I-8, r. 15.1.1.1 - Regulation respecting specialized nurse practitioners

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Updated to 9 December 2020
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chapter I-8, r. 15.1.1.1
Regulation respecting specialized nurse practitioners
SPECIALIZED NURSE PRACTITIONERS
Nurses Act
(chapter I-8, s. 14, par. f).
I-8
Act to amend the Nurses Act and other provisions in order to facilitate access to health services
(2020, chapter 6, s. 2, par. 1).
December 9 2020January 25 2021
DIVISION I
GENERAL PROVISIONS
1347-2020, Div. IO.C. 1347-2020, Div. I.
1. The purpose of this Regulation is to regulate the classes of specialization to which specialized nurse practitioners must belong in order to perform the activities referred to in section 36.1 of the Nurses Act (chapter I-8), to determine the terms and conditions for performing such activities, to determine the form and content of the verbal or written prescriptions made by specialized nurse practitioners, and to establish an advisory committee.
The purpose of the Regulation is also to determine the terms and conditions for the issue of clinical placement authorizations to specialized nurse practitioner students and attestations of practice to specialized nurse practitioner candidates, as well as the terms and conditions under which they may perform the activities referred to in section 36.1 of the Act.
1347-2020O.C. 1347-2020, s. 1.
2. In this Regulation,
(1)  specialized nurse practitioner candidate means a nurse who holds the diplomas giving access to a specialist’s certificate as a specialized nurse practitioner pursuant to the Regulation respecting the diplomas issued by designated educational institutions which give access to permits or specialist’s certificates of professional orders (chapter C-26, r. 2) or who has obtained equivalence for the issue of such a certificate pursuant to the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2) and who, in addition, is eligible to sit the specialty examination;
(2)  specialized nurse practitioner student means either
(a)  a nurse registered in a university-level training program leading to the diplomas giving access to a specialist’s certificate as a specialized nurse practitioner pursuant to the Regulation respecting the diplomas issued by designated educational institutions which give access to permits or specialist’s certificates of professional orders (chapter C-26, r. 2); or
(b)  a nurse who, in order to obtain equivalence for the issue of a specialist’s certificate as a specialized nurse practitioner, is required to complete a clinical placement at a site appearing on the list of training environments drawn up by the program review subcommittee pursuant to the Regulation respecting the committees on training of the Ordre des infirmières et infirmiers du Québec (chapter I-8, r. 11);
(3)  community-based care means health care that
(a)  is intended for persons having particular needs or usual and various health problems that do not require specialized or highly specialized care to be resolved; and
(b)  includes a series of care and health services, provided locally, that are based on a simple infrastructure in terms of diagnostic and therapeutic means;
(4)  specialized care means health care that
(a)  is intended for persons with complex health problems that cannot be resolved by community-based care; and
(b)  includes a series of care and health services that are mainly specialized and are based on an advanced infrastructure and technology in terms of diagnostic and therapeutic means;
(5)  highly specialized care means health care that
(a)  is intended for persons having health problems that are very complex or often have a lower prevalence and that cannot be resolved by specialized care; and
(b)  includes a series of health care and services that are based on a very advanced infrastructure and technology in terms of diagnostic and therapeutic means.
1347-2020O.C. 1347-2020, s. 2.
DIVISION II
CLASSES OF SPECIALIZATION OF SPECIALIZED NURSE PRACTITIONERS AND ISSUE OF A SPECIALIST’S CERTIFICATE
1347-2020, Div. IIO.C. 1347-2020, Div. II.
3. The classes of specialization of specialized nurse practitioners are as follows:
(1)  nurse practitioner specialized in neonatology;
(2)  nurse practitioner specialized in mental health;
(3)  nurse practitioner specialized in adult care;
(4)  nurse practitioner specialized in pediatric care;
(5)  nurse practitioner specialized in primary care.
1347-2020O.C. 1347-2020, s. 3.
4. A specialist’s certificate in one of the classes of specialization of a specialized nurse practitioner is issued by the board of directors to a specialized nurse practitioner candidate who passes the specialty examination.
