NSDA Newsletter - October 2019
A Cautionary Tale
This is a fictional dietitian's renewal experience.
Last year, Charlie’s Continuing Competency Program (CCP) submission was audited and the audit team rated it “unsatisfactory.” A letter was sent by registered mail and email reminders were sent to Charlie indicating that their next submission would be audited and that their license would not be renewed if there was a second "unsatisfactory" submission. The second submission was also unsatisfactory. There is a renewal grace period, and Charlie had time to resubmit their CCP submission. A late fee of $200 was charged and their license was renewed.
Read the excerpt below from Charlie explaining what happened:
“… I received the mail but did not read the entire letter so I misinterpreted its message. I did not realize my license would not be renewed …”
What happened could happen to any one of us. We are all bombarded with emails. Scanning is sometimes the only way to triage the messages we get. We all have developed our own ways of prioritizing the messages we receive. As regulated health professionals, our professional obligations are to meet a regulatory body's administrative and practice standards. There may be a financial penalty or other consequence to our license status if information is not read. Had Charlie never written the national exam and if their license had expired, they would have been required to write the national exam to have their license reinstated.
We are sending messages in various formats multiple times to do our part to make it easier for you to meet your obligations. How do you prioritize the messages you get? Read on for some tips.
Happy fall everyone!
I would like to start my message by welcoming our two new Board members, Sarah Campbell-Bligh and Erica Reynolds. I would also like to thank all our returning Board members for their continued work and commitment to the NSDA board.
To conclude our last fiscal year, the Board hosted an education day and annual general meeting (AGM) in Dartmouth. The education day focused on continuing competency – in line with our strategic plan. Feedback from the education session and AGM was greatly appreciated and will be taken into account for future planning.
Into 2020, our Governance and Nominations Board Committees continue with their work and will continue to be led by Sarah MacDonald and Melissa Campbell respectively. Our risk lead for the next year is Megan Austen. A huge thank you is extended to these individuals for their commitment to the work of the Board.
There is a lot of very beneficial information presented in this newsletter. Please take the time to read it.
The main content of this message revolves around an inquiry that was conducted into the performance of the College of Dental Surgeons of British Columbia (CDSBC).
In March 2018, British Columbia's Minister of Health Adrian Dix announced the appointment of Mr. Harry Cayton, then-CEO of the UK's Professional Standards Authority, to conduct a review into board governance as well as the administrative and operational practices of CDSBC. The objective was to enhance the ability of a health college to carry out its public protection duties and to enhance governance, transparency and accountability of a college.
The outcome of this review is the Cayton Report and this report is of great significance to all self regulatory authorities. It is an extremely interesting and compelling document. If you have interest in this area, the report itself can be seen HERE. Click HERE to read a summary of the report.
I will attempt to present some highlights of the Cayton Report as succinctly as possible.
The Overall Message of the Report
The Cayton Report is very clear that regulatory authorities must be cognizant of the need for improved governance and regulatory performance in the interest of patient and public safety.
Members versus Registrants
The report specifically denotes the difference between “members” and “registrants.” It states that the term “member” implies that the membership body at large owns and controls the College, whereas the term “registrant” implies that individuals are accountable to the College. Another term commonly used is “licensee.” It is very important that NSDA registrants fully understand the difference between these two terms because, as a regulatory authority, NSDA does NOT have members, but rather registrants, meaning that the registrants, that is, all of us licensed by NSDA, are in fact accountable to NSDA for professional practice and all that impacts our professional practice.
Twenty years ago, NSDA dropped its association role and began functioning solely as a regulatory body. NSDA’s mandate is not to be an advocate for its registrants or the profession, but rather to ensure public safety by ensuring registrants practice in a safe, ethical and competent manner.
Self-Regulation is Changing
The way in which professions regulate varies from province-to-province. There is a trend for more government oversight and more public representation on boards. Governments/the public may perceive that professions are not regulating in the public interest. Therefore, as a self-regulatory authority, it is of paramount importance that all of the work and practices of the NSDA board and organization itself, ensures public protection. Board recruitment, selection, orientation and ongoing training of board members is critical to ensure that the college is governed in an acceptable manner. Once proclamation as a College is obtained, we will be required to have public members on our Board (those who are not dietitians). This helps to ensure decisions are made in the public interest.
Transparency – No Secrets
Although this concept applies to transparency of the Board and the organization to its’ registrants and the public, in the Report’s context, that is not the case. In the Report’s context, it relates to the relationship of the board with employees, and in our case as a small organization, operational volunteers.
“The Board should partner with staff to achieve the organization’s mandate; staff do not just administratively implement board directions. Dysfunction in an organization occurs when board members and staff no longer respect and trust each other.”
As such, Amanda Connors, Practice Advisor will attend board meetings.
