LEADING THE WAY in Nursing Regulation

Insert Text College of Registered Nurses of Nova Scotia LEADING THE WAY in Nursing Regulation 2013 ANNUAL REPORT Table of Contents 3 Mission, Vision, Mandate 4 Strategic Ends 5 President & ED Message 6 Council 8 Promoting Excellence 11 Instilling Confidence 14 Building Capacity 18 Leading Innovation 21 Accountability & Integrity 26 Financial Statements 37 Member Demographics 39 College Staff

Regulating Nursing in the Public Interest The College of Registered Nurses of Nova Scotia (the College) has the legislated mandate under the Registered Nurses Act to regulate the practice of nursing in the public interest. As the regulatory body, the College delivers on this mandate by: y Licensing registered nurses (RNs) and nurse practitioners (NPs) practicing in Nova Scotia, y Setting the standards for nursing practice, y Approving nursing education programs, y Enhancing the continuing competence of nurses, y Providing RNs and NPs with advice and resources to promote quality practice, and y Addressing complaints received about nursing practice if standards are not met. The College is committed to supporting RNs and NPs, as professionals, to uphold their standards of practice and Code of Ethics in order to provide Nova Scotians with safe and quality nursing care. Nursing has been a self-governing profession in Nova Scotia since 1910. This means that government, through the Registered Nurses Act, has delegated the responsibility to oversee nursing practice to registered nurses themselves. The public trusts that registered nurses practice with public interest as their priority and it is the role of the College to ensure that practice in the public interest is maintained. It is a testament to the incredible work of registered nurses, and effective oversight on the part of the College, that the legacy of trust and self-regulation has been maintained over 104 years. Surveys will tell you that nurses are one of the most trusted professionals. Maintaining the trust bestowed on the nursing profession is important to the public, registered nurses, other healthcare providers, employers, educators, the unions, government and the College. The strong history of nursing in Nova Scotia is something that we must all take pride in and cultivate for the generations that follow. We look forward to a stronger future together. Annual Report 2013 College of Registered Nurses of Nova Scotia, Halifax, NS 2 This document may be downloaded from www.crnns.ca.

Mission Registered nurses regulating their profession to promote excellence in nursing practice. Vision Our vision of success is a future where the College: y Empowers nurses to recognize and realize their contribution to the health of the public and healthcare system and advance their professional development; y Implements innovative regulation that enables the profession to shape the future healthcare system; y Inspires nurses to be leading contributors to public safety; y Enhances nurses capacity to meet increased demand and higher expectations of registered nurses and nurse practitioners; y Has a wealth of evidence to set public policy directions; y Is making connections, building coalitions and influencing change. Mandate The College s mandate is to regulate the practice of nursing in the public interest. The College s core regulatory functions are to: y Set the educational requirement for those entering the nursing profession; y Issue annual licences to qualified applicants to practise nursing; y Establish and improve standards for nurses practice; y Enhance the continuing competence of nurses; and y Review and take appropriate action on complaints about nurses practice or behaviour. Mission, Vision, Mandate 3

Strategic Ends Strategic Ends 2012-2014 Ends (goals) and policies provide direction to the College s Executive Director and staff. They are established by Council in accordance with legislation. Mega End Excellence in RN self-regulation for the health of Nova Scotians. Ends A. Public receives safe, competent, ethical and compassionate care from registered nurses and nurse practitioners. B. Registered nurses and nurse practitioners work to their optimal scope of practice in an evolving healthcare system. B1. Clients receive coordinated care within and across the care continuum. C. Registered nurses and nurse practitioners are competent to practise in intra- and interprofessional collaborative teams. D. Registered nurses and nurse practitioners practise self-regulation. 4

Message from the President and Executive Director Peter MacDougall, RN, BScN President Donney Denney, MN, RN Executive Director It has been our privilege and honour to serve as President and Executive Director of the College of Registered Nurses of Nova Scotia this past year. 2013 marked an eventful and meaningful year, thanks in large part to your participation and involvement as the registered nurses of this province. Committed to protecting the public through the regulation of registered nurses, we worked together to enhance and strengthen the future of the nursing profession for all Nova Scotians. President & ED Message This annual report has been produced to demonstrate our commitment in regulating the practice of registered nurses in the public interest during the 2013 year. Excellence in nursing is the cornerstone of the College and each project and activity we ve shared in this report is work that was undertaken to promote good practice, prevent poor practice and intervene when practice is unacceptable. At the College, we believe that when registered nurses are engaged in their profession, there is a positive impact on system improvements and health outcomes for clients. RN engagement leads to greater competence, increased nurse satisfaction and accountability and boosts overall role clarity and pride recognition among nurses. This past year, the College focused on engaging with registered nurses across Nova Scotia through the Real engagement project to empower nurses to be champions within the healthcare system. This is an exciting time for the profession as we continue to engage nurses, not only through this initiative, but through their participation in various College activities. This marks the final annual report for both of us as the College prepares to welcome a new President, Jackie Garden-Jayasinghe in July 2014 and a new Executive Director in January 2015. Nursing has been more than just a career choice for each of us and we both feel that the profession has given back to us more than we could have imagined. Nova Scotia has a long and proud history of nursing and we are confident registered nurses will continue to pave the way to a bright and positive future in Nova Scotia. We would like to express our gratitude to Council, College staff, our many stakeholders and the over 10,000 registered nurses of Nova Scotia for their hard work and dedication to excellence during 2013. Please read through the rest of the College s annual report to learn more about how we spent the past year together. Thank you for allowing us to serve as your President and Executive Director. Peter MacDougall Donna Denney 5

Council Council The College of Registered Nurses of Nova Scotia has been regulating the profession of nursing since 1910. The Council is the College s governing body and is represented by 19 individuals who are passionate about the provision of safe and quality nursing care in Nova Scotia. back row (l-r): Marlene Ash, Ruth Whelan, Kathy LeBlanc, Cyndee MacPhee, Tim Guest, Kelly Ann Lackie, Marian Mac Lellan, John Hudec, Rosalind Beniot, David Samson, Anne Bigelow front row (l-r): Carolyn Fowler, Peter MacDougall (President), Donna Denney (Executive Director), Jacquelyn Garden-Jayasinghe (President-elect), Colleen MacNeil 6

Members President Peter MacDougall, Health Services Director Capital District Health Authority, Halifax President-Elect Jacquelyn Garden-Jayasinghe Nurse Practitioner, Nephrology Capital District Health Authority, Halifax District Councillors Marie Arnott, Highland Assistant Professor, St. FX University, Antigonish Marlene Ash, Atlantic Critical Care Nurse, QEII Health Sciences Centre, Halifax Edna Carloss, Atlantic Clinical Practice Team Leader, Oakwood Terrace, Nova Scotia Hospital, Dartmouth Council Public Representatives Paulette Anderson, New Glasgow Anne Bigelow, Stellarton Adélard Ed Cayer, Shelburne Carolyn Fowler, Dartmouth Bruce Holmes, Dartmouth John Hudec, North Sydney Nancy Jones, Cape Sable Island Vincent MacLean, East Bay Colleen MacNeil, Halifax David Samson, Louisdale Student Nurse Council Members Cameron Boys, St. FX University, Antigonish Kendra MacCuspic, Cape Breton University, Sydney Councillors-at-Large Rosalind Benoit, Nurse Practitioner Capital District Health Authority, Halifax Ruth Whelan, Nurse Educator RN Professional Development Centre, Halifax Lena MacDonald, Nurse Practitioner, Heart Health Clinic, St. Martha s Regional Hospital, Antigonish Clare Currie, Cape Breton District Nursing Strategy Manager, Northside General Hospital, North Sydney Rebecca Dorey, Western Director of Nursing, Harbour View Haven Nursing Home, Lunenburg Timothy Guest, Annapolis Vice President, Acute Care & Chief Nursing Officer, Annapolis Valley DHA, Kentville Kelly Ann Lackie, Atlantic IPE Faculty Lead, RN Professional Development Centre, Halifax Kathy LeBlanc, Cobequid Principal, Changing Tides Consulting Inc., Amherst Marian Mac Lellan, Highland Chair, School of Nursing, St FX University, Antigonish Cyndee MacPhee, Cape Breton Assistant Professor, Nursing, Cape Breton University, Sydney Darlene O Reilly, Cobequid Manager, Continuing Care Programs, Amherst January 1-June 30, 2013 Peter MacDougall, Jacquelyn Garden-Jayasinghe, Kendra MacCuspic, Rosalind Benoit, Lena MacDonald, Timothy Guest, Edna Carloss, Kelly Ann Lackie, Clare Currie, Cyndee MacPhee, Darlene O Reilly, Marie Arnott, Rebecca Dorey, Paulette Anderson, Bruce Holmes, John Hudec, Nancy Jones, Vincent MacLean, David Samson July 1-December 31, 2013 Peter MacDougall, Jacquelyn Garden-Jayasinghe, Kendra MacCuspic, Rosalind Benoit, Ruth Whelan, Timothy Guest, Marlene Ash, Kelly Ann Lackie, Cyndee MacPhee, Clare Currie, Kathy LeBlanc, Marian Mac Lellan, Rebecca Dorey, Paulette Anderson, Carolyn Fowler, John Hudec, Colleen MacNeil, Adélard Ed Cayer, David Samson 7