1347-2020O.C. 1347-2020, s. 4.
DIVISION III
ISSUE OF A CLINICAL PLACEMENT AUTHORIZATION AND ATTESTATION OF PRACTICE
1347-2020, Div. IIIO.C. 1347-2020, Div. III.
§ 1.  — Clinical placement authorization
1347-2020, Sd. 1O.C. 1347-2020, Sd. 1.
5. A clinical placement authorization is issued by the Order to a specialized nurse practitioner student who pays the fee payable for the issue of the authorization.
1347-2020O.C. 1347-2020, s. 5.
6. The clinical placement authorization indicates the name of the specialized nurse practitioner student, the class of specialization concerned and, as applicable, the educational institution where the student is enrolled or the environment where the student is completing a clinical placement.
The clinical placement authorization is valid, as applicable, until the date when the specialized nurse practitioner student is no longer enrolled in the university-level training program leading to the diplomas giving access to a specialist’s certificate as a specialized nurse practitioner or has completed the professional training period required to obtain equivalence for the issue of a specialist’s certificate as a specialized nurse practitioner.
1347-2020O.C. 1347-2020, s. 6.
§ 2.  — Attestation of practice
1347-2020, Sd. 2O.C. 1347-2020, Sd. 2.
7. An attestation of practice is issued by the Order to a specialized nurse practitioner candidate who
(1)  provides the Order with an attestation showing that the candidate’s services have been retained by a centre operated by an institution where a director of nursing care has been appointed; and
(2)  pays the fee payable for the issue of an attestation of practice.
1347-2020O.C. 1347-2020, s. 7.
8. The attestation of practice indicates the name of the specialized nurse practitioner candidate, the class of specialization concerned and the name of the centre operated by an institution that has retained the candidate’s services.
The attestation of practice is valid, as applicable, until the date when the candidate’s services as a specialized nurse practitioner candidate are no longer retained by the centre operated by an institution or until the date when the candidate is no longer eligible for the specialty examination.
1347-2020O.C. 1347-2020, s. 8.
DIVISION IV
SPECIALTY EXAMINATION
1347-2020, Div. IVO.C. 1347-2020, Div. IV.
§ 1.  — Eligibility for the specialty examination
1347-2020, Sd. 1O.C. 1347-2020, Sd. 1.
9. A specialized nurse practitioner candidate who registers for an examination session within the period determined by the Order and who pays the registration fee payable is eligible for the specialty examination.
1347-2020O.C. 1347-2020, s. 9.
10. A specialized nurse practitioner candidate who is eligible for the specialty examination must pass it within 3 years following the first examination session held after the date on which she obtains the diplomas giving access to a specialist’s certificate as a specialized nurse practitioner or following the date on which she obtains equivalence for the issue of such a certificate.
However, a specialized nurse practitioner candidate may obtain a further year to pass the examination if she demonstrates to the board of directors that she was unable to pass the specialty examination within the prescribed time on serious grounds, including a death, a parental leave, a health problem or unavoidable circumstances.
1347-2020O.C. 1347-2020, s. 10.
§ 2.  — Specialty examination
1347-2020, Sd. 2O.C. 1347-2020, Sd. 2.
11. The board of directors forms an examination committee with the mandate of
(1)  drawing up and approving the content of the examination for each class of specialization of a specialized nurse practitioner based on the guidelines set by the board of directors;
(2)  determining whether a specialized nurse practitioner candidate has passed the specialty examination.
The examination committee is composed of 5 members and may retain the services of any person whose expertise is necessary to achieve its mandate.
1347-2020O.C. 1347-2020, s. 11.
12. The specialty examination covers the theoretical and clinical aspects of the class of specialization concerned. In particular, it assesses, in various clinical situations, the assimilation and application of knowledge and skills acquired by specialized nurse practitioner candidates in order to determine if they are able to practice independently as specialized nurse practitioners in the class of specialization concerned.
1347-2020O.C. 1347-2020, s. 12.
13. The Order holds a minimum of one examination session per year in each class of specialization, and determines the date and location of each session.
1347-2020O.C. 1347-2020, s. 13.
