NSRMLS Standards of Practice

General medical laboratory technologists are highly skilled healthcare professionals working in various areas of laboratory technology including; histology, hematology, transfusion science, immunology, parasitology, virology, tissue bank, clinical chemistry, molecular and microbiology. They are involved with the various aspects of collection, preparation and analysis of specimens received in the laboratory. This analysis aids in the diagnosis, preventions and treatment of disease.

Cytotechnologists are highly skilled health care professionals who are able to aid physicians with cancer detection and disease diagnosis in all body sites. Cytotechnologists prepares specimens for analysis, grossing, immunohistochemistry, molecular, and flow cytometry, process and screen cell smears, Analyzes routine, special and ancillary stains and techniques such as Papanicolaou, H&E, telepathology, flow cytometry, FISH, PCR and EM, male fertility specimens, fine needle aspiration biopsies and body fluids for cancerous or precancerous changes and other pathologies. The results have direct impact on patient care and implications for follow-up care.

Clinical geneticists are highly skilled health professionals with a skill set that is constantly evolving. They help patients and families by utilizing cutting edge technology in areas such as prenatal diagnosis, congenital abnormalities, inherited disorders and hematologic and other malignancies enabling physicians to diagnose, treat and monitor a patient’s condition. Results have direct impact on patient care, family counselling and future medical care. Clinical Genetics Technology involves the detailed analysis of the human genome using FISH, banded metaphase chromosomes and molecular genetic techniques on a variety of human tissues.

NSRMLS, establishes standards of practice governing registrants' practice, and communicates professional expectations and requirements to the public and employers.

• Medical laboratory technologists
• Combined laboratory and x-ray technologists
• Medical laboratory assistants

Expectations for Medical Laboratory Professionals

• All medical laboratory professionals are required to follow these standards of practice
• It is crucial for each MLP to have a through understanding of the knowledge, skills, judgements and attributes expected of them

They are relevant across various practice environments, including:

• Clinical settings
• Educational institutions
• Evaluation and research facilities
• Management and operational contexts

Purpose of the Standards

The Standards of Practice serve as a benchmark for the NSRMLS, employer, other health professionals and the public to evaluate the work of laboratory professionals. Collectively, the standards, as well as relevant legislation (including regulations and bylaws), position statements, policies, and practice guidelines, establish a framework for the practice of MLP in Nova Scotia. Their primary objectives include:

• Outlining performance requirements, accountabilities, and responsibilities involved in providing safe, competent and ethical practice for the Registrant.
• Providing a reference of expectation of professional practice, and is used for complaints and discipline, accountabilities by NSRMLS.
• Providing clarity to other healthcare professionals for the roles and responsibilities of an MLP.
• Providing a reference for the Employer in the development of job descriptions, professional roles and performance evaluation in the workplace.

Competency and Assessment

Medical Laboratory Professionals (MLP) must demonstrate:

• Knowledge
• Skills
• Good judgment
• Attitudes relevant to their professional duties

Individual profesional practice will be evaluated based on

• Standards of Practice
• Code of Ethics
• Competency Profile

NSRMLS Framework

• Establish expectations for entry, ongoing practice, and re-entry into practice.
• Set continuing competency requirements.
• Establish guidelines for assessing the professional conduct and clinical performance of MLPs.

This approach ensures clarity and emphasizes the importance of adherence to the established standards for all medical laboratory professionals.

The standards of practice are inclusive and are designed to support practitioners at all levels and roles, including combined laboratory and x‑ray technologists, medical laboratory assistants, and medical laboratory technologists. Accountability is limited to the standards relevant to your authorized scope of practice and individual competence. Registrants of the NSRMLS are professionally accountable to practice in accordance with these Standards.

It is important to note:

1. The Regulated Health Professions Act, C13 2023 s.2 states that professional misconduct includes: “Failing to maintain standards of practice.”
2. Employers may have policies in place that relate to specific standards of practice. If an employer’s policies are more restrictive than the NSRMLS’s expectations, the MLP must abide by the employer’s policies. Where an employer’s policies are more permissive than those of the NSRMLS, the MLP must adhere to the NSRMLS’s requirements.

• 1.1 MLPs practice and adhere to applicable legislation, regulations, by-laws, NSRMLS and employer policies and NSRMLS practice guidelines.
• 1.2 MLPs must be cognizant of the legal and ethical standards governing laboratory work, ensuring clients’ rights are respected and adhere to the standard of care. MLPs are obligated to uphold the rights, dignity, values, and autonomy of their clients.
• 1.3 MLPs must possess the essential knowledge and skills necessary for entry to practice and effectively apply this knowledge across all laboratory theoretical, technical, and clinical areas.
• 1.4 MLPs are required to meet the minimum registration requirements for practice and fulfill annual renewal obligations.
• 1.5 MLPs must engage in NSRMLS's continuing education and document all self-development activities to maintain professional competence, in line with the standards set by the NSRMLS Board of Directors.
• 1.6 MLPS seek appropriate guidance prior to accepting delegated function that are beyond scope of practice.
• 1.7 MLPs are responsible for their professional actions and inactions, and accepting accountability for the outcomes.
• 1.8 MLPs should understand and adhere to the NSRMLS Code of Ethics as well as related policies.
• 1.9 MLPs must receive informed consent that’s voluntary, valid, and considers the person’s capacity, situation.