To help clearly portray the importance of the Cayton Report to NSDA, I would like to close with a direct quote from the summary provided by the law firm Steinecke Maciura LeBlanc (SML).
“The report makes a number of sweeping short term and long term proposals for regulatory reform for all health professional regulators. These include a completely appointed board of twelve people, half of whom are public members, merging regulators, separating out the adjudication of discipline matters and the operation of a single public register, and the creation of an oversight agency that would review and report on the regulatory performance of the regulators.
This report is broadly consistent with recent developments in British Columbia and other provinces, including Ontario and Nova Scotia, and the regulatory regime that has existed in Quebec for many years.”
We are indeed privileged to still be a self-regulated profession, but we must be prepared for the possibility that this may change in future years.
Until next time,
NSDA President 2018-2020
2019-20 Board of Directors. From left to right/top row: Valerie Joy, Jennifer Hemeon, Sarah MacDonald, Amy MacDonald, Laura Bockus-Thorne. From left to right/bottom row: Jennifer Josey, Erica Reynolds, Megan Austen, Melissa Campbell, Sarah Campbell Bligh, Judy Lowe. Missing: Janice Terry.
Executive Manager's Update
NSDA’s vision is “trust and excellence in regulation and practice.” Work is well underway on our strategic plan toward this vision. In addition, new tools and processes have been introduced to ensure sound decision-making and due process.
NSDA's volunteers and staff stay informed of best practices in professional regulation. Influenced by training, collaborations and recent reports (e.g. Cayten Report), we have implemented new processes and developed tools to ensure and document that decisions are made in a fair and objective manner. A document, Integrity in Decision-making, is a tool for board and committee members, and staff to reflect upon, identify and address conflict of interest and bias. We developed a decision-making framework to systematically address issues and consider stakeholders’ perspectives to ultimately inform decisions that are fair, objective, consistent, reasonable and in the public interest.
Later in the fall, we will undergo our Fair Registration Practices Progress Review. This is undertaken in collaboration with the province’s Fair Registration Practices Act Review Office. Every two years, we review our registration practices, report on our action plan to improve registration practices, and file a report on the results. We will share the results with you and the report will be published on the Review Office’s website.
In contrast to a union or professional association, NSDA regulates the profession. Self-regulation, whereby legislation delegates regulation to the profession, is a privilege. This is not the trend internationally and is why self-regulation is referred to as a privilege. It is important for the public to trust NSDA’s ability to regulate in a manner that is in their interest. It is also important for the profession to trust that NSDA’s processes and decisions are fair and objective.
Jennifer Hemeon (previously Garus)
Consultation on Draft Standards of Practice
NSDA is seeking input from dietitians on the draft standards of practice through this online survey. These standards were developed in partnership by the College of Dietitians of Alberta (CDA) and the Saskatchewan Dietitians Association (SDA).
The standards are based on the assumptions that they:
- Support NSDA’s primary professional obligation to protect and serve the public interest;
- Apply to the many diverse professional roles of dietitians;
- Represent the minimum practice performance of dietitians in delivering safe, competent, ethical services;
- Outline mandatory performance expectations;
- Are one element of a continuum of documents such as legislation, codes of ethics, etc;
- Are a comprehensive unit that dietitians are expected to be knowledgeable of and conform to at all times;
- Exist within the context of legislative, regulatory, and organization/employer requirements.
Click HERE to complete the survey by October 30
Consultation on College Bylaws
In preparation for college proclamation, college bylaws are currently being drafted. They will be emailed to registrants for consultation prior to college proclamation.
Consultation on the Draft Active Practice Policy
Thank you to those who provided feedback on the draft Active Practice Policy. This policy will be relevant when there is an active practice hour requirement under the college act. The feedback will be incorporated into a Q&A document. There is not currently an active practice requirement.
Continuing Competency Program Audit Results
The annual Continuing Competency Program (CCP) auditing process is outlined in Policy 5.2. The rubric used to evaluate submissions can be found HERE. Fifteen percent of CCP submissions are audited annually through random selection and based on screening for satisfactory completion. Auditors are dietitians who volunteer to audit. For consistency and correctness, all auditors are trained on how to complete the audit. Every effort is made to keep submissions confidential and anonymous to auditors.
|# submissions audited||146||138||88|
|Score less than 50 or incomplete||15(10%)||36(26%)||12(14%)|
Overall in 2019, audit results improved. If your submission was unsatisfactory, your subsequent submission will also be audited. A personalized letter is sent by registered mail indicating problem areas, specific suggestions for improvement, and follow up action. Upon notification of audit results, support is offered to facilitate understanding of the expectations of the CCP. Dietitians are strongly encouraged to meet with the Practice Advisor, Amanda Connors. A license will not be renewed if the subsequent submission is unsatisfactory.