Promoting Excellence Promoting Excellence in Governance Awards The College celebrated the success of registered nurses and nurse practitioners across the province at the 2013 Awards Banquet where registered nurses were recognized for their accomplishments as outstanding role models within the nursing profession. The following excellence in nursing awards were presented on May 15, 2013: Excellence in Nursing Administration y Kathryn Inkpen, Manager, Healthy Development, Public Health Branch, Nova Scotia Department of Health and Wellness, Halifax Excellence in Clinical Practice y Linda MacDonald, Care Co-ordinator, Colchester East Hants District Health Authority, Truro y Debora Mander, Clinical Resource Nurse, Medical-Surgical, Annapolis Valley Health, Kentville Queen Elizabeth II Diamond Jubilee Medals Heather Jewers, Assistant Professor at St. Francis Xavier and Mary Morris, Director of the Office of the Employer Advisor Nova Scotia Society were awarded Queen Elizabeth II Diamond Jubilee Medals in 2012. These awards were presented nationally at the CNA event. In addition, the College recognized the presentation of these awards at the May 15th, 2013 ceremony in Dartmouth, Nova Scotia. 8

Council Election The Council Election 2013 was launched in November 2012 with a call for candidates by the College s Nominations Committee. In March 2013, the Nominations Committee confirmed all positions for election were filled by acclamation with the exception of Cobequid (Council appointed Kathy LeBlanc). The successful candidates in the 2013 election were: yclare Currie, District Councillor, Cape Breton ymarian Mac Lellan, District Councillor, Highland ycyndee MacPhee, District Councillor, Cape Breton yruth Whelan, Councillor-at-Large Promoting Excellence Risk Management In early 2013, the Healthcare Insurance Reciprocal of Canada (HIROC) Risk Management Program was implemented by the College s Risk Management Committee. Each of the program s modules were reviewed to assess and manage the College s risks in relation to security, governance and management, registration and licensure, finance, human resources, quality assurance, and complaints and resolution. The Risk Management Program has enabled the College to identify potential and actual risk, categorize the risk as critical, moderate, or low, and monitor the risk until it is resolved. The College s Regulatory Excellence Framework (visit crnns.ca) depicts the relationship of risk management, quality assurance and quality improvement. This framework was published in the Journal of Nursing Regulation and has been used in the development of new College policy initiatives. Ends Monitoring in 2013 Each year, the College conducts surveys with key nurse stakeholders in order to monitor the achievement status of the College s Ends. The College compares the survey results to its Ends and then creates enhanced services and resources to contribute to the achievements of the Ends under the College s mandate. Significant discrepancies within the survey are also further reviewed and appropriate steps are taken. In 2013, the College conducted seven surveys: a Registered Nurse (RN) member survey, RN Employer survey, Nurse Practitioner (NP) member survey, NP employer survey, new RN graduate survey, new RN employer survey and a new NP graduate survey. For monitoring purposes, the data from these surveys was compared to similar surveys conducted in 2012 in order to spot trends and issues. Data collected from each survey in 2013 was accepted by Council as evidence of reasonable progress towards meeting each of the College s Ends. 9

Promoting Excellence END A: Public receives safe, competent, ethical and compassionate care from RNs and NPs RN & NP Member Results y 97% of RNs and 98% of NPs are confident to very confident in their ability to provide safe, competent, ethical and compassionate care. END B: RNs and NPs work to their optimal scope of practice in an evolving healthcare system RN & NP Member Results y 69% of RNs and 71% of NPs feel that they are currently working to their optimal scope of practice. RN & NP Employer Results y 80% of RN Employees and 90% of NP Employers agreed that RNs and NPs are practising to their optimal scope of practice. END C: RNs and NPs are competent to practice in intra and interprofessional collaborative teams RN & NP Member Results New RN Graduate Results y 96% of RNs and 93% of NPs feel confident to very confident in their ability to function effectively as a member of the intraprofessional team. y 94% of RNs and 100% of NPs feel confident to very confident in their ability to function effectively as a member of the interprofessional team. y 83%-97% of New RN Graduates indicated they were confident in functioning independently with both the intra and interdisciplinary teams New RN Graduate Employer Results y 78% of new RN Graduate Employers agreed that the new RN graduates provide leadership by coordinating care with other disciplines. END D: RNs and NPs practice self-regulation RN & NP Members Results y 98% of RNs and 97% of NPs will take action to resolve professional practice issues that compromise their ability to provide safe, quality care. y 92% of RNs and 95% of NPs would pursue additional steps when their interventions have not resulted in the successful resolution of a practice issue. With the exception of the survey of new RN graduate employers, the College commissioned MQO Research to conduct its surveys in 2013. The survey samples were: RNs = 730; Employers of RNs = 318; NPs = 73; Employers of NPs = 44; New RN Grads = 82; New NP Grads = 17; New RN Grad Employers = 50. 10

Instilling Confidence in the Nursing Profession Instilling Confidence Registration & Licensure Maintaining licensing rosters of registered nurses and nurse practitioners who are legally allowed to practise nursing in Nova Scotia is fundamental to our mandate to regulate the practise of nursing in the public interest. In order to practice as a registered nurse or a nurse practitioner in Nova Scotia, individuals must first meet the requirements for initial registration and licensure with the College, and then have to apply to be licenced with the College on an annual basis. The College has a rigorous application process and only those applicants who satisfy the requirements and meet the criteria set by the Registered Nurses Regulations are licenced to practice nursing as registered nurses and nurse practitioners. It is against the law for a nurse or nurse practitioner to practise if they are not on one of our licensing rosters. Any member of the public can check the licence status of a registered nurse or nurse practitioner through the online licence status search on the College s website. The College issued licences to 10,249 qualified registered nurses and nurse practitioners in Nova Scotia. This compares with 10,171 licences issued in 2012. First Time LIcences RN 538 NP 10 Renewed Licences RN 9556 NP 145 Most Visited Webpages 1. Licence Status Check 2. Renew/Apply for RN Licence 3. Renew your Licence Continuing Competence By participating in the College s continuing competence program (CCP) first established in 2002, registered nurses indicate to the public that they are maintaining their competence to practice. This is an important program which allows registered nurses to demonstrate that they are providing the public with safe, competent, ethical and compassionate care. Today, CCP is a requirement of licensure for RNs and involves several components including the completion of a self-reflective tool (selfassessment and learning plan) that is not verified. The College is currently the only RN regulator in Canada that does not verify their members learning plan. In April 2013, Council approved CCP additions that include indication that the RN has completed her/ his learning plan when they licence, verification of learning plan completion (random sampling), and a mandatory education requirement. These CCP enhancements are anticipated to be phased in during the 2016 licensure year. Changes to the RN Regulations are required in order for the College to verify members learning plans. The College has met with leadership from the Nova Scotia Nurses Union (late 2013) and the Nova Scotia Government and General Employees Union (early 2014) to inform them of these changes. Members will be informed and engaged throughout the enhancement process. The self-assessment tool will still be confidential and submission is not a requirement. 11

