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How did ‘the Network’ come to be established?
The Regulated Health Professions Network (the Network) had its beginnings in 2007 when the regulated health professions in the province agreed that it would be in the public’s best interest to have a structured, yet informal, mechanism through which they could more effectively share information and promote best regulatory practices.
Who are the members of the Network?
Each member bodies exists under separate statutes (legislation), however, share a common mandate: to serve and protect the public. Representatives from the Department of Health and Wellness are also part of the Network, serving as non-voting members. View a complete list of our members here.
How is the Network making a difference?
Over the past five years,The Network has focused a great deal of attention on how best to ensure self-regulatory processes keep pace with changes in healthcare, specifically the move toward more interprofessional (collaborative) care teams. Recognizing that more and more health professionals will be working with others outside of their professions in the future, in order to better meet the healthcare needs of Nova Scotians the Network decided it would be prudent to explore the concept of collaborative regulatory processes. While working together to enhance professional practice and regulatory excellence, the Network has adopted polices for collaborative investigations, registration appeal, and a framework on decision making regarding scopes of practice.
The Network is a forum to share resources, trends, and issues among its members thus enabling them to build capacity for their respective regulatory bodies. It is a single point of contact for discussion and consultation with government on matters related to health profession regulation. The Network facilitates development of strategies and approaches that enable members to respond individually and collectively to regulatory challenges and opportunities. Two recent examples are changes to scopes of practice for Licensed Practical Nurses and Registered Nurses regarding Naloxone; and, Medical Assistance in Dying (MAiD).
Why was legislation the right way to go?
The RHPN Act formalizes the Network as a corporate entity (i.e. the Nova Scotia Regulated Health Professions Network) and strengthens self-regulation through a voluntary approach to collaborative regulatory processes. While supporting self-regulation, this legislation also addresses barriers that currently constrain regulatory collaboration.
As individual health professionals are expected to meet the expanding demands of collaborative practice, it makes sense that the organizations that regulate these professionals also have processes in place that will foster and enable them to collaborate when it is in the best interests of the public.
Why incorporate the Network?
Besides the benefit of having a more formal structure through which regulatory bodies can share knowledge and expertise, incorporation establishes a governance and decision-making structure for the Network and enables it to formally speak on behalf of all the professions (as one voice) to government and other stakeholders when it is in the best interests of the public (i.e. to facilitate improvements in regulation or the delivery of health care). Incorporation also benefits those wanting to connect with all the professions by allowing the Network to serve as a central access point.
Will this legislation change the autonomy of the regulators?
No. While the RHPN legislation incorporates the Network and enhances the current regulatory system through the introduction of collaborative regulatory processes, it also preserves the autonomy (and existing legislation) of each of the health professions and their respective regulatory bodies.
Who is the Network accountable to?
As all regulated health professions function under specific statutes, the individual members of the Network (i.e. the 22 regulatory bodies) are always accountable to their respective governing councils/boards and, ultimately, the public. Establishing the Network was intended as a mechanism through which to have representatives from each of the regulatory bodies meet on a regular basis to share information and ideas on best regulatory practices and address common issues/challenges.
How will this legislation enhance regulatory excellence?
Self-regulation is a privilege granted by government through legislation; a privilege that can be taken away if not held to a high standard of excellence. Collaborative approaches to self-regulation will improve the Network’s ability to promote consistently high standards of regulatory practice in the best interests of Nova Scotians by sharing best practices and resources, adopting common training mechanisms for regulators, and serving as one forum in influencing regulatory enhancements.
For example, the RHPN Act will enable health profession regulators in the province to voluntarily collaborate, when deemed appropriate, in regulatory processes related to the:
- investigation of complaints
- interpretation and/or modification of scopes of practice
- review of registration appeals (i.e. when an applicant has been refused registration in a particular profession)
When would a collaborative investigative process be used and who would benefit?
Under the RHPN legislation, collaborative investigations may be used when two or more member professions voluntarily choose to do so, in response to complaints filed against healthcare providers from more than one profession involved in the same incident.
Under current statutes, individuals intending to file a complaint about a situation involving care providers from more than one health profession must file a complaint with each of the respective health regulatory bodies. There are no options for the regulators to collaborate in the investigations or share any of the information gathered. In other words, an individual who has concerns about a situation involving care providers from one or more health profession is required to file more than one complaint and to proceed through the investigative processes of each of the related health professions.
Based on the RHPN legislation, given that the involved regulators agree, an individual submitting a complaint involving different health professions would have to ‘tell their story’ only once and the information they provide would be shared by the involved regulators.
The benefits of collaborative investigation processes would include, but not limited to:
- increased efficiencies in time and resources
- reduced stress for witnesses
- more comprehensive data collection
- more effective investigations (with resources being matched to the complexity of each investigation)
- enhanced ability to identify health systems issues: to assist in improving patient safety and healthcare delivery.
Collaboration with another member of the Network would also be an option for a regulatory body that does not have the experience or resources needed to conduct a complex investigation.
Would the collaborative process extend to disciplinary decisions?
No. The collaborative process would be limited to the investigation of complaints. Although the information collected during a collaborative investigative process could be shared by regulatory bodies, decisions made on the basis of this information would rest solely with each profession’s respective investigative and discipline processes (all of which require both peer and public participation).
