Introduction
Bill 77: Nursing Profession Act (Bill 77) received second reading on March 29, 2023, and was referred to the Standing Committee on Social Development (Committee) for review. Bill 77 repeals and replaces the Licensed Practical Nurses Act (Act), which has only had minor amendments since coming into force in 2004. It is intended to improve regulatory function by establishing a single regulatory framework for all nurses in the Northwest Territories (NWT). It will also standardize the assessment of credentials and oversight of nursing practices under one regulatory structure.
Bill 77 was developed through close collaboration with Registered Nurses Association of Northwest Territories and Nunavut (RNANTNU), which will be renamed the College and Association of Nurses of the Northwest Territories and Nunavut. Regulatory bodies of this kind have been established in other jurisdictions.
Bill 77 changes the following:
- Repeals the Licensed Practical Nurses Act and transfers the authority of RNANTNU;
- Establishes new nursing designations, scopes of practice, registers, and associated requirements for Licensed Practical Nurse, Registered Nurse Authorized Prescriber,
- Registered Psychiatric Nurse, and Registered Psychiatric Nurse Authorized Prescriber;
- Allows Registered Nurses and Registered Psychiatric Nurses who meet certain qualifications to order and interpret specific diagnostic and screening tests, make diagnoses, and prescribe specific medications;
- Updates the complaints and discipline process, including the appointment of a Complaints Officer;
- Adds a requirement for employers to report to RNANTNU if they terminate a nurse, or if the nurse chooses to resign instead of being terminated, due to unprofessional conduct;
- Adds by-law making powers to regulate the practice of nurses, including nurses who practice solely through virtual care; and
- Modernizes language.
Committee Considered Public Input
Committee sought public feedback on Bill 77 with a public notice and targeted engagement letters. Committee received written submissions from the Canadian Nurses Protective Society (CNPS), Scott Robinson RN, and RNANTNU which are appended to this report.
On May 10, 2023, Committee held a public hearing to review Bill 77. At that meeting, Committee heard remarks from the Minister of Health and Social Services and her staff, and they received oral comments from RNANTNU and the public. Committee thanks all these participants for their engagement.
One area of concern identified was the need to provide clarity and certainty with respect to the complaints process. Committee agreed with this concern. RNANTNU stressed the need to redact information in the complaints summary to protect client health and other sensitive information. In response, Committee stressed the importance of procedural fairness, specifically that nurses should receive full, unredacted copies of complaints made against them.
Committee also had concerns about how complaints regarding unprofessional conduct would be addressed by the new statutory officer created by Bill 77, and asked questions about complaints related to Cultural Safety competencies and standards of care for Indigenous residents and those living in small communities. The Minister referred to Living Well Together: Indigenous Cultural Awareness and Sensitivity Training for GNWT employees, and RNANTNU discussed existing standards of practice with respect to Cultural Safety during the public hearing. While these continuing Cultural Safety initiatives are important, Committee stressed the need for nurses to provide culturally safe care in the NWT. Committee was initially concerned about changes to the scope of practice, job descriptions, and change of pay for some nurses. For instance, Registered Psychiatric nurses will see major changes with Bill 77 because they will now be regulated in the NWT.
Committee also asked questions about whether the Government of the Northwest Territories was corresponding with Nunavut on amendments to the Act and heard that the territories were working together but not aligned legislatively. RNANTNU maintains it will be able to operate under the NWT and Nunavut's respective Acts governing the practice of nursing in both jurisdictions.
One area that CNPS and other members of the public identified was the need to provide clarity around insurance and protection, as well as the appeal mechanism for respondents ordered to pay costs during the complaints process. Committee shared these concerns.
After careful consideration, Committee supported six motions amending Bill 77. Three of these proposed amendments were the direct result of public engagement. Committee negotiated the exact wording with the GNWT. The other three proposed amendments were non-contentious: two corrections were made to French language clauses in the Act, and one was an agreed upon change regarding insurance and liability protection.
Committee Amended Six Clauses
Motion 1
Both Committee and the GNWT supported the submission made by CNPS to amend Clause 20 of Bill 77 by adding the words “liability insurance or protection” to paragraph 20(1)(t), striking out "liability insurance." A motion reflecting this change was drafted and passed at the clause-by-clause review.
Motions 2 and 4
While Committee noted the mechanism in place to appeal decisions, submissions during public engagement noted this would not apply to costs of investigations in situations where complaints were dismissed by the Board of Inquiry.
Two motions related to this issue were drafted. The first proposed that Bill 77 be amended by adding language “establishing the procedure to be followed in appeals of directions to pay the costs of investigations” after clause 20(1)(z.19). The second amended clause 67 by introducing substantial changes regarding an “Appeal of Direction to Pay Costs of Investigation” where a hearing was not required 67.1(1), concerning notice of direction 67.1(2), appeal 67.1(3), referral to the Board of Inquiry 67.1(4), and language clarifying an order as to costs 67.1(5). The Minister concurred with both motions, and they were passed at the clause-by-clause review.
Motion 3
Committee feels that it is procedurally fair for nurses to receive full, unredacted copies of complaints made against them. Committee also noted that while nurses are entitled to receive a copy of a complaint made against them under the Act, they may be unaware of this right.
The GNWT and RNANTNU remain concerned about protecting client health information, and redacting potentially vexatious material from complaints, and therefore prefer to provide summaries of complaints.
After negotiation with the GNWT, a motion was drafted concerning “notice of right to receive copy of complaint” which proposed to amend clause 56(5) by adding “(5.1) A summary of a complaint provided under paragraph (2)(a) or (5)(a) must include a statement advising the respondent of the right to receive a copy of the complaint under paragraph (2)(b) or (5)(b) on request.” The Minister concurred with the motion, and it was passed at the clause-by-clause review.
Motions 5 and 6
Committee agreed to support the GNWT's recommendation to correct the French versions of clause 70, under the heading “Renvoi à une commission d'enquête” and 119(3), by striking out "qui n'est pas un médecin" and substituting "qui est un médecin." Two motions reflecting these amendments were drafted and passed at the clause-byclause review.
Conclusion
On May 31, 2023, Committee held a clause-by-clause review.iv Committee passed the motions to report Bill 77, as amended, to the Legislative Assembly as ready for consideration in Committee of the Whole. In the House on June 1, Bill 77, Nursing Profession Act, was orally reported as ready. On June 2, Bill 77 was cited in the Orders of the Day as one of the items under Consideration in Committee of the Whole of Bills and Other Matters.
This concludes Standing Committee on Social Development's review of Bill 77: Nursing Profession Act.