Instilling Confidence Jurisprudence Examinations Jurisprudence is an individual s awareness of legislation, standards and regulatory policies that impact their field of work. The jurisprudence exam measures an individual s knowledge about legislation and standards relevant to nursing practice in Nova Scotia, which is something that is of importance to registered nurses, the College and Nova Scotians. Council approved the newly established jurisprudence exams for both registered nurses and nurse practitioners in December 2012 and resources were created and placed on crnns.ca in order to support those preparing to write the exam. The College met with nursing faculty representatives from Dalhousie University, St. Francis Xavier, Cape Breton University and the RN Professional Development Centre throughout 2013 to ensure nursing curriculums were reflective of the required regulatory education to practice nursing in Nova Scotia. First Writing Pass Rates Registered Nurses: y NS graduates: 98% y Out-of province candidates: 88% y International candidates: 100% Nurse Practitioners: y NS graduate: 100% The jurisprudence exams for registered nurses and nurse practitioners were piloted in June 2013 and debuted as a requirement for initial registration and licensure in September 2013. Although some candidates have reported difficulties in accessing and/or submitting their exams, the College has worked closely with the Nova Scotia Community College, the exam administrator, to reduce the occurrence of these technical issues. Between September and December 31, 2013 a total of 98 nurses wrote the Jurisprudence Exams. Application Status Portal The Application Status Portal is an enhanced service offered by the College to keep new applicants informed about the progress of their application for initial registration and licensure. This service is an exciting addition to the registration process and is the result of a College effort to improve customer service to our members. Through the use of a secure and personalized portal, new applicants are aware of their position in the application process, which allows them to progress smoothly through each stage of the process. Entry-Level Competencies Entry-level competencies describe the competencies required for entry-level registered nurses to provide safe, competent, compassionate, and ethical nursing care in a variety of practice settings. Entry-level competencies guide curriculum development and inform the public and employers as to what they can expect of entry-level registered nurses. 12 The Application Status Portal allows new applicants to: y View the status of their application. y Submit identification documents through email. y View both received and outstanding application documents. y View memos received from the College s Registration Department. y Request a name or address change. The Canadian Council of Registered Nurse Regulators approved the national entry-level competencies in March of 2013. After consultation with the University Schools of Nursing, the College revised the existing Nova Scotia-specific entry-level competencies based on the nationally accepted standard and released the Entry-Level Competencies for Registered Nurses in Nova Scotia in September 2013.

Where do my Fees go? Member Services Operations Infrastructure CNA Instilling Confidence CNPS Education review, licensure and professional conduct Operations 6% $288,139 Infrastructure 7% $353,380 CNA 11% $543,234 CNPS liability insurance 5% $261,677 Education review, licensure and professional conduct 43% $2,212,223 Member Services 28% 1,451,952 In order to satisfy the College s mandate, we invest in foundational work that supports registration and renewal, establishes the standards of nursing practice, supports nurses to meet and uphold the standards of practice, and intervenes when practice is unacceptable. The vast majority of the College s revenue that is required to carry out this work comes from members annual licensing fees. In April 2013, after careful consideration of the College s five-year financial plan (2013-2017), Council made the decision to approve a fee increase of $100 for RNs and $145 for NPs for the 2014 licensure year. Before this, the College had not increased licensing fee since 2006. The cost of doing business changes over time and the College s operational and member affiliate costs (CNA and CNPS) had increased significantly since 2006. Other cost drivers, in addition to the breadth and volume of the College s work supporting our mandate, had also increased. 13

Building Capacity to Practise Building Capacity Safely, Competently, Compasionately and Ethically Real engagement The College introduced the Real engagement project thanks, in large part, to some dedicated members who felt strongly about supporting the work of registered nurses as decision-makers and leaders in healthcare and the College couldn t agree more. Members brought forward a motion at the 2011 AGM that resulted in Real Conversations that made way for the evolution of the Real engagement project, which kicked off in 2013. This work has been a significant catalyst for change. An advisory committee of 20 RNs representing some of the profession s finest, half of which are front-line nurses, developed a plan to engage with as many RNs across Nova Scotia as possible. Peter MacDougall, College President and Donna Denney, Executive Director, travelled to 12 different locations across the province and met with over 300 registered nurses and nurse practitioners who came together to discuss the core issues facing the nursing profession and to envision the future they wanted to create. The outcomes of these community sessions were presented to the nursing community in a document entitled, From New Conversations to Real engagement: Taking RN Practice into the Future, which identified three themes proposed by RNs to help shape their future: lead with a solution-focused approach; re-ignite pride in the profession; and, be decision-makers in health system change. The group established a framework, in the later part of 2013, to help transform registered nursing practice in Nova Scotia. It includes five components: y Nurture and sustain positivity y Promote and strengthen leadership y Clarify the RN role y Articulate and communicate the importance of the RN role y Build a strong and vibrant RN community. These five building blocks, established in Real engagement to Real Action, have created the foundation for the Real engagement initiative going forward and will help guide new actions in 2014. Real engagement has generated the kind of positive energy that is already making a difference. What s next and how do we keep this good energy growing? The next phase is for the College, in collaboration with the working group, to develop an action plan that will help the Real engagement team roll ahead with an eye on future goals. The movement is gathering momentum with each RN who joins us and together, we are poised to re-shape and strengthen the future of the nursing profession. Stay tuned for the next phase of this work as we roll into Real action. 14

Practice Consultations One of the College s roles is to provide support to the nursing profession through practice consultations. A practice consultation is a confidential interaction between a Practice Consultant and an individual in order to provide expert advice on a nursing topic or issue. The majority of consultations are usually conducted with RNs and NPs to help resolve practice and workplace issues affecting their ability to meet their practice standards and/or assisting them in the interpretation of legislation or policy. In 2013, the College s Practice Consultants responded to a total of 802 requests for advice or information, compared to 915 in 2012. Of these 802 calls, 569 were from RN members, 69 were from NP members and 164 were from other stakeholders. Although all practice consultations are confidential, the nature of the consultations and the feedback provided is documented in the College s electronic database. The College s Practice Consultants use this information to identify and analyze trends and issues affecting RNs, NPs and other stakeholders within the nursing profession in Nova Scotia. Identified Practice Consultation Caller registered nurses As in previous years, the top three themes reflected in the consultations were professional practice, policy nurse practitioners (legislation, regulation, licensure), and scope of practice, other stakeholders followed by patient safety and violence in the workplace. Consultants received 336 calls related to professional practice issues (42% of calls), 227 related to policy (28%), 228 related to scope of practice (28%), 7 related to patient safety (1%), and 4 related to violence in the workplace (1%). Building Capacity Practice Consultation Themes professional practice issues policy scope of practice patient safety violence in the workplace In order to increase clarity and education amongst College s stakeholders, the trends and issues noted above are reviewed annually in order to guide College staff in the development of relevant policies and practice resources. In 2013, the College developed 18 action items to address identified RN trends and issues and four action items in order to address new NP legislation and regulation. Member Workshops In 2013 the College invited members to 17 workshops including nurse manager leadership, compassionate care, and the Real engagement initiative. Approximately 500 registered nurses from across Nova Scotia participated in education opportunities that allowed them to enhance their nursing practice in the public interest. 15

