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Five legislative changes in New Brunswick for nurses.

Every year, the Legislative Assembly of New Brunswick adopts new laws and makes legislative changes to existing laws that have an impact on registered nurses and nurse practitioners in the province. There were a few noteworthy changes in 2016. The following five legislative changes are by no means exhaustive, but they will likely be of interest to most, and in certain circumstances, directly impact the practice of some nurses.

1 Advance Health Care Directives Act

Commonly referred to as a living will, an Advance Health Care Directive (AHCD) is a document that allows individuals to make decisions in advance regarding their own health care in the event that they cease to have the capacity to make or to communicate their wishes respecting treatment. They can also designate a proxy to make health-related decisions on their behalf once they lose capacity. A decision expressed in an AHCD or by a proxy is as effective as if made by the patient. Under this law nurses, and nurse practitioners in particular, have specific responsibilities. They should consider the following:

* The term "health care professional" includes nurse practitioners;

* If two health-care professionals determine that a patient ceases to have capacity to make decisions and has an AHCD, one of them must inform the patient that they will rely on the AHCD;

* Health-care professionals must retain a copy of an AHCD in the patient's file if one is supplied;

* Health-care professionals do not need to carry out a decision in an AHCD or a direction from a proxy if it is unethical or unconscionable;

* A health-care professional can revoke the appointment of a proxy, if the proxy fails to make timely decisions, which may have a negative impact on the health of the patient. A revocation of appointment, no matter the grounds, must be documented;

* Health-care professionals are not responsible for failing to abide by an AHCD if they acted in good faith relating to the AHCD or if they did not know of the existence of the AHCD.

2 Volunteer Emergency Aid Act

This is a new law that clarifies the legal responsibility of bystanders when providing (or failing to provide) emergency assistance. While this law applies to everyone, nurses often provide emergency assistance off-duty because of their expertise and knowledge. Even if the assistance they provide is negligent and causes harm or damage to another person they will not be found responsible at law, unless their actions (or inactions) are "grossly negligent." The threshold for gross negligence is stricter than usual negligence in that the person has to have had reckless disregard or willful indifference for the harm that might come to a person.

It is also notable that the Nurses Act already states that when a nurse provides first aid or emergency treatment, without compensation and outside a hospital or doctor's office, they have the same level of legal responsibility as an ordinary person. Therefore, the "gross negligence" exception under the Volunteer Emergency Act applies to nurses in the same way as it applies to ordinary bystanders.

This exception does not apply, however, if a person is providing emergency medical services as part of their employment. Therefore, even if a nurse were not "grossly negligent" they could still be found negligent in law for providing emergency services, if such services are normally part of their job.

3 The Practice of Midwives

Following the coming into force of the Midwifery Act in February 2016, the Midwifery Council of New Brunswick was established to regulate the practice of midwifery in the province. As a result, a number of regulations have been amended to clarify the roles and responsibilities of midwives in their practice. Of particular interest, the Hospital Act regulation has been amended to include midwives as medical staff, who may be given hospital privileges to provide health care to a patient and use diagnostic services in a hospital.

4 Health Quality and Patient Safety Act

The New Brunswick legislature has developed a reporting scheme, by which regional health authorities and Ambulance New Brunswick Inc. will have an obligation to create "quality of care and safety of patients committees" once the new law is enacted. These committees, whose composition is not defined in the law, must review all reports of incidents where health care contributes or could contribute or result in the harm or death of the patient. It is the health authorities' obligation to report incidents to the quality of care and safety of patients committee for review. The committee must then present recommendations to the board of directors of the health authority based on its review of the incident.

The Act also creates an obligation on health authorities to inform patients involved in patient safety incidents of the recommendations of the committee and the steps taken to improve the quality of care and safety of patients.

It is noteworthy that this law provides protection to those who flag patient safety incidents to the health authority or the quality of care and safety of patients committee. Specifically, if a person makes a report, they cannot be dismissed, suspended, demoted, disciplined, harassed or otherwise disadvantaged because of their report of an incident. Also, an employee of a health-care organization can make an apology in relation to a patient safety incident without it creating an admission of their fault or liability.

While many health authorities will already have workplace policies related to incident reporting, this law creates a dedicated committee for the review of incidents, and obligatory reporting to patients and the health authorities' board of directors. Some workplace policies may change in the coming months as a result of this law.

5 An Act Respecting Nurse Practitioners

This law comes into force on April 1, 2017, and will amend the Vital Statistics Act, with respect to the duties of nurse practitioners. Specifically, nurse practitioners in some circumstances may now complete and sign the medical certificate of cause of death portion of their patient's death registration. Also, nurse practitioners may have to provide information in their possession regarding any birth, stillbirth, marriage or death to the Registrar General of Vital Statistics, on demand. This duty to provide information to the Registrar General may include the disclosure of certain records. Nurse practitioners are encouraged to contact the CNPS for guidance should this occur to ensure they are respecting their privacy obligations.

These five changes may have some legal impacts to the practice of nurses in New Brunswick. Nurses who have questions about these legislative changes, or any legal aspects or considerations that arise from their delivery of nursing services, can contact the Canadian Nurses Protective Society (CNPS) for legal advice.

DISCLAIMER: This article is for information purposes only. Nothing in it should be construed as legal advice from any lawyer, contributor or the CNPS. Readers should consult legal counsel for specific advice.

About the CNPS

The Canadian Nurses Protective Society is a not-for-profit society that offers legal advice, risk-management services, legal assistance and professional liability protection related to nursing practice in Canada to eligible registered nurses and nurse practitioners. For more information about CNPS services and benefits, contact CNPS at 1-844-4MY-CNPS (1-844-469-2677) or visit
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Title Annotation:Canadian Nurses Protective Society
Publication:Info Nursing
Article Type:Report
Geographic Code:1CNBR
Date:Mar 22, 2017
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