Tips for Completing the CCP
In the spring, you were invited to complete a survey about the CCP. Survey results are under review and will be shared with you later in the fall. When asked which aspects of the CCP found to be most challenging, the highest response (59 of 105 responses) was "completing the learning log throughout the year." Not surprisingly, when asked which aspects of the CCP to be easiest, the lowest response (10 of 105 responses) was "completing the learning log throughout the year."
Via an online questionnaire, we asked you to offer tips to prevent the last minute scramble and to keep abreast of the Program. This is what we heard from you.
- Complete learning log entries throughout the year as you complete the education. Keeping my learning log up to date makes renewal so much easier!
- Summer tends to be slower at work, so I use downtime at work or summer vacation to complete the learning log with education activities I have completed to date.
- I use an online calendar (Google, Outlook) to keep track of learning events (conferences, webinars) and refer to the calendar when I am entering items into the learning log.
- I set aside time at the end of each month (or every 2 or 3 months) to update the learning log.
- When I participate in new learning (PEN, read an article etc), I scribble the date and the learning event on a piece of paper. I also make a few notes, so I have some points of reflection to return to later. I then file the paper in a file folder labelled “learning log entries for current year.” When I get a chance, I put those papers in chronological order and enter them into the online learning log.
- I make a point to add my entries to my learning log immediately after completing a learning activity. This way, it is fresh in my mind and I can better reflect on the experience.
- I add a monthly reminder in my day planner and record learning activities every month.
- I keep a journal and write down when I attend sessions, read articles, watch webinars, etc. This keeps it all in one place. I then update the learning log periodically with the entries from the journal.
- I keep the NSDA website link on my desktop and add entries to the learning log as I do them. I also try to schedule tasks/objectives at the beginning of the year as well as check points to ensure I don’t lose track of the learning activities. I also have a file that I drop items related to my learning objectives into so I can easily capture the activities for each goal.
- I link my learning goals to work goals contained within my existing Performance Management Agreement.
- I keep a running list of questions that come up at work. This gives me ideas for developing next year’s goals or prompts me to change my current goal.
- I write my goals on a sticky note and post it where I can read it every day.
- I put appointments in my calendar once every few months to remind myself to update my learning log.
- I use an online calendar (Google, Outlook) to log learning activities so that I can review the calendar at the end of the year and add them to my learning log. Colour-coding the calendar makes it easy to view when I go to enter them into my learning log.
- I print a copy of all educational sessions and put them in a binder close to my workspace. Every month, I enter these into a logbook with a date and bullet point highlights. I elaborate later with wording to describe how the learning impacts my practice.
Example of how to use an online calendar to support completion of the CCP
I’ve been struggling with whether an intern should pass their practicum placement. Since I am unsure, is it okay to rely on the national exam (CDRE) to confirm their competency?
Regulatory bodies rely on the assumption that students have been assessed during their education program to successfully perform all of the performance indicators. The CDRE is a validation of competence. It is important to be aware that graduates practice for a short time before they write the exam and that the CDRE does not test all of the performance indicators. Below are examples of performance indicators that can not be tested on a multiple-choice exam, but impact competent, safe and effective practice. It is therefore very important for preceptors to assess to all of the performance indicators rather thanto rely on the exam as a competency assessment.
- The ability to ensure appropriate and secure documentation (1.10)
- The ability to use effective written and oral communication skills (2.02 & 2.03)
- The ability to use effective interpersonal skills (2.04)
- The ability to deliver group educational sessions (2.05 g)
- The ability to contribute productively to teamwork and collaborative processes (2.06)
- The ability to obtain client perspective (3.01 c), obtain and interpret medical history (3.01 d), obtain and interpret demographic, psychosocial and health behaviour history (3.01 d) and obtain and interpret nutrition-focused physical findings (3.01 k)
- The ability to manage implementation of nutrition care plans (3.03)
- The ability to complete several aspects related to managing food services (5.03), including contributing to purchasing, receiving, storage, inventory control, or disposal activities for food products, contribute to food production and distribution activities, contribute to improvement initiates related to food services and contribute to activities related to compliance with health and safety requirements.
Click HERE for the link to Integrated Competencies for a comprehensive comparison of what is assessed in academic, internship and the national exam.
What will change when NSDA becomes known as a College under new legislation?
When the Dietitians Act (2009) is proclaimed, NSDA will become the Nova Scotia College of Dietitians and Nutritionists (NSCDN). The aim of professional regulation is to protect the public by ensuring professionals are qualified to practice and practice in a competent, safe and ethical manner. NSDA was established in 1956 and had the dual role of functioning as both a regulatory body and an association. In 1998, NSDA began functioning solely as a regulatory body. Dietitians of Canada took on the profession's association role.
Under NSDA's current legislation, the profession's titles are protected. Therefore, only those licensed with NSDA may use the protected titles: dietitian and nutritionist. The new Act protects the titles, registered dietitian (RD) and nutritionist.
