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