CNO - College of Nurses of Ontario Legal and Regulatory Framework Questions and Answers — Questions and Answers
Question 1: A nurse receives a phone call from a man who identifies himself as the adult son of an elderly client on the unit. The son asks for a detailed update on his mother's condition. The client's chart has no specific instructions about disclosing information to family. What is the nurse's most appropriate action according to the Personal Health Information Protection Act, 2004 (PHIPA)?
- Provide the requested information, as he is immediate family.
- Ask the son for the client's date of birth to verify his identity before sharing details.
- Inform the caller that without the client's explicit consent, no health information can be shared. (Correct answer)
- Tell the son to come to the hospital with photo ID to prove his relationship.
Correct answer: Inform the caller that without the client's explicit consent, no health information can be shared.
The Personal Health Information Protection Act, 2004 (PHIPA) governs the collection, use, and disclosure of personal health information. [19, 24] A core principle is that consent is required for disclosure. [25] Unless the client has provided explicit consent or the son is the designated substitute decision-maker for an incapable client, the nurse cannot legally or ethically share personal health information. [23, 26] Being an immediate family member does not automatically grant access to this protected information. [26]
Question 2: According to the Nursing Act, 1991, who is legally permitted to use the professional title "nurse" in Ontario?
- Any individual employed in a healthcare setting to provide direct patient care.
- Only members of the College of Nurses of Ontario (CNO). (Correct answer)
- Graduates of an accredited nursing program who are awaiting their registration exam results.
- Retired nurses who maintain their knowledge through continuing education.
Correct answer: Only members of the College of Nurses of Ontario (CNO).
The Nursing Act, 1991, protects professional titles to ensure the public can identify qualified and regulated practitioners. [4, 5] The Act explicitly states that only members of the College of Nurses of Ontario (CNO) are legally permitted to use titles such as "nurse," "Registered Nurse," or "Registered Practical Nurse." [2, 6, 11] Using the title without being a CNO member is considered an illegal practice. [4, 11]
Question 3: Which of the following responsibilities falls exclusively under the mandate of the College of Nurses of Ontario (CNO)?
- Advocating for better salaries and working conditions for nurses.
- Offering professional liability protection to members.
- Establishing requirements for entry to practice to ensure public safety. (Correct answer)
- Negotiating collective bargaining agreements with employers.
Correct answer: Establishing requirements for entry to practice to ensure public safety.
The CNO's primary mandate, as dictated by provincial legislation, is to protect the public. [29] This is achieved by regulating the nursing profession, which includes setting the standards and requirements for individuals to enter the profession. [4, 29] Advocating for nurses' working conditions and negotiating salaries are roles of a union, like the Ontario Nurses' Association (ONA), while offering liability protection and other professional development are often functions of a professional association, like the RNAO. [29, 32]
Question 4: A nurse is preparing to perform a procedure on a 75-year-old client who has been deemed incapable of making treatment decisions. The client has a spouse, two adult children, and a long-time friend who holds a valid power of attorney for personal care. According to the Health Care Consent Act, 1996, from whom must the nurse obtain consent?
- The friend who holds the power of attorney for personal care. (Correct answer)
- The client's spouse, as they are the closest next of kin.
- The two adult children, by a majority decision.
- The physician in charge of the client's care.
Correct answer: The friend who holds the power of attorney for personal care.
The Health Care Consent Act, 1996, establishes a specific hierarchy for substitute decision-makers (SDMs). [3, 7] A person named as an attorney for personal care in a power of attorney document ranks higher than family members such as a spouse or children. [8, 10] Therefore, the nurse must obtain consent from the friend who holds the power of attorney.
Question 5: What is the relationship between the Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991?
- The RHPA is an umbrella legislation for all regulated health professions, while the Nursing Act contains provisions specific to nursing. (Correct answer)
- The Nursing Act is the primary legislation, and the RHPA provides supplementary, optional guidelines.
- The two acts are independent and do not relate to one another in the regulation of nursing.
- The RHPA applies only to physicians and surgeons, while the Nursing Act applies to all other nurses.
Correct answer: The RHPA is an umbrella legislation for all regulated health professions, while the Nursing Act contains provisions specific to nursing.
The Regulated Health Professions Act, 1991 (RHPA) is the overarching framework that governs all self-regulated health professions in Ontario. [5, 9, 14] The Nursing Act, 1991, is a profession-specific act that works in conjunction with the RHPA. [4, 20] The Nursing Act establishes the CNO and provides specific rules and regulations for the nursing profession that complement the general rules laid out in the RHPA. [4, 9]
Question 6: A nurse makes an error in a client's electronic health record by documenting on the wrong chart. Which of the following actions is the most appropriate and legally sound way to correct this error according to CNO's Documentation practice standard?
- Delete the incorrect entry completely to avoid any future confusion.
- Leave the incorrect entry as is, but add a new, separate note explaining the error.
- Copy the entry to the correct chart and then delete the original incorrect entry.
- Document that the entry was made in error, ensuring the original entry remains visible, and then make the correct entry in the appropriate chart. (Correct answer)
Correct answer: Document that the entry was made in error, ensuring the original entry remains visible, and then make the correct entry in the appropriate chart.
The CNO's Documentation practice standard emphasizes that a health record is a legal document and original entries should never be deleted or obliterated. [12, 15] When an error is made, the correct procedure is to clearly indicate that the entry is an error (e.g., using a strikethrough for paper or a 'mistaken entry' function in an EHR) while ensuring the original information remains visible or retrievable. [12, 21] The nurse should then create a new, correct entry. This maintains the integrity and legal standing of the health record.
CNO - College of Nurses of Ontario Legal and Regulatory Framework Questions and Answers
A nurse receives a phone call from a man who identifies himself as the adult son of an elderly client on the unit.
The son asks for a detailed update on his mother's condition.
The client's chart has no specific instructions about disclosing information to family.
What is the nurse's most appropriate action according to the Personal Health Information Protection Act, 2004 (PHIPA)?