In the new legislation, the profession's scope of practice is defined. A defined scope of practice will enable dietitians to practice to their full capacity. In other words, they will be authorized to do what they are qualified to do. For example, the dietitian will be licensed to order an enteral nutrition regime for a patient in the hospital. Standards for nutrition prescription have been drafted and will be launched after college proclamation.
There will be new license categories and the ability to move onto a non-practicing roster if a registrant is taking a leave of absence from practice. The new legislation will enable the college to regulate and board to govern in accordance with best practices and in-line with other colleges in Nova Scotia.
In-person presentations are scheduled at the following locations:
November 25 from 2:30-4 p.m. at Digby General Hospital boardroom
November 26 from 10-11:30 a.m.at Yarmouth General Hospital, Bluenose room
November 4 in Port Hawkesbury at the Straight Richmond Hospital in the board room from 1-3 p.m.
November 5 from 10:30-12:30 p.m. at Cape Breton Regional at the renal clinic
Click HERE to register.
TELUS Health eClaims
Dietitians can now submit claims directly on behalf of clients to major insurance companies through the TELUS Health eClaims service.
If you intend to submit claims directly through the TELUS Health eClaims service, TELUS must be able to recognize your credential as a dietitian. TELUS has requested that NSDA provides your personal information (phone number and email address), but your consent to share this information is required.
Moving out of province? When dietitians apply to other colleges, NSDA completes a Labour Mobility Verification Form to inform the other college that the dietitian is registered in good standing. There is a $25 administration fee for NSDA to send the new college verification of credentials, exam results, and the Labour Mobility Form. The fee is payable by cheque or e-transfer. If your last CCP submission was unsatisfactory, this will be communicated to the other college.
As I am not currently practicing as a dietitian, should I maintain my license with NSDA?
At this time, you are advised to maintain your license with NSDA if there is a possibility that you will return to dietetic practice at some point. When NSDA becomes a college, there will be a non-practicing roster. Before resigning, contact NSDA to understand implications specific to your situation.
I am moving out of Canada to practice as a dietitian, but I may return to Nova Scotia to practice at a later date. Should I maintain my license in Nova Scotia?
You are advised to maintain your license with NSDA if you have never written and passed the Canadian Dietetic Registration Exam (CDRE). Based on Policy 4.10, you would be required to pass the CDRE for reinstatement unless you are registered in good standing with another Canadian dietetic regulatory body at the time of application.
If you passed the CDRE more than three years before the date of application, you will need to satisfy the Registration Committee that you have been registered as a dietitian in good standing in the other jurisdiction, have practiced a minimum of 600 hours in three years before the date of your application and have met a regulatory body’s continuing competency requirements. Otherwise, the Registration Committee may deem upgrading required for reinstatement.
How do I change my email address in the NSDA renewal system?
You can access the online database throughout the year. Please keep your email address, mailing address and employment information up to date by logging onto the membership database and updating your profile details.
If you have a change in email address or wish to change your password, log on and click on your name at the top right corner of the screen. Then click Account.
Where do I find my renewal receipt and license verification?
To access your renewal receipt, log onto the membership database and click on My Applications (found on the left side of the screen under Applications). Hard copies of license cards are no longer mailed out. To access your license verification online, log-on and click on Download My License (found on the left side of the screen under My License).
NSDA is on Facebook
There is an NSDA Facebook group to enhance communication with Nova Scotia dietitians about regulatory related issues. Employment and continuing education opportunities are also posted.
With any social media site, there are risks because information is not private. Inappropriate or misinterpreted posts can harm the reputation and integrity of individual professionals or the profession. Posts will be monitored. If you have concerns, please contact NSDA directly. It is not intended to replace the networking forums that already exist through Dietitians of Canada or the Dietitians Network of Nova Scotia. Join the NSDA Facebook group HERE.
OKAY…SO YOU MADE IT TO THE END…SORT OF LIKE SITTING THROUGH THE CREDITS OF A MOVIE FOR THE CUT SCENES RIGHT?
Tips to Prioritize Email Communications
- Use a non-work email address – When you are on leave you probably aren’t checking work emails and may not even have access to it. If you change jobs you won’t have to worry about updating your email address, and you will have control over the spam/firewall protection.
- Make sure your email address is up-to-date by logging in under MEMBERSHIP RENEWAL and updating your profile.
- Ensure all NSDA email addresses are in your “never junk mail” protected list.
- Flag, star, prioritize, or respond to emails. Don’t let email account algorithms think you just delete NSDA messages.
- Read every message from NSDA in entirety.
- Finally, ask yourself this. Where do I find my license receipt? If you know don’t know, you just scanned past a heading that said IMPORTANT INFORMATION.