How does the RHPN legislation address scopes of practice?
This legislation will legally authorize regulators to reach agreements on the interpretation and modification of scopes of practice without the need for further legislative amendments, given that the Minister of Health and Wellness (the Minister) determines these agreements are in the public interest.
Over the years, regulatory bodies have made agreements on the interpretation of professions’ respective scopes of practice in order to enhance the delivery of quality care by enabling health professionals to practise to their full potential. The RHPN legislation will enable the health profession regulators to make these agreements with the confidence that they are being made with legal authority. However, the Minister will have the option to intervene if there is a concern that an interpretative agreement is not in the public interest.
Given that the RHPN legislation is intended to enhance the delivery of quality care and protect the public interest, it is anticipated that interpretative agreements on scopes of practice will be more common than those pertaining to the modification of a scope of practice.
According to current statutes, the only mechanism available to modify a profession’s scope of practice is through a legislative amendment. The RHPN legislation offers a voluntary mechanism for health professions considering a modification in their scopes of practice to review the considerations with other affected health professions in order to reach an agreement and, ultimately, amend the existing scope of practice.
Modifications in scopes of practice may be desirable to reflect shared competencies among professions, and to enable more effective healthcare delivery by competent, available providers. The RHPN legislation will ensure that modifications in scopes of practice are rigorously reviewed, by requiring that:
- the Network member seeking a modification consult with all other Network members with scopes of practice that include the requested modification
- when an agreement is reached by the above noted members, they consult with all other members of the Network
- Network members consult with all other relevant stakeholders
- the public be notified via the Network’s website, with at least 30 days to provide feedback
- the Minister of Health and Wellness be advised of the proposed modification,consultation processes, and feedback
- any additional consultations be conducted at the request of the Minister
When an agreement is reached, the Minister may: 1) recommend the modification in scope of practice to the Governor-in-Council for approval; or 2) deny the proposed changes, with reasons. When an agreement cannot be reached by the relevant members of the Network, the traditional mechanism of legislative amendments will be required to pursue modifications in scopes of practice.
How will the RHPN legislation address registration reviews?
According to the province’s Fair Registration Practices Act, individuals denied registration in a particular profession must have access to an appeal process. Some health professions have an appeal process clearly stated in their legislation, however, some statutes are silent on this process. Under the RHPN legislation, a collaborative registration review process could be established (e.g. appointing one committee to conduct reviews). In cases where a profession’s statue is silent on a registration appeal process, the individual appealing a regulator’s decision and the respective regulatory body could agree to proceed with the collaborative registration review process established under this legislation. In the event that a particular profession’s statue does include a registration review process, an individual appealing a regulator’s decision and the relevant regulator could agree to follow existing legislative processes or proceed with the collaborative registration review process made available through the RHPN legislation.
The establishment of one committee to conduct reviews would prove beneficial in terms of the time and costs associated with preparing for and conducting reviews (e.g. developing an expert panel of reviewers, sharing overall costs).
Will individual health professionals be more vulnerable to increased risks as a result of the RHPN legislation?
No. Both the statutory rights under each health profession’s governing legislation and common law principles of procedural fairness remain in place and are not adversely impacted by the RHPN legislation.
The purpose of this legislation is to enable health professions, through the auspices of the Network, to make their self-regulatory processes more efficient, responsive and effective. The introduction of collaborative regulatory processes is intended to enhance the Network’s ability to promote consistently high standards of regulatory practice in the interest of all Nova Scotians.
This legislation will not change or add new professional conduct requirements to any of the regulated health professions in the province. Instead, it will provide an additional process to ensure that investigations are efficiently and effectively conducted in the public interest.
Will membership in the Network be mandatory?
The RHPN legislation does state that membership is mandatory; however, participation in the collaborative regulatory processes is voluntary. In other words, the legislation will enable health professions to collaborate – but will not mandate them to do so.
Mandatory membership is an indication that all 22 health profession regulatory bodies value and support the purpose of the Network. The voluntary approach to collaborative regulatory processes has been proposed because the Network is fully committed to maintaining the autonomy of each of the self-regulated professions and believes that an approach initiated by the professions themselves stands a greater chance of success than a system that is imposed on them.
Who will pay for the Network?
Expenses for the Network are being borne by the members of the Network (i.e. the 22 regulatory bodies), and not by individual health professionals licensed with each of the regulatory bodies. The Department of Health and Wellness has also provided financial support for the Network.
Is this collaborative self-regulation initiative unique to Nova Scotia?
Yes. Prior to the RHPN legislation and after examining alternative systems of regulation throughout Canada and in other countries, it was determined that there were no other regulatory models that could be reproduced to suitably build on the strengths of Nova Scotia’s current model of health profession regulation while meeting the demands and challenges within our province’s healthcare system.
While the Network members were confident that the current regulatory system was fully upholding and protecting the public interest, they firmly believed that collaborative regulatory legislation would simply enhance the existing structure and be in the best interests of the public – to whom they are all ultimately accountable.
In 2016 William Lahey and Katherine Fierlbeck co-authored “Legislating collaborative self-regulation in Canada: A comparative policy analysis”. They compared the approaches in Ontario and Nova Scotia. In their view, “…Nova Scotia’s approach may be stronger…”. Read the article here.