Building Capacity e-learning Available 24 hours a day, seven days a week on crnns.ca, e-learning sessions enable RNs and NPs to take advantage of professional development opportunities essential to their nursing practice. Available on the College s website, over 2,000 members accessed 13 different e-learning sessions in 2013. The College added two new sessions in 2013 for a total of 13 online modules: y Social Media y Assignment and Delegation Guidelines for Registered Nurses & Licensed Practical Nurses Survey results indicate that: Who s viewing elearning? Where do participants practice? staff nurse manager educator other acute care long term care community other setting The College is also set to develop a Compassionate Care module to be launched in 2014. Continuing Nursing Education (CNE Telehealth) CNE Telehealth sessions have been offered by the College in partnership with the Department of Health and Wellness since 1998. These sessions provide registered nurses and nurse practitioners with accessible and relevant education opportunities to support them in maintaining their capacity to practice nursing. The sessions are based on learning needs identified by nurses and are accessed live via the Nova Scotia Telehealth Network throughout the province. Some sessions are also recorded and made available on the College s website. In 2013, the College enabled even more facilities to participate in each live Telehealth session. More than 900 nurses (835 RNs, 101 NPs) accessed the 54 live CNE Telehealth sessions offered last year. 90% of RNs and NPs surveyed reported that sessions were relevant to their practice and enhanced their learning. Website Statistics The CNE Telehealth page is the fourth most visited webpage on crnns.ca. y Schedule - 18,000 visits y Recorded Sessions - 16,000 visits 16

Optimizing Scope of Practice Collaborative Emergency Centres Collaborative Emergency Centres (CECs) were introduced to make patient access to emergency care a seamless part of primary health care in Nova Scotia. College staff continue to support the implementation of CECs by: (1) practice consultations with RNs working in CEC s; (2) meeting with the union to hear issues still being experienced by RNs; and (3) collaboration with the Department of Health and Wellness on staffing and other issues. Also in 2013, the College provided both pre- and post-implementation information and support of the new mobile CEC in New Waterford. Medical Certification of Death Education The Timely Medical Certificates Act enacted by the provincial government in January 2013, authorizes nurse practitioners to pronounce death and complete medical certificates of death. Building Capacity The College collaborated in the development of three mandatory education sessions to prepare NPs for this new authority. A total of 120 NPs took the program in 2013 and 75% of all licensed NPs have completed the required education. The College will be working with Dalhousie University to integrate Medical Certificate of Death (MCD) education within the NP Program and to develop a method that would allow NPs from other universities and jurisdictions to access the education. Nurse Practitioners Prescribing of Controlled Drugs and Substances The Federal Controlled Drugs and Substances Act established the authority for nurse practitioners to prescribe narcotics and other controlled substances once supports are in place. The College developed a Controlled Drugs and Substance (CDS) regulatory framework in order to provide direction for policy development, education, support mechanisms, and evaluation of this new authority for nurse practitioners (NPs) in Nova Scotia. The College is working to prepare NPs who will begin to prescribe CDS in November 2014. In order to prescribe CDS, NPs will be required to complete a compulsory online theory course and a one-day Nova Scotia Controlled Drugs and Substances Regulatory Workshop. The College approved three CDS theory courses based on recommendations from the Canadian Council of Registered Nurse Regulators (CCRNR) in 2013. Published Resources Position Statements y Prescribing Methadone and Benzodiazepines on In-patient Withdrawal Management Units in Nova Scotia (joint position statement with the College of Physicians and Surgeons of Nova Scotia) y Recommended and/or Publicly Funded Vaccines for Immunizations of Staff and Volunteers in Nova Scotia Health Agencies/ Facilities (joint position statement with the Department of Health & Wellness) y The Role of Registered Nurses in Cosmetic Procedures: BOTOX and Dermal Fillers Guidelines y Guidelines to Assist Registered Nurses and Nurse Practitioners with the Personal Directives Act and Personal Health Information Act: Questions & Answers for Registered Nurses Updated Resources y College By-laws y Entry-Level Competencies for Registered Nurses in Nova Scotia y Nurse Practitioner Sensitive Outcomes Report y Profile of the Newly Graduated Registered Nurse y Registered Nurse Sensitive Outcomes Report y Transitioning to Professional Practice - A resource for recent graduates planning to register with the College of Registered Nurses of Nova Scotia Reports & Articles y From New Conversations to Real engagement - Taking RN Practice into the Future y Regulatory Excellence Framework 17

Leading Innovation Leading Innovation in Regulation Canadian Council of Registered Nurse Regulators The Canadian Council of Registered Nurse Regulators (CCRNR) is an organization made up of representatives from Canada s 12 provincial/territorial bodies that regulate the practice of registered nurses. CCRNR promotes excellence in professional nursing regulation and serves as a national forum and voice regarding interprovincial/territorial, national, and global regulatory matters for nursing regulation. CCRNR has established the following regulatory priorities: y NCLEX-RN Exam y Nurse Practitioner Exam y National Nurse Practitioner Practice Analysis CCRNR is coordinating the transition to the NCLEX-RN and engaging all jurisdictions (excluding Quebec and Yukon) in preparing for the administration of the NCLEX-RN for Canadian graduates. The College is co-lead with the College of Registered Nurses of British Columbia for the provision of entry-level NP examinations and is also leading the NP Practice Analysis work. See page 20 for details. Since the passage of the New Class of Practitioners Regulations under the Federal Controlled Drugs and Substances Act, CCRNR has formed a national working group to establish national standards of practice to guide nurse practitioner (NP) prescribing of controlled drugs and substances (CDS) and make recommendations on policy development and educational requirements for NPs in preparation for the addition of this prescriptive authority. Since its formation in 2011, CCRNR has established itself as the national voice for the provincial jurisdictions on regulatory matters working toward excellence in nursing regulation while encouraging and respecting the autonomy of decisions made at the provincial level by each of the regulatory bodies. 18

Fair Registration Practices Act Everyone who practices as an RN or NP in Nova Scotia must be registered and licensed with the College. The Registered Nurses Act governs the process we follow to register/licence applicants, however, the College must also meet the requirements of the Fair Registration Practices Act (FRPA). FRPA states that registration must follow a fair procedure and be transparent, objective, and impartial. In the summer of 2013, the College participated in a FRPA review with the provincial Review Officer. The review included an assessment of our current registration and licensure processes for internationally educated nurses as well as domestic graduates and nurse practitioners. Upon completion of the review, the College received one recommendation in relation to simplifying our website materials and several complements on our registration and licensure processes. The final report related to the FRPA review was posted on the Labour and Advanced Education website. Leading Innovation NCLEX Examination Council approved the NCLEX-RN as the entry-to-practice exam to be introduced in Nova Scotia in January 2015. The computer-adaptive exam will provide a modern, state of the art entry-to-practice exam for RNs across Canada (excluding Quebec and the Yukon) that will meet regulatory needs today and in the future. Throughout 2013, the College worked in collaboration with the Canadian Council of Registered Nurse Regulators (CCRNR) for the transition to the NLEX-RN exam. Some of last year s highlights included: y presentation of both regional and provincial workshops for RN educators, y creation of NCLEX Communiqués sharing timelines, progress and milestones available on crnns.ca, y the development of new FAQs created to answer your NCLEX-RN questions available on crnns.ca, y volunteer recruitment NCLEX Item Development Program and Item Review Panels, y recruitment for the NCLEX-RN Practice Analysis Expert Panels and the NCLEX-RN Knowledge Skills and Abilities (KSA) Expert Panels, y the provision of ongoing feedback on the Canadian manual of administrative procedures for NCLEX. National Nursing Assessment Service The National Nursing Assessment Services (NNAS) is an incorporated non-profit organization whose members are the 22 regulatory bodies and associations of registered nurses, licensed practical nurses and registered psychiatric nurses across Canada (excluding Quebec and the Territories). NNAS members collectively developed a harmonized approach to the initial assessment of internationally educated nurses (IENs) applying for licensure in Canada. This national approach provides greater transparency, timeliness and predictability across Canadian jurisdictions, in addition to applying rigorous standards for qualification assessment, in the interest of the public. Effective August 12th, 2014, in order to apply to be a nurse in Canada, all internationally educated nurse (IEN) applicants must submit their documents and credentials to NNAS for verification. The College has participated in the NNAS initiative since 2006 and in 2013, became part of the national Change Management Working Group. The mandate of this group is to ensure a smooth transition to the centralized credential assessment process for IENs. To this end, the College s IT and Registration staff have been working on technological modifications and the development of new policies and procedures. 19

