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. A coronavirus is a type of virus that can infect both humans and animals. Other types of coronavirus 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.

Current evidence indicates that the virus causing COVID-19 is mainly transmitted by respiratory droplets and close contact. The virus may become airborne during aerosol generating medical procedures (AGMPs). Guidance from the World Health Organization (WHO) and the Public Health Agency of Canada (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. See WHO’s summary of evidence.

There is currently no vaccine or approved treatment for COVID-19. Researchers are working hard to develop a vaccine; the earliest possible date for widespread availability is anticipated to be spring 2021.

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.

We currently do not have accurate information about the number of Canadian nurses who have contracted and/or tested positive for COVID-19, but CNA is working closely with other national health-care organizations to advocate for required reporting of rates of COVID-related health-care worker infection, disease and death, and is exploring novel ways to collect this information. We will provide more information as it becomes available.

This will likely depend on your employer and the pandemic preparedness plans in place. All provinces and territories have now declared states of emergency due to COVID-19. As a result, this provides ministries of health with the authority to redistribute health-care workforces based on need. You may be redeployed to a different role, unit or an assessment and testing centre to support the COVID-19 pandemic. For more information on ethical dilemmas, considerations and responsibilities during a pandemic, read what CNA’s Code of Ethics has to say.

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.

As the professional association of Canada’s nurses, CNA is working closely with other national organizations, such as the Canadian Federation of Nurses Unions (CFNU), to advocate for appropriate support and protection of nurses and other healthcare workers. CNA has urged — and will continue to urge — all levels of government to err on the side of over-protection.

For more information, see CNA’s advocacy letters.

The current recommendations from the Public Health Agency of Canada require contact and droplet precautions, which include facial protection (with surgical or procedure mask and eye protection — goggles, safety glasses, visor, or face shield), 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.

For aerosol-generating medical procedures (AGMPs), N95 respirators are required in place of a surgical mask. This recommendation is informed by the current evidence that indicates COVID-19 is spread through respiratory droplets from coughing, sneezing or prolonged personal contact. 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

The choice about equipment used in clinical situations in hospitals are made by health-care providers in each situation. Nurses are well prepared to make those decisions — and must base them on sound guidelines and evidence. Employers have a responsibility to provide appropriate protective equipment in sufficient quantities to protect nurses.

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].

Medical masks (surgical, medical procedure masks and respirators, such as N95) should be kept for those providing direct care to COVID-19 patients. Public use of masks is optional, but when used alone, will not prevent the spread of COVID-19. Homemade facial cover/non-medical mask can be used, in addition to routine prevention strategies, to protect others around you when physical distancing is not possible. This is not proven to protect the wearer of the mask, but rather those you come in contact with. Other measures, such as frequent handwashing and social distancing, are necessary.

Additional resource:

• Health Canada — Non-medical masks and face coverings: About

There have been increased reports of limited resources and supplies — in particular surgical masks and N95 respirators — for regulated nurses across Canada. Many nurses have inquired if cloth or homemade masks are acceptable for use. Current guidance from Health Canada emphasizes using caution with homemade masks, as they are not regulated and may not be effective in blocking virus particles. For further direction, please refer to your organization or provincial/territorial health authority.

Guidance regarding the reuse of masks is mixed, as most masks are designed for single use. Due to critical shortages of personal protective equipment (PPE), reprocessing and/or decontamination of N95 respirators for reuse is being considered by Health Canada. See CNA’s Key Messages on PPE [PDF, 196.8 KB] to review a table comparing guidance on reusing masks along with other strategies for optimizing use.

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.

The well-being of nursing students is at the forefront of concern for nursing faculty across Canada. Significant efforts are underway to identify a variety of scenarios for the upcoming semesters to minimize the impacts on students’ learning, educational journey and experience. The use of technology has helped connect students with their peers and faculty, as well as school-based supports, such as counselling services.

For more information, the Canadian Association of Schools of Nursing has released resources and guidance for schools of nursing responding to COVID-19.