12 13 14 NAME Medeiros, Jodi Kuling, Michelle Shellian, Barb McDonagh, Meg Hare, Jeannie Palmer, Natalie Graham, Tasha Jackman, Deirdre Smith, Jean Whalen, Janalee Razao, David Seely, Kelly McKenzie, Audrey Mullings, Melane DESIGNATION RN RN RN RN, NP RN RN RN RN RN RN RN RN RN RN 15 Brown, Meghan Student 16 Bourgeault, Kendra Student 17 Love, Christie Student CARNA NUMBER 101875 83188 32939 54576 29050 75852 95611 56811 52635 75846 100700 60968 60969 74622