Leading Innovation Collaborative Self-Regulation Increasingly, registered nurses are expected to collaborate with other nurses and health care providers in order to provide Nova Scotians with safe and quality nursing care. Likewise, there has been a shift in regulation both nationally and provincially for regulators to collaborate in order to work more efficiently and effectively in the public interest. New legislation passed in September 2013, enables the College and other members of the Nova Scotia Regulated Health Professions Network to collaborate in the best interests of the public. The Regulated Health Professions Act (RHPNA) supports a collaborative approach to regulatory matters such as scopes of practice, investigation of complaints, and sharing of information to support health system improvements. The College also collaborated extensively with the Canadian Council of Registered Nurse Regulators (CCRNR). In 2013, CCRNR defined three main priorities and the College participated in all three and was the lead on two of them. Nurse Practitioner Practice Analysis In support of a national approach to nursing practitioner licensure/registration, the Canadian Council of Registered Nurse Regulators (CCRNR) launched the NP Practice Analysis, a project to analyze nurse practitioner (NP) practice across Canada. The College, along with seven other nurse regulators, forms the project s national working group. In early 2013, the NP Practice Analysis got off the ground with the help of Human Resource Services Development Canada s approval of the project s funding. Once funding was secure, the working group distributed a request for proposal to six potential vendors for the completion of the project. The project s original purpose and objectives were revised and the final project outcomes were finalized as the following: y To form the basis of one or more entry-level exams for NPs in Canada; y To help develop consistent requirements for NP licensure/registration across the country, enabling NPs to work in different provinces more easily and help internally educated NPs to more readily integrate into the workforce. The College was chosen as Chair of the working group under the direction of CCRNR. The working group is responsible for recommending individuals to participate on the project s Research Advisory Committee and its three NP Subject Matter Expert Panels. The working group is also the liaison between CCRNR and the vendor selected to conduct the analysis. Next year will bring a flurry of activities, as the successful vendor will be chosen and intensive work will begin on the analysis. The project will begin recruiting Research Advisory Committee and Subject Matter Expert Panel members to provide expertise to the project and NP volunteers will participate in the project s delineation of practice and the associated survey tools. Nurse Practitioner Examinations During 2013, the Canadian Council of RN Regulators (CCRNR) established an ad hoc exam committee to provide regulatory oversight of exam review and administration of the Nurse Practitioner (NP) pediatric and adult entry-level examinations. Co-chaired by the College and the CRNBC, the committee completed an analysis of the short term options to ensure examinations are available to assess whether an individual has demonstrated the competencies necessary to practice safely and effectively as an NP for a designated stream of practice. 20

Balancing Public Accountability and Professional Integrity Accountability & Integrity Professional Conduct Statutory Committees Central to our mandate of regulating the practise of nursing in the public interest, the College, in accordance with the professional conduct provisions of the Registered Nurses Act and Regulations, receives, investigates and disposes of complaints where there are allegations that a registered nurse or nurse practitioner has displayed professional misconduct, conduct unbecoming, incompetence or incapacity. Four statutory committees are involved in the professional conduct process: the Complaints Committee, the Professional Conduct Committee, the Fitness to Practise Committee, and the Re-instatement Committee. When a new complaint is filed with the College, the professional conduct process typically requires: y Initial assessment of the complaint, including determining whether urgent action is required to remove a nurse from practice until the professional conduct process is completed if there is risk to public safety; y Appointment of an investigator to investigate the complaint; y Convening a Complaints Committee to determine whether the allegations contained in the complaint and subsequent investigation can be resolved or whether the allegations require a full hearing before the Professional Conduct Committee; y Convening a Professional Conduct Committee to determine whether the allegations are proven, and the appropriate licensing sanction required; and/or y Convening a Fitness to Practise Committee to resolve issues of a nurse s incapacity (medical, physical, mental or emotional condition, disorder or addiction of the nurse that renders her/him unable to practise safely). In 2013, the College handled 109 complaints in the professional conduct process: 44 new complaints filed in 2013 and 60 complaints carried over from 2012. These complaints involved 95 nurses, or 0.09% of the College s licenced members in 2013. 21

Accountability & Integrity Before, during or after the investigation of a complaint, the Executive Director has the power to resolve certain complaints in accordance with the Regulations. Of these 109 complaints, the Executive Director resolved 22 complaints as follows: y Dismissed eight complaints as being outside the jurisdiction of the College and/or incapable of substantiation. The Complaints Committee reviewed three of the dismissals and ordered that two of the dismissals be further investigated by the College; y Provided warning letters to 12 nurses who practised without a licence (e.g. not renewing their 2014 licence by November 1, 2013) as this was the first offence for each nurse involved; y Permitted two nurses to voluntarily resign their licence on permanent basis (meaning they are both ineligible to renew their licence in the future); and y Informally resolved two complaints with the agreement of the complaint and responding nurse. Of the remaining 87 complaints, 24 complaints were dealt with by a professional conduct statutory committee in 2013. Complaints Committee Members: Lorna Khan (Chair), Charlene Murphy (Vice-Chair), Valerie Banfield, Fred Beaton, Garland Brooks, Douglas Bungay, Kimberly Clark, Daphne Connolly, Dannie Currie, Melissa Currie, Valerie Eden, Kim Fleming, Caroline Fowler, Ethel Gunn, Alison Hodder, Kristine Kempton, Sue Laroche, Bill Lawlor, Deborah Linton, Emerson MacDonald, Ronald MacPherson, Debora Mander, Maria Marshall, Jill Morse, Kate Muir, Ken Nason, James Pritchett, Lora Roberts, Suzanne Sheppard-Jackman, Michele Steele, Heather Wood The Complaints Committee is comprised of registered nurses/nurse practitioners and members of the public. The role of the committee is to review all complaints not resolved by the Executive Director and dispose of them in accordance with the Regulations. A panel of the Complaints Committees, comprised of two nurses and one public representative, acts as a screening committee by resolving less serious complaints at the Complaints Committee level and referring serious allegations of professional misconduct, incompetence, incapacity or conduct unbecoming the profession to a Professional Conduct Committee. The Committee has the authority to issue non-disciplinary warnings (counsel, caution) and to request that a nurse consent to a reprimand and/or conditions/restrictions on her/his licence. In 2013, the Complaints Committee met to consider complaints against 16 nurses (involving 21 complaints) with the following results: y Four nurses had the complaints against them dismissed; y Two nurses received a caution; y Nine nurses consented to reprimands or reprimands with conditions/restrictions; and y One nurse was referred to the Professional Conduct Committee; In addition to the above decisions, the Committee has the power to direct portions of the College s investigation, including ordering competence and health assessments or ordering the interim suspension of a nurse s licence to practise nursing until the final determination by the Committee. In 2013, the Complaints Committee also met to order that: y Four RNs undergo a competence assessment at RNPDC (three of whom were also given interim suspensions); y Two RNs undergo a health assessment (both of whom were given interim suspensions); and y One nurse receive an interim suspension. 22

Professional Conduct Committee Members: W. Brian Smith (Chair), Sandra MacPherson-Duncan, (Vice-Chair), Camilla Benoit, Kenneth Bowes, Barb Campbell, Ramon Cansanay, Glenda Carson, Sharon Chafe, Jacklyn Clark, Jeannette Combes, Barbara Darby, Susan Gouthro, Agnieszka Grabowska-Comeau, Linda Hale, William Hodder, Kara Henman, Christine Hines, Linda Hutchins, Evelyn Kennedy, Sarah Leathley-Britain, James Maclean, Wendy Miles, Deidre Mombourquette, Darlene Mott, Janet Purvis, Jennifer Riis, Elaine Rivers, Erin Sarrazin, Paula Wadden, Joanne Zevenhuizen The Professional Conduct Committee conducts formal professional conduct hearings into the allegations referred to it by the Complaints Committee. A panel of the Professional Conduct Committee, made up of three registered nurses/nurse practitioners and two members of the public, hears evidence to determine whether one or more of the allegations against a nurse can be proven true, and if so, whether such proof amounts to a finding of professional misconduct, conduct unbecoming the profession, incompetence and/or incapacity. If the Committee makes one or more of the these findings, the Committee must then decide on appropriate licensing sanction. Accountability & Integrity The Committee did not hold any hearings in 2013, but did approve applications from two nurses for consent revocation. Fitness to Practice Committee Members: Cindy Cruickshank (Chair), Michele Steele (Vice chair), Fred Beaton, Lindsay Burke, William Hodder, Carol MacEachern, Heather Spencer-Benoit, Christina Vardy The Fitness-to-Practise Committee determines whether a registered nurse is suffering from a medical, physical, mental or emotional condition, disorder or addiction that is affecting, or could affect, her or his practice. The Committee also determines what action may be necessary to protect the public. In 2013, the Committee approved one Remedial Agreement permitting a nurse to return to practice with conditions and restrictions, after the nurse completed treatment for capacity. Reinstatement Committee Members: Cyndee MacPhee (Chair), Paulette Anderson, Carolyn Fowler, Kelly Ann Lackie, Darlene O Reily The Reinstatement Committee is comprised of registered nurses and members of the public who hear applications from persons seeking reinstatement of their registration or licence to practise nursing after having their registration or licence revoked by a Professional Conduct Committee. The Committee did not receive any applications for reinstatement in 2013. 23