• 2.1 MLPS must recognize and acknowledge unprofessional conduct and take appropriate actions in response.
• 2.2 MLPs must maintain professional boundaries with all clients, colleagues and other healthcare professionals.
• 2.3 MLPs must report any sexual abuse or sexual misconduct by another healthcare professional when they become aware.
• 2.4 MLPs have an ethical duty to raise concerns regarding another professional’s conduct or practice to safeguard the public interest.
• 2.5 MLPs are responsible for reporting and cooperating with other regulatory authorities concerning issues that affect public safety or other regulatory matters, including reporting incidents, accidents, or potential regulatory violations.
• 2.6 MLPs understand the role of their profession in health promotion, health education and preventing ill health.

• 3.1 MLPS must recognize and understand the need for active participation in training, supervision and mentoring.
• 3.2 MLPS must demonstrate effective time management skills.
• 3.3 MLPS must practice within the limits of their individual and professional competencies while adhering to institutional and laboratory policies.
• 3.4 MLPs must recognize and work within the limits of their competence when accepting responsibility for assignment and or delegation.
• 3.5 MLPs must identify the limits of their practice and when to seek advice or refer to another healthcare professional or service.
• 3.6 MLPs must adhere to established client safety principles and quality assurance measures to anticipate, identify, evaluate, and promote continuous improvement for safe culture.
• 3.7 The MLP must evolve and enhance their knowledge to maintain current skills and technical principles that advance their scope of practice and ensure the implementation of best practices and the use of new technology.

• 4.1 MLPs should operate within the boundaries of their profession, utilizing professional judgment in their actions.
• 4.2 MLPs must maintain and demonstrate professional behaviour and sound judgement appropriate to the situation.
• 4.3 MLPs must apply critical thinking to systematically evaluate and analyze information regarding pre-examination and examination tasks such as identification, sample appropriateness, result assessment, interpretation and reporting, validation and reporting within their individual scope of practice.
• 4.4 MLPS should recognize and perform additional techniques that can assist in diagnosis or make recommendations as required according to laboratory policies.
• 4.5 MLPs must understand and apply the fundamental concepts of the knowledge base pertinent to their profession.
• 4.6 MLPs should possess in-depth scientific knowledge of the theory, techniques, and clinical application of medical laboratory / radiography science within their scope of practice.
• 4.7 MLPs should continually enhance knowledge, skill and application of relevant medical laboratory / radiography procedures.
• 4.8 MLPs should understand the relationship between analysis, diagnosis, clinical information and treatment.
• 4.9 MLPs should understand the role of their profession in diagnosis, treatment and management of disease during the pre-examination, examination and post-examination, phases of medical laboratory science.
• 4.10 MLPs when within their scope of practice, should be able to evaluate analysis using qualitative and quantitative methods to assist in the diagnosis, screening, treatment and monitoring of health conditions and disorders.
• 4.11 The MLP supports client comfort and safety across all procedures, including transport, transfers, positioning, and personal care, and fall prevention.
• 4.11.1 CLXTs shall adhere to principle of As Low As Reasonably Achievable (ALARA) for clients, colleagues and others, in accordance with the appropriate safety legislation.
• 4.12 The MLP acquires optimal images and assess diagnostic images, perform post processing on image data and utilize digital networking system.
• 4.13 The MLP applies fluoroscopy procedures and ensures safe administration of contrast media.
• 4.14 MLPs are prohibited from using artificial intelligence (AI) to circumvent standard operating procedures, regulations or competency.
• 4.15 AI must augment not replace the judgement and accountability of licensed MLPs.

• 5.1 MLPs should apply their knowledge and skills to inform and enhance their professional practice.
• 5.2 MLPs must prioritize workflow in accordance with appropriate policies and procedures.
• 5.3 MLPs must adhere to technical troubleshooting processes to recognize and document errors and initiate corrective action according to laboratory policies.
• 5.4 MLPs during the pre-analytical phase; properly collect, handle, accession, identify, document, store, and transport specimens in a retrievable manner, following the appropriate guidelines and policies to preserve specimen integrity.
• 5.5 MLPs must apply professional judgement in assessing the integrity and suitability of specimens submitted for examination.
• 5.6 MLPs shall ensure and recognize when relevant specimen information is required for correct interpretation and or testing.
• 5.7 MLPs must understand and interpret critical values, reference ranges, and detection limits of each technique within individual scope of practice.
• 5.8 MLPS must understand reasons for unexpected test results and potential interactions within the individual scope of practice.Register patient/specimens information using appropriate LIS/HIS.
• 5.9 MLPS must operate and maintain equipment as identified in employers standard operating procedures and manufacture recommendations.
• 5.10 MLPS must perform calibration and quality control checks as per laboratory protocol.
• 5.11 MLPS must be able to recognize, troubleshoot, and document issues with equipment, instruments, and reagents while ensuring any appropriate corrective actions and preventive maintenance are taken in a timely fashion.
• 5.12 MLPS within their individual scope of practice, must recognize and take corrective action if errors occur and report as required by laboratory procedure.
• 5.13 MLPs report results accurately and promptly, and communicate critical or stat results in accordance with established policies.
• 5.14 MLPS must comply with policies and procedures for storage and disposal of specimens.
• 5.15 MLPS must ensure all non-regulated laboratory personnel who perform laboratory tasks are properly trained and supervised in accordance with laboratory standards and maintain oversight.

• 6.1 MLPs must maintain an accurate inventory of necessary supplies and materials.
• 6.2 MLPs must demonstrate and understand the importance to assess and evaluate new procedures, reagents, quality controls before routine implementation.
• 6.3 MLPs must apply principles of quality control and quality assurance by following established procedures and taking corrective action as needed.
• 6.4 MLPs must utilize, update, and maintain all relevant documents including procedures and protocols as necessary and appropriate.
• 6.5 MLPs must demonstrate