Resources and FAQs

The novel coronavirus (COVID-19) was first detected in a cluster of cases of pneumonia in Wuhan, China, and subsequently reported to the World Health Organization on December 31, 2019.¹ A coronavirus is a type of virus that can infect both humans and animals. Other types of coronaviruses have infected humans before, namely SARS and MERS-CoV. COVID-19 was confirmed as a new coronavirus that has not previously been identified in humans.

Yes. Current evidence indicates that the virus causing COVID-19 is mainly transmitted by respiratory droplets and aerosols.2 The droplets may differ in size with large droplets falling to the ground near the person infected with COVID-19; aerosols, or smaller droplets, may linger in the air.² As the situation continues to evolve, the Public Health Agency of Canada (PHAC) recognizes there are multiple modes of transmission.

Evidence is growing on the amount of aerosols during production by aerosol generating medical procedures (AGMPs).³ Guidance from PHAC is based on this current evidence. Exactly which procedures are considered to be an AGMP may differ based on provincial/territorial definition; please refer to your jurisdictional guidelines. The situation is evolving and we continue to monitor for any changes in the evidence or guidance.

Several therapeutic treatments and vaccines for COVID-19 are authorized for use in Canada.

For general information about COVID-19, as well as current statistics regarding the pandemic in Canada, please visit the Public Health Agency of Canada’s website.

As the national professional association for regulated nurses, CNA’s role focuses on advocacy to address and mitigate challenges experienced by nurses, improve health outcomes for the public, and develop evidence-informed resources to support nurses in their practice. CNA also coordinates with the International Council of Nurses to represent the voice of Canadian nursing globally. During the COVID-19 pandemic, CNA has advocated to federal and provincial ministers for policies, resources and the support nurses need to provide safe, quality and ethical care.

CNA continues to monitor the situation closely and be responsive to the needs of regulated nurses who are working during this unprecedented public health crisis.

The current recommendations from the Public Health Agency of Canada require a minimum of contact and droplet precautions, which include a medical mask, eye protection (i.e., face-shield fully covering front and sides of the face or well-fitted goggles), gown and gloves for routine care of a suspected or confirmed cases of COVID-19. Hand hygiene should be performed whenever indicated, paying particular attention to during and after the removal of PPE, and after leaving the patient care environment.

An N95 or equivalent respirator are required in place of a medical mask when aerosol-generating medical procedures are being performed and under other circumstances where there is a risk of exposure to aerosols of the virus. Each province/territory may develop separate guidance; therefore, it is important to determine what the provincial and organizational guidance states in your place of work.

CNA believes regulated nurses and other health-care workers should be provided with the maximum level of protection available to them and that the choice for appropriate protection used in clinical situations in hospitals are made by providers in each situation. Regulated nurses are well prepared to make those decisions — but they base them on sound guidelines and evidence and they need to be able to quickly access appropriate protection for the clinical situation at hand. Read CNA’s Key Messages on PPE [PDF, 196.8 KB].

As health-care professionals, we are both responsible and capable of making a risk assessment of our work environment. Employers have a responsibility to provide appropriate personal protective equipment (PPE) in sufficient quantities to protect nurses. As well, PPE should be used in conjunction with other types of controls, including engineering and administrative controls. If your work environment is not congruent with these guidelines, there is an opportunity to advocate for improvement.

Additional resources:

• CNA’s Key Messages on PPE [PDF, 196.8 KB]
• Public Health Agency of Canada guidance documents
• Virtual simulation module on COVID-19 assessment and PPE

In a pandemic situation, decisions between a nurse’s duty to provide care and their own, or their family’s, health and safety become more complex. These are decisions that are personal and difficult. The CNA Code of Ethics [PDF, 880.4 KB] defines nurses’ duty to provide care as a professional and legal obligation, while also acknowledging that “there may be some circumstances in which it is acceptable for a nurse to withdraw from care provisions or to refuse to provide care.”

Self-reflection and discussion of the specific risks and benefits that nurses face while working during a pandemic are valuable strategies. Nurses may find it helpful to ask themselves certain questions:

• What is the risk to the person in care if the nurse does not assist?
• Is the nurse’s intervention directly relevant to preventing harm?
• Will the nurse’s care probably prevent harm?
• Does the intervention outweigh the harms the nurse might incur — and is that an acceptable risk?

For more information, read CNA’s Nurses’ Ethical Considerations During a Pandemic [PDF, 244.3 KB].

Additional resource:

• Health Canada — Optimizing the use of masks and respirators during the COVID-19 outbreak

The discussion of end-of-life choices is an important aspect of nursing care. The role of nursing is critical in listening to patient reflections and concerns, observing family dynamics and providing (and repeating) clear and concise information about potential end-of-life care options. Nurses in all settings should be encouraging advance care planning with patients/clients, family and friends.

Additional resources:

• Advance care planning toolkit
• Pallium Canada’s palliative care learning modules
• CNA Code of Ethics [PDF, 880.4 KB]
• Joint position statement from CNA, the Canadian Hospice Palliative Care Association and the Canadian Hospice Palliative Care Nurses Group: The Palliative Approach to Care and the Role of the Nurse [PDF, 570 KB]

Feelings of guilt are not uncommon, as captured in a recent article in Nursing Times. It is important to recognize the contributions of all nurses in all domains (practice, education, research, policy, administration) during the COVID-19 pandemic. Together, we are collectively supporting our colleagues at the point of care.

Moral distress — the anguish felt when one feels constrained for doing what one perceives is the right thing in a care situation — is bound to increase in emergency environments. Connecting with colleagues to discuss how this incredibly challenging work is making you feel is one of the most powerful ways to mitigate moral distress. It takes effort, but we each need to nurture opportunities to connect, talk through what we are experiencing, and support one another. See the mental health resources listed above.