Accountability & Integrity Statutory Committee Reports Education Advisory Committee Members: Jo-Anne MacDonald (Chair), Courtney Breen, Garland Brooks, Duana d Entremont, Anita Ferguson, Cherie Gilbert, Lynn Miller, Cyndee MacPhee, Ruth Martin-Misener, John McNeil, Kimberly Newton, Mary van Soeren, Audrey Walsh, Ruth Whelan The Education Advisory Committee (EAC) advises and makes recommendations to Council on establishing the standards for nursing education programs; and approves, conditionally approves or denies approval of baccalaureate, nurse practitioner and nursing re-entry programs. Program approval is a mandatory process for nursing programs and occurs at times determined by Council. In 2013, a program review of the RN Bridging/Re-Entry Education Program for Canadian and Internationally Educated Nurses was completed. Council approved the EAC recommendation to approve the Program for three years until September 30, 2016 with recommendations to be addressed in their annual progress reports. Also in 2013, a program review of the Grant MacEwan RN Refresher (Re-entry) Program was completed. Council approved the Refresher Program for three years until December 13, 2016 with recommendation to be addressed in their annual progress reports. EAC reviewed the 2013 Annual Progress Reports from the following programs that are submitted between formal program approvals: y Cape Breton University: Bachelor of Science in Nursing Program y St FX University: Baccalaureate Nursing Programs y Dalhousie University: Baccalaureate Nursing Programs y Dalhousie University: Nurse Practitioner Program y RN-Professional Development Centre: RN Bridging/Re-Entry Program y Grant MacEwan: RN Refresher Nursing Program Interdisciplinary Nurse Practitioner Practice Review Committee Members: Keith Cockersell (Chair), Paulette Anderson, Shelagh Campbell-Palmer, Marsha Campbell-Yeo, Barbara Currie, Sandra Duke, Nancy Edgecombe, Douglas Grant, Kim Hebert, Darla MacPherson, Lynn Miller, Cindy Planetta, Connie Venedam-Marchand The Interdisciplinary Nurse Practitioner Practice Review Committee (IDPRC) is established to determine and ensure compliance of nurse practitioners (NPs) practice in accordance with the Registered Nurse Act and the Nurse Practitioner Standards of Practice. The Committee fulfills this responsibility through the development, implementation and evaluation of the Nurse Practitioner Quality Monitoring Program (NP-QMP). The NP-QMP is a quality monitoring program designed to help support NPs in continuously improving their practice. Through mandatory participation, NPs are provided with detailed, multi-source performance feedback that allows them to set goals to improve their practice. The work of the IDPRC, through the NP-QMP, support s the College role of regulating NP practice in the public s interest. This year marked the final year in the program s first five year rotation. In 2014, the College will publish a NP-QMP summative report evaluating its effectiveness. 24

Nurse Practitioner Committee Members: Ruth Martin-Misener (Chair), Marsha Campbell-Yeo, Dawn Chubbs, Nancy Edgecombe, Geralynn Hirsch, Debbie Roach The Nurse Practitioner Committee is established by legislative authority to conduct competence assessments for nurse practitioners when a nurse practitioner has changed practice settings, or is working with a different client population, or a competence assessment is otherwise required by the Act or Regulations. In the 2013, NP Committee members conducted competence assessments of eight nurse practitioners who were changing their patient populations and/or practice settings. The results of these assessments are as follows: y Five NPs met the required competencies without having to complete a clinical practicum or case studies; y One NP is in the process of completing a clinical practicum and documented case studies for review by assessors; y One NP successfully completed a competence assessment review by assessors; and y One NP is required to complete formal university education and subsequent examination for the client population. Accountability & Integrity Registration Appeal Committee Members: W. Brian Smith (Chair), Rosalind Benoit, Elizabeth Cooper, Agnieszka Grabowska-Comeau, Nancy Jones, Amy MacDearmid The Registration Appeal Committee, appointed by Council, meets to consider requests from applicants that request a review of the College s decision to deny registration or licensure as a registered nurse or nurse practitioner in Nova Scotia. The Committee must include at least one public representative, three registered nurses and one nurse practitioner. In 2013, the College received a total of three registration appeals from applicants appealing the denial of their registration with the College. Two of the hearings were heard in September by the Registration Appeal Committee. The committee upheld the College s decisions to deny registration in both cases. The third appeal will not be heard until 2014. Standing Committees Awards Committee Members: Kelly Ann Lackie (Chair), Rebecca Dorey, Marian Mac Lellan, Colleen MacNeil, Ruth Whelan Committee on Appointments Members: David Samson (Chair), Tim Guest, Ruth Whelan Nominations Committee Members: Judith Bailey (Chair), Braden Davie, Darlene Mott, Carolyn Power 25

Financial Statements Financial Statements 26

Independent auditor s report To the members of the College of Registered Nurses of Nova Scotia We have audited the accompanying financial statements of the College of Registered Nurses of Nova Scotia, which comprise the statement of financial position as at December 31, 2013 and the statements of operations, changes in net assets and cash flows for the year then ended, and a summary of significant accounting policies and other explanatory information. Grant Thornton LLP Suite 1100 2000 Barrington Street Halifax, NS B3J 3K1 T (902) 421-1734 F (902) 420-102648 www.grantthornton.ca Financial Statements Management s responsibility for the financial statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with Canadian accounting standards for not-for-profit organizations, and for such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. Auditor s responsibility Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with Canadian generally accepted auditing standards. Those standards require that we comply with ethical requirements and plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained in our audits is sufficient and appropriate to provide a basis for our audit opinion. Opinion In our opinion, the financial statements present fairly, in all material respects, the financial position of the College of Registered Nurses of Nova Scotia as at December 31, 2013, and the results of its operations and its cash flows for the year then ended in accordance with Canadian accounting standards for not-for-profit organizations. Halifax, Canada April 7, 2014 Chartered Accountants 27

Financial Statements College of Registered Nurses of Nova Scotia Statement of financial position December 31 2013 2012 Assets Current Cash and cash equivalents $ 502,645 $ 143,999 Short term investments (note 3) 6,223,591 7,573,014 Receivables 110,103 67,604 Prepaids 30,802 27,672 6,867,141 7,812,289 Long term investments (note 3) 1,602,579 200,000 Property and equipment (note 4) 194,448 224,846 $ 8,664,168 $ 8,237,135 Liabilities Current Payables and accruals (note 5) $ 618,796 $ 583,883 Deferred revenue 4,086,856 3,182,283 4,705,652 3,766,166 Deferred lease incentive (net of accumulated amortization of $13,758; 2012 $10,912) 14,706 17,552 Retirement benefits (note 6) 300,364 365,304 5,020,722 4,149,022 Net assets Net investment in property and equipment 194,449 224,846 Net investment in liquidity reserve 1,019,859 1,140,089 Unrestricted 2,429,138 2,723,178 3,643,446 4,088,113 $ 8,664,168 $ 8,237,135 Commitments (note 8) On behalf of the Council President Executive Director 28

College of Registered Nurses of Nova Scotia Statements of operations Year ended December 31 2013 2012 Revenue Membership $ 4,258,681 $ 4,053,541 Investment income 131,233 181,601 Other 276,024 233,205 4,665,938 4,468,347 Expenses Administrative 220,009 216,565 Interagency 543,234 544,690 Legislated services 2,212,223 2,085,626 Member services 1,713,629 1,685,146 Premises 353,380 341,927 Amortization of property and equipment 68,130 72,847 Loss on disposal of property and equipment 4,858 5,110,605 4,951,659 Financial Statements Excess of expenditures over revenues $ (444,667) $ (483,312) College of Registered Nurses of Nova Scotia Statement of changes in net assets Year ended December 31 Investment in Investment property and in liquidity 2013 2012 equipment reserve Unrestricted Total Total Net assets, beginning of year $ 224,846 $ 1,140,089 $ 2,723,178 $ 4,088,113 $ 4,571,425 Excess of expenditures over revenues (68,130) (376,537) (444,667) (483,312) Purchase of property and equipment 37,733 (37,733) Transfers (from) to liquidity reserve (120,230) 120,230 Net assets, end of year $ 194,449 $ 1,019,859 $ 2,429,138 $ 3,643,446 $ 4,088,113 29

Financial Statements College of Registered Nurses of Nova Scotia Statement of cash flows Year ended December 31 2013 2012 Increase (decrease) in cash and cash equivalents Operating Net loss $ (444,667) $ (483,312) Amortization 68,130 72,847 Amortization of deferred lease incentive (2,846) (2,846) Loss on disposal of property and equipment 4,858 (379,383) (408,453) Change in non cash operating working capital (note 7) 893,857 45,353 514,474 (363,100) Investing (Purchase of) proceeds from investments, net (53,155) 408,598 (Decrease) increase in retirement benefits liability (64,940) 47,855 Purchase of property and equipment (37,733) (92,054) (155,828) 364,399 Net increase in cash and cash equivalents 358,646 1,299 Cash and cash equivalents Beginning of year 143,999 142,700 End of year $ 502,645 $ 143,999 30

College of Registered Nurses of Nova Scotia Notes to the financial statements December 31, 2013 1. Nature of operations The College of Registered Nurses of Nova Scotia (the "College") is the professional regulatory body for registered nurses and nurse practitioners licensed to practice in Nova Scotia. The College is a non profit organization exempt from tax under paragraph 149(1)(L) of the Income Tax Act and, therefore, is not required to pay income taxes. 2. Summary of significant accounting policies These financial statements have been prepared in accordance with Canadian accounting standards for not for profit organizations ( ASNPO ). The significant accounting policies are detailed as follows: Financial Statements Fund accounting The accounts are maintained in accordance with the principles of fund accounting. This method ensures observance of restrictions, if any, on the use of the resources by maintaining separate accounts for each fund. Funds that have limitations placed on their use by internal or external parties are classified as restricted. The following provides a brief description of each fund group: The unrestricted fund is for general operating funds. The net investment in liquidity reserve represents an estimate of three months of operating expenditures net of non cash and externally funded expenditures allocated to fund a future wind down or contingencies. The net investment in property and equipment is the balance in capital assets less associated amortization. Financial instruments Initial measurement The College s financial instruments are measured at fair value when issued or acquired. For financial instruments subsequently measured at cost or amortized cost, fair value is adjusted by the amount of the related financing fees and transaction costs. Transaction costs and financing fees relating to financial instruments that are measured subsequently at fair value are recognized in operations in the year in which they are incurred. Financial instruments consist of cash and cash equivalents, receivables, short term and long term investments, payables and accruals and deferred revenue. Subsequent measurement At each reporting date, the College measures its financial assets and liabilities at cost or amortized cost (less impairment in the case of financial assets), except for equities quoted in an active market, which must be measured at fair value. The financial instruments measured at amortized cost are cash and cash equivalents, receivables, payables and accruals and deferred revenue. 31

Financial Statements College of Registered Nurses of Nova Scotia Notes to the financial statements December 31, 2013 2. Summary of significant accounting policies (continued) Financial instruments (continued) For financial assets measured at cost or amortized cost, the College regularly assesses whether there are any indications of impairment. If there is an indication of impairment, and the College determines that there is a significant adverse change in the expected timing or amount of future cash flows from the financial asset, it recognizes an impairment loss in the statement of operations. Any reversals of previously recognized impairment losses are recognized in operations in the year the reversal occurs. The College s main financial instrument risk exposure is detailed as follows: Credit risk Credit risk on financial instruments is the risk of financial loss occurring as a result of default or insolvency of a counterparty on its obligations to the College. The College s credit risk is primarily attributable to receivables. Receivables are managed by closely monitoring delinquent contributors and ensuring that any late payments or deviations are investigated. Liquidity risk Liquidity risk is the risk that the College will not be able to pay financial instrument liabilities as they come due. The College s liquidity risk from financial instruments is its need to meet operating requirements for payables and accruals. The majority of assets held by the College are invested in securities that can be readily disposed of as liquidity needs arise. Market risk Market risk is the risk that the fair value or future cash flows of a financial instrument will fluctuate because of changes in market prices. For purposes of this disclosure, the College segregates market risk into three categories: interest rate risk, currency risk and other price risk. The College is not exposed to significant currency or other price risk. Interest rate risk The College is exposed to interest rate risk through the cash and interest bearing investments held. The College manages its portfolio investments based on its cash flow needs and with a view to optimizing its interest income. The investments held as of December 31, 2013 are invested in guaranteed investment certificates, treasury bills, and mutual funds with fixed interest rates ranging from 1.35% 4.1% with maturity dates between January 2014 to October 2017. Sensitivity to a plus or minus 1% change in rates would not have a significant effect on the College s operations. Cash and cash equivalents Cash and cash equivalents include cash on hand and balances with banks. Property and equipment Property and equipment is recorded at its original cost and subsequently measured at cost less accumulated depreciation. Property and equipment is depreciated over its estimated 32

College of Registered Nurses of Nova Scotia Notes to the financial statements December 31, 2013 2. Summary of significant accounting policies (continued) useful life. Management reviews estimates of the useful lives of property and equipment and adjusts the estimates as required. Management regularly reviews assets for impairment and adjusts as necessary. Property and equipment is depreciated over the estimated useful life of the asset using the methods and rates as follows: Computer software and hardware Office equipment 40% declining balance 20% declining balance Financial Statements Leasehold improvements are being amortized using the straight line method to the end of the lease term. Deferred revenue All fees collected or receivable as at year end, which relate to future fiscal years, are recorded as deferred revenue. Deferred lease incentive The deferred lease incentive is amortized on a straight line basis over the term of the lease. Revenue Membership fees Revenue from membership fees are recognized on an accrual basis as the related services are provided. Investment income Investment income is recognized as it is earned. Other income Income related to projects and professional development are recognized as the related services are provided. Use of estimates The preparation of the financial statements in conformity with ASNPO requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. By their nature, these estimates are subject to measurement uncertainty and the effect on the financial statements of changes in such estimates in future periods could be significant. Items subject to significant management estimates include useful lives of capital assets. 33

Financial Statements College of Registered Nurses of Nova Scotia Notes to the financial statements December 31, 2013 2. Summary of significant accounting policies (continued) Allocation of expenses The College allocates its general IT and finance support expenses across administrative, legislative and member services. These allocations are determined annually based on the estimated amount of time the individuals within these support areas are working in each functional area. The amount allocated to each functional area is listed in note 9. Multi employer pension plan Employees of the College participate in the Nova Scotia Health Employees' Pension Plan, a contributory defined benefit pension plan which provides pension benefits based on length of service and earnings. Contributions to the plan are required by both employees and the College. Total contributions made by the College during the year were $209,991 (2012 $207,166) and are recognized as an expense in the period. The College is not obligated for any unfunded liability, nor does the College have entitlement to any surplus that may arise in the plan. 3. Investments 2013 2012 Total investments $ 7,826,170 $ 7,773,014 Less: Investments maturing within the next year (6,223,591) (7,573,014) Long term investments $ 1,602,579 $ 200,000 4. Property and equipment 2013 2012 Accumulated Net book Net book Cost depreciation value value Furniture and fixtures $ 486,499 $ 387,778 $ 98,721 $ 121,961 Leasehold improvements 68,080 25,767 42,313 50,443 Computer equipment 221,653 175,843 45,810 45,390 Computer software 23,711 16,107 7,604 7,052 $ 799,943 $ 605,495 $ 194,448 $ 224,846 5. Payables and accruals 2013 2012 Trade $ 117,638 $ 225,342 Miscellaneous 156,104 111,733 Government remittances 345,054 246,808 $ 618,796 $ 583,883 34