14. The specialty examination is available in French and in English. Specialized nurse practitioner candidates may sit the examination in either language.
1347-2020O.C. 1347-2020, s. 14.
15. The Order sends the results of the examination, within 90 days, to the specialized nurse practitioner candidates who sat the examination.
1347-2020O.C. 1347-2020, s. 15.
16. Registration under false pretences, fraud, plagiarism, participation in fraud or plagiarism or attempted fraud or plagiarism all entail a fail mark for the specialty examination, following a decision by the examination committee.
1347-2020O.C. 1347-2020, s. 16.
17. A specialized nurse practitioner candidate who fails the specialty examination may resit the examination twice.
Sections 9 to 16 apply to resits.
1347-2020O.C. 1347-2020, s. 17.
§ 3.  — Review
1347-2020, Sd. 3O.C. 1347-2020, Sd. 3.
18. A specialized nurse practitioner candidate who fails the specialty examination may request that the board of directors review the result if the failure was caused by a factor relating to the examination process. She may also request that the board of directors review a decision made by the examination committee pursuant to section 16.
The request, with the fee payable for its analysis, must be submitted in writing within 7 days from the date on which the examination results or the decision made by the examination committee pursuant to section 16 were received, and must contain the observations of the specialized nurse practitioner candidate concerned.
The board of directors forwards its decision to the specialized nurse practitioner candidate concerned within 90 days of the date on which the Order received the request for review.
1347-2020O.C. 1347-2020, s. 18.
DIVISION V
TERMS AND CONDITIONS FOR PERFORMING THE ACTIVITIES REFERRED TO IN SECTION 36.1 OF THE NURSES ACT BY SPECIALIZED NURSE PRACTITIONERS
1347-2020, Div. VO.C. 1347-2020, Div. V.
§ 1.  — General provisions
1347-2020, Sd. 1O.C. 1347-2020, Sd. 1.
19. To perform the activities referred to in section 36.1 of the Nurses Act (chapter I-8), a specialized nurse practitioner must, within 30 days of obtaining a specialist’s certificate and not later than 1 April of each subsequent year, file a statement with the secretary of the Order on the prescribed form, containing the following information:
(1)  her class of specialization;
(2)  the name, address and telephone number of the institution, clinic, dispensary or other place where she performs professional activities;
(3)  the area of care in which she performs professional activities, where applicable.
1347-2020O.C. 1347-2020, s. 19.
20. A specialized nurse practitioner must report to the secretary of the Order, in writing, any change in the information referred to in paragraph 2 or 3 of section 19.
The change must be reported within 30 days of its occurrence, except if it concerns the area of care. In the latter case, a specialized nurse practitioner must report the new area of care at least 30 days before performing professional activities in the new area of care, and establish that she has updated her knowledge in order to perform those activities.
1347-2020O.C. 1347-2020, s. 20.
21. A specialized nurse practitioner must take reasonable measures to ensure that collaborative mechanisms to provide continuity of care and services required by a client’s state of health are in place throughout the care trajectory, or help establish such collaborative mechanisms.
1347-2020O.C. 1347-2020, s. 21.
22. A specialized nurse practitioner, based on her class of specialization, may perform the activities referred to in paragraphs 1 and 4 of section 36.1 of the Nurses Act (chapter I-8) for diseases that involve recognized diagnostic criteria and clinical manifestations.
1347-2020O.C. 1347-2020, s. 22.
§ 2.  — Special provisions
1347-2020, Sd. 2O.C. 1347-2020, Sd. 2.
23. A nurse practitioner specialized in neonatology performs the activities referred to in section 36.1 of the Nurses Act (chapter I-8) for neonatal clients requiring specialized or highly specialized care.
1347-2020O.C. 1347-2020, s. 23.
24. A nurse practitioner specialized in mental health performs the activities referred to in section 36.1 of the Nurses Act (chapter I-8) in the field of mental health for clients of all ages requiring community-based, specialized or highly specialized care.
1347-2020O.C. 1347-2020, s. 24.
