The amendments to the Public Hospitals Act – Regulation 965 are divided into two groups. The first group of amendments deals with the practice of RN(EC)s in public hospitals. The second group of amendments deals with nursing leadership in public hospitals including the definition of the Chief Nursing Executive (CNE).

1. The definition of extended class nursing staff is amended to include two classes of RN(EC)s :
1. RN(EC)s who are employed by a hospital and are authorized to diagnose, prescribe for and treat outpatients in the hospital; and
2. RN(EC)s who are not employed by a hospital and to whom the hospital board has granted privileges of diagnosing, prescribing for or treating outpatients in the hospital.
2. The role of the Medical Advisory Committee (MAC) is amended as follows :
1. the MAC is to make recommendations to the hospital board on the quality of care provided by RN(EC)s [Section 7(2)(a)(v)];
2. the MAC is to supervise the practice of the extended class nursing staff [Section 7(2)(b)]; and
3. the role of the MAC in making recommendations to the board re appointments and privileges of RN(EC)s apply only to RN(EC)s who are not hospital employees and to whom the board has granted privileges [Section 7(2.1)].
3. Clause 11(3)(c) of the Regulation is amended to authorize RN(EC)s to register outpatients.
4. Clauses 19 (5)(a), (c) and (h) are amended so that the contents of medical records for out-patients include references to RN(EC)s.
5. Subsections 24 (1) and (2) of the Regulation permit RN(EC)s to record orders for treatments and diagnostic procedures for out-patients including those ordered by telephone.

1. In subsection 1(1), chief nursing executive (CNE) is defined as the senior nurse employed by the hospital who reports directly to the administrator and is responsible for nursing services provided in a hospital. Administrator is defined in the Public Hospitals Act as the person with direct and actual superintendence and charge of a hospital, i.e. the hospital's Chief Executive Officer.
2. Subsection 2(3) of the Regulation sets out duties of the hospital board. It is amended by providing that, in the case of a hospital whose by-laws provide for a nursing advisory committee, the board is required to appoint the CNE as chair of the nursing advisory committee.
3. Clause 2(3)(e) of the Regulation states that the board shall ensure that the administrator, medical staff, staff nurses and nurses who are managers develop plans to deal with specified emergency situations in the hospital. The CNE is added to the list of persons who are to develop such plans.
4. Subsection 4(1) of the Regulation sets out required hospital by-laws to be enacted by the board. Clause 4(1)(a) deals with by-laws concerning the management and administration of hospitals. It is amended to provide that the board must enact by-laws setting out procedures for the appointment by the administrator of a nurse as the CNE and the functions and responsibilities of the CNE.
5. Subsection 4(1)(b.1) is added to provide that, in the case of a hospital whose by-laws provide for a nursing advisory committee, by-laws are required to provide for the election or appointment of members of the nursing advisory committee and for the duties of the committee.
6. Sub-clauses 4(1)(f)(I) and (ii) of the Regulation deal with by-laws providing for participation in hospital decision-making and hospital committees by staff nurses and nurses who are managers. These sub-clauses are amended by adding specific reference to the CNE.
7. Subsection 5(1) of the Regulation sets out the composition of the fiscal advisory committee and includes, in clause 5(1)(d), one person representing nurses who are managers. This clause is amended by referring to the CNE or another person representing nurses who are managers.
8. The Regulation provides for a nursing advisory committee. The new provision is enabling rather than mandatory. If a hospital wishes to establish a nursing advisory committee, it can do so by by-law [Section 7.1].
9. Section 18 of the Regulation is amended to require the administrator to notify the CNE in connection with members of the extended class nursing staff who are unable, for any reason, to perform their professional duties with respect to a patient.

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