College of Registered Nurses of Nova Scotia Notes to the financial statements December 31, 2013 6. Retirement benefits Post retirement health subsidy benefit Employees are eligible for a post retirement health subsidy program if the employee retires directly from active status after age 60, has been employed by the College for a minimum of ten continuous years and is enrolled in the Health Association of Nova Scotia Health Plan. The benefit is equal to 65% of the monthly premium of either single, couple or family coverage as charged by the Health Association of Nova Scotia Retirement Health Plan. This subsidy ceases upon the retiree reaching age 65. The most recent actuarial valuation of this plan was as of December 31, 2013. The next valuation will occur on December 31, 2015. Financial Statements Retirement allowance Employees retiring after the age of 60 and who have been employed by the College for a minimum of ten continuous years are eligible to receive a retirement allowance. The allowance is equal to one weeks' pay for each year of full time service, to a maximum of 30 weeks. If an eligible employee dies while actively employed, the retiring allowance will be paid to the employee's beneficiary or estate. No allowance is paid to a member who terminates employment prior to eligibility for benefits. The most recent actuarial valuation of this plan was as of December 31, 2013. The next valuation will occur on December 31, 2015. 2013 2012 Balance, beginning of the year $ 365,304 $ 317,446 Retiring allowance accrued and expensed during the year (70,578) 40,074 Health subsidy accrued and expensed during the year 5,638 7,784 Accrued benefit liability $ 300,364 $ 365,304 7. Supplemental cash flow information 2013 2012 Change in non cash operating working capital Receivables $ (42,499) $ 11,335 Prepaids (3,130) (8,520) Payables and accruals 34,913 110,995 Deferred revenue 904,573 (68,457) $ 893,857 $ 45,353 8. Commitments The College has entered into various lease agreements for premises and equipment. Minimum payments required over the next five years for the base rent of the premises lease and equipment leases are as follows: 2014 $ 384,792 2015 392,688 2016 395,010 2017 389,610 2018 393,538 35

Financial Statements College of Registered Nurses of Nova Scotia Notes to the financial statements December 31, 2013 9. Allocation of administrative expenditures Member Legislated Total Total services services Administration 2013 2012 Information technology $ 98,896 $ 98,896 $ 98,896 $ 296,688 $ 357,987 Finance and human resources 124,545 124,545 124,544 373,634 302,841 $ 223,441 $ 223,441 $ 223,440 $ 670,322 $ 660,828 10. Government contributions During the year, the College received government contributions as follows: 2013 2012 Nova Scotia Department of Health Nursing School Transcripts $ 14,400 $ 14,400 Nova Scotia Department of Health Nova Scotia Telehealth 72,000 72,000 Nova Scotia Department of Health NSRHPN 50,000 71,446 136,400 157,846 Deferred contributions, beginning of year 78,430 65,502 Deferred contributions, end of year 116,532 78,430 Government contributions earned during the year $ 98,298 $ 144,918 Of the total government contributions earned during the year, $86,400 (2012 $87,304) is recognized in membership revenue while the remainder of $11,898 (2012 $57,614) is recognized in other revenue. 11. Comparative figures The financial statements have been reclassified to conform with the financial statement presentation adopted for the current year. 36

Roles & Responsibilities Ambulatory Care 299 Cardiovascular 148 Community Health 406 Critical Care 628 Education 47 Emergency Care 641 Gastroenterology 27 Geriatric/Long Term Care 1,154 Home Care 309 Hospice / Palliative Care 101 Maternal/Newborn 535 Medical/Surgical 1822 Nephrology 112 Neuroscience 65 Nursing Research Only 12 Occupational Health 74 Oncology 188 Other - Administration 197 Other - Direct Patient Care 581 Other - Education 26 Other - Research 76 Pediatrics 281 PeriAnesthesia 128 perioperative/or 7 Psychiatric/Mental Health 553 Public Health 175 Rehabilitation 108 Service 367 Several Clinical Areas 119 Teaching Clients 73 Teaching Employees 104 Teaching Students 211 1080 ANNAPOLIS Member Demographics Age Ranges of Members <25 435 4.2% 25-29 953 9.3% 30-34 945 9.2% 35-39 839 8.2% 40-44 1,039 10.1% 45-49 1,397 13.6% 50-54 1,686 16.5% 55-59 1,576 15.4% 60-64 939 9.2% 65+ 440 4.3% Total 10,249 100% Employment Status Regular Full-Time 6,243 65.2% Regular Part-Time 2,221 23.2% Casual Full-Time 178 1.9% Casual Part-Time 934 9.8% 726 COBEQUID 4674 ATLANTIC Total 9,576 100% Where Our Members Work 778 HIGHLAND 1531 CAPE BRETON Member Demographics 781 WESTERN 37

Member Demographics Nova Scotia New Graduates Saint Francis Xavier University 85 Cape Breton University 56 Dalhousie University 177 Employment Status of Nova Scotia New Graduates Regular Full-Time 256 84.5% Regular Part-Time 2 0.7% Casual Full-Time 11 3.6% Casual Part-Time 6 2.0% Employed in Other Than Nursing & Seeking Nursing Employment 3 1.0% Employed in Other Than Nursing & Not Seeking Nursing Employment 0 0.0% Not Employed & Seeking Nursing Employment 21 6.9% Not Employed & Not Seeking Nursing Employment 4 1.3% Total 303 100% First Time Licence in Nova Scotia New NS Grads 303 53.9% Other Provinces 215 38.3% International (Examination) 13 2.3% International (licenced in another province) 4 0.7% Registration only (Did not license) 27 4.8% Total 562 100% Out of Province Alberta 12 British Columbia 11 Manitoba 5 New Brunswick 73 Newfoundland 34 Northwest Territories 1 Ontario 44 Prince Edward Island 21 Quebec 7 Saskatchewan 3 International Australia 1 United Kingdom 5 India 2 Iran 1 Ireland 1 Israel 1 Jamaica 1 New Zealand 1 Philippines 5 United States 3 38

College Staff College Staff Executive Office Donna Denney, Executive Director Shelley Farouse, Executive Assistant Jane Wilson, Communications Consultant Corporate Services Colleen Arnold, Director Colleen Burke, Communications Officer Hillary MacEachern, Communications Consultant Sheri MacLellan, Corporate Services Assistant Karen Mahoney, Multimedia Designer Edith Mosher, Finance Officer Song Peng, Technology Applications Specialist Lee Whynot, Technology & Information Systems Officer Jia Zhu, Records Management Analyst Policy, Practice & Legislation Services Teri Crawford, Director Jennifer Best, Practice Consultant Clare Brown, Practice Consultant Trent MacIsaac, Practice Consultant Darlene Martin, Administrative Assistant Lynn Miller, Policy Consultant Crystal Morgan, Administrative Assistant Paula Prendergast, Policy Consultant Professional Conduct & Registration Services Heather Totton, Director Karen Boutilier, Administrative Assistant Ann Marie Cameron, Registration Officer Matthew Lafond, Professional Conduct Consultant Sheri MacLellan, Registration Services Assistant Krista Mosher, Registration Services Assistant Darlene Mott, Professional Conduct Consultant Elizabeth Parenteau, Professional Conduct Consultant Cathy Rose, Policy Consultant, Registration Services Shelly Spears, Registration Services Assistant Haley Young, Administrative Assistant 39