25. A nurse practitioner specialized in adult care performs the activities referred to in section 36.1 of the Nurses Act (chapter I-8) for adult clients requiring specialized or highly specialized care, including clients with mental health problems.
1347-2020O.C. 1347-2020, s. 25.
26. A nurse practitioner specialized in pediatric care performs the activities referred to in section 36.1 of the Nurses Act (chapter I-8) for pediatric clients requiring specialized or highly specialized care, including clients with mental health problems.
1347-2020O.C. 1347-2020, s. 26.
27. A nurse practitioner specialized in primary care performs the activities referred to in section 36.1 of the Nurses Act (chapter I-8) for clients of all ages requiring community-based care, including clients with mental health problems.
1347-2020O.C. 1347-2020, s. 27.
DIVISION VI
STANDARDS FOR PRESCRIPTIONS GIVEN BY SPECIALIZED NURSE PRACTITIONERS
1347-2020, Div. VIO.C. 1347-2020, Div. VI.
28. The Réglement sur les normes relatives aux ordonnances faites par un médecin (chapter M-9, r. 25.1), with the necessary modifications, applies to prescriptions given by specialized nurse practitioners.
1347-2020O.C. 1347-2020, s. 28.
DIVISION VII
TERMS AND CONDITIONS FOR PERFORMING THE ACTIVITIES REFERRED TO IN SECTION 36.1 OF THE NURSES ACT BY SPECIALIZED NURSE PRACTITIONER STUDENTS AND SPECIALIZED NURSE PRACTITIONER CANDIDATES
1347-2020, Div. VIIO.C. 1347-2020, Div. VII.
29. A specialized nurse practitioner student holding a clinical placement authorization may perform the activities referred to in section 36.1 of the Nurses Act (chapter I-8) provided that
(1)  she complies with the terms and conditions prescribed in Divisions V and VI, with the necessary modifications;
(2)  she performs the activities in a site appearing on the list of training environments drawn up by the program review subcommittee in accordance with the Regulation respecting the committees on training of the Ordre des infirmières et infirmiers du Québec (chapter I-8, r. 11);
(3)  she performs the activities under the responsibility of a specialized nurse practitioner or a physician designated as a supervisor for the clinical placement;
(4)  the activities are supervised on-site by a specialized nurse practitioner, a physician or a person authorized to perform those activities who is designated by the supervisor for the clinical placement; and
(5)  the performance of the activities is required to complete the program in which she is enrolled or, where applicable, to complete a clinical placement period for the recognition of equivalence.
1347-2020O.C. 1347-2020, s. 29.
30. A specialized nurse practitioner candidate holding an attestation of practice may perform the activities referred to in section 36.1 of the Nurses Act (chapter I-8) provided that
(1)  she complies with the terms and conditions prescribed in Divisions V and VI, with the necessary modifications;
(2)  she performs the activities in
(a)  a centre operated by an institution where a director of nursing care has been appointed;
(b)  a medical office, a medical clinic, a dispensary or any other place providing care, to the extent that she is employed by an institution where a director of nursing care ensures the supervision of the care they provide; and
(3)  a specialized nurse practitioner or a physician practising in the area of care is designated as a supervisor and is available at all times to intervene quickly.
1347-2020O.C. 1347-2020, s. 30.
DIVISION VIII
ADVISORY COMMITTEE ON THE PRACTICE OF SPECIALIZED NURSE PRACTITIONERS
1347-2020, Div. VIIIO.C. 1347-2020, Div. VIII.
31. The advisory committee on the practice of specialized nurse practitioners is hereby established.
The committee’s mandate is to examine
(1)  the terms and conditions for performing the activities referred to in section 36.1 of the Nurses Act (chapter I-8) by specialized nurse practitioners and the standards for prescriptions made by specialized nurse practitioners;
(2)  the issues connected with the clinical practice of specialized nurse practitioners;
(3)  the new clinical practices of specialized nurse practitioners or improvements that take into account scientific developments or new conclusive data;
(4)  any other matter related to the professional activities of specialized nurse practitioners.
The committee will report its findings to the board of directors and formulate, when it considers it appropriate, an opinion containing, where applicable, recommendations.
