CPNRE Legal Scope and Accountability 2 — Questions and Answers
Question 1: A client requests access to their health record. Under which Canadian legislation is this right protected?
- The Canadian Charter of Rights and Freedoms
- Provincial privacy legislation such as PHIPA (Ontario) or FOIPPA (British Columbia) (Correct answer)
- The Canada Health Act
- Provincial human rights codes
Correct answer: Provincial privacy legislation such as PHIPA (Ontario) or FOIPPA (British Columbia)
Provincial health privacy legislation (PHIPA in Ontario, FOIPPA in BC, HIA in Alberta) governs client rights to access their own health information.
Health information privacy is governed provincially: PHIPA in Ontario; FOIPPA in BC; HIA in Alberta; PHIA in Manitoba. These statutes give clients: the right to access their own health record; the right to correct errors; protection from unauthorized disclosure; and remedies for privacy violations. The Canada Health Act governs healthcare funding, not privacy. Practical nurses must know their provincial privacy legislation and facility privacy policies.
Question 2: A practical nurse realizes they made a medication error but the client experienced no harm. What is appropriate?
- Say nothing since there was no harm
- Tell only the charge nurse verbally
- Complete an incident report, notify the charge nurse, assess the client, and notify the physician (Correct answer)
- Document in a way that minimizes the description
Correct answer: Complete an incident report, notify the charge nurse, assess the client, and notify the physician
All medication errors must be reported through the incident reporting system regardless of harm, for client safety and regulatory compliance.
A medication error, even without apparent harm, requires: immediate client assessment (some effects may be delayed); notify charge nurse and attending physician; complete a medication incident report; document client assessment and actions (do NOT document that an incident report was filed in the clinical record); document objectively. Accreditation Canada requires robust incident reporting. Provincial regulatory colleges (CNO, CRNBC) require disclosure and reporting. Concealing errors is a professional conduct violation.
Question 3: Before witnessing a client's advance directive, what must the practical nurse ensure?
- The document is typed and in proper legal format
- The client is competent, signing voluntarily, and understands the document (Correct answer)
- The nurse has known the client for at least one year
- The attending physician has reviewed and approved it
Correct answer: The client is competent, signing voluntarily, and understands the document
A witness must ensure the client has capacity, is signing voluntarily without pressure, and understands what they are signing.
When witnessing an advance directive (living will, personal directive, healthcare proxy) in Canada: the client must have decision-making capacity; must be acting voluntarily (no coercion); must understand what they are signing. The practical nurse may not witness if they are a beneficiary, substitute decision-maker, or have a conflict of interest. Provincial legislation governing advance directives varies (Health Care Consent Act in Ontario, Representation Agreement Act in BC, Personal Directives Act in Alberta). Practical nurses must know their provincial requirements.
Question 4: A practical nurse recognizes a client as a famous Canadian public figure and sees their diagnosis in the chart. Which action is appropriate?
- Share the interesting clinical information with a trusted colleague
- Review the chart only to the extent necessary for care and maintain confidentiality (Correct answer)
- Access the chart more thoroughly out of curiosity
- Share the diagnosis with staff who know the public figure
Correct answer: Review the chart only to the extent necessary for care and maintain confidentiality
All clients have equal privacy rights regardless of public status. The practical nurse must access only information necessary for care.
The minimum necessary access principle applies to all clients regardless of identity. Under provincial privacy legislation (PHIPA, FOIPPA, HIA), practical nurses must access only information required to provide care. Accessing records beyond clinical need is a breach of privacy legislation and may result in professional discipline (reprimand, suspension, revocation), termination, legal consequences under privacy legislation, and civil liability. CNA Code of Ethics explicitly addresses confidentiality. Snooping in health records is a serious professional conduct violation.
Question 5: Which principle underpins the practical nurse's obligation to obtain informed consent?
- Beneficence
- Autonomy (Correct answer)
- Justice
- Non-maleficence
Correct answer: Autonomy
Informed consent is fundamentally an expression of patient autonomy, the right to make informed decisions about one's own healthcare.
Autonomy (self-determination) underlies informed consent: individuals have the right to make decisions about their own bodies and healthcare. For valid consent in Canadian law and ethics: client must have decision-making capacity; consent must be voluntary; client must receive sufficient information (nature, risks, benefits, alternatives); client must have opportunity to ask questions and understand. In cases of incapacity, substitute decision-making legislation governs (Health Care Consent Act in Ontario, etc.). Informed consent is a legal and ethical requirement for all invasive procedures in Canada.
Question 6: A practical nurse discovers they have HIV and is concerned about disclosure obligations to their employer. What is their primary obligation?
- Immediate public disclosure to all clients and colleagues
- Following provincial occupational health guidelines and regulatory college standards regarding fitness to practice (Correct answer)
- No obligation to disclose to anyone
- Ceasing all nursing practice immediately
Correct answer: Following provincial occupational health guidelines and regulatory college standards regarding fitness to practice
Specific obligations are outlined in provincial regulatory college standards. Disclosure is context-dependent, not absolute.
Healthcare workers with HIV have obligations under: provincial Human Rights Codes (protection from discrimination); OH&S legislation; regulatory college practice standards (CNO, CRNBC). HIV does not automatically preclude nursing practice. Focus is on specific exposure-prone procedures (EPPs). Disclosure to employers is required by some provincial regulatory bodies when EPPs are performed. Public or broad disclosure is generally not required. The healthcare worker must follow their provincial regulatory college's specific guidelines. Immediate cessation of all practice is not required. This is governed by provincial regulatory standards per CMA and nursing regulatory college guidelines.
CPNRE Legal Scope and Accountability 2
A client requests access to their health record.
Under which Canadian legislation is this right protected?