1347-2020O.C. 1347-2020, s. 31.
32. The advisory committee is composed of the following 13 members:
(1)  a representative of the Order;
(2)  a representative of the Collège des médecins du Québec;
(3)  a physician specializing in family medicine appointed by the Collège;
(4)  a physician specializing in a field other than family medicine appointed by the Collège;
(5)  a nurse practitioner specialized in neonatology appointed by the Order;
(6)  a nurse practitioner specialized in mental health appointed by the Order;
(7)  a nurse practitioner specialized in adult care appointed by the Order;
(8)  a nurse practitioner specialized in pediatric care appointed by the Order;
(9)  a nurse practitioner specialized in primary care appointed by the Order;
(10)  a specialized nurse practitioner with teaching duties in a university-level training program relevant to the activities referred to in section 36.1 of the Nurses Act (chapter I-8), appointed by the Bureau de coopération interuniversitaire;
(11)  a representative of the Direction nationale des soins et services infirmiers at the Ministère de la Santé et des Services sociaux;
(12)  a director of nursing care appointed by the Order;
(13)  a patient partner appointed by the Order.
The committee may retain the services of any person deemed necessary to achieve its mandate.
1347-2020O.C. 1347-2020, s. 32.
33. The quorum of the advisory committee is 7 members, including 4 specialized nurse practitioners, 1 physician and the representatives of both professional orders.
1347-2020O.C. 1347-2020, s. 33.
34. The members of the advisory committee are appointed for a maximum 3-year term and remain in office until reappointed or replaced.
1347-2020O.C. 1347-2020, s. 34.
DIVISION IX
TRANSITIONAL AND FINAL PROVISIONS
1347-2020, Div. IXO.C. 1347-2020, Div. IX.
35. A specialized nurse practitioner student who was enrolled, before 8 March 2018, in a university-level program leading to the diplomas giving access to a specialist’s certificate as a specialized nurse practitioner in cardiology is eligible, in accordance with Division IV of this Regulation, for the specialty examination for nurse practitioners specialized in adult care.
1347-2020O.C. 1347-2020, s. 35.
36. A specialized nurse practitioner or specialized nurse practitioner candidate who obtained the diplomas giving access to a specialist’s certificate in primary care before 1 September 2017 must complete the training recognized by the Order before performing the activities referred to in section 36.1 of the Nurses Act (chapter I-8). The same applies to a specialized nurse practitioner student who, before that date, was enrolled in a university-level training program leading to the diplomas giving access to a specialist’s certificate in primary care.
The same also applies to a nurse practitioner specialized in primary care who obtained her specialist’s certificate before 8 March 2018 based on recognition of equivalence in accordance with the Règlement sur les normes d’équivalence de diplôme ou de la formation aux fins de la délivrance d’un certificat de spécialiste d’infirmière praticienne spécialisée (chapter I-8, r. 15.2).
The training, which lasts 35 hours, specifically focuses on the elderly and includes the following: advanced clinical evaluation, advanced physiopathology and advanced pharmacology. At least 10 hours focus on the elderly who present behavioural and psychological symptoms of dementia.
The persons referred to in the first and second paragraphs must complete the training within 2 years from the date of coming into force of this Regulation (2021-01-25).
1347-2020O.C. 1347-2020, s. 36.
37. The advisory committee on the practice of specialized nurse practitioners is composed of 9 members until the Order is able to appoint a nurse practitioner specialized in pediatric care, a nurse practitioner specialized in mental health, a director of nursing care and a patient partner.
During this period, the quorum for the committee is 5 members, including 2 specialized nurse practitioners, 1 physician and the representatives of both professional orders.
1347-2020O.C. 1347-2020, s. 37.
38. This Regulation replaces the Regulation respecting the classes of specialization of specialized nurse practitioners (chapter I-8, r. 8).
1347-2020O.C. 1347-2020, s. 38.
39. (Omitted).
1347-2020O.C. 1347-2020, s. 39.
REFERENCES
O.C. 1347-2020, 2020 G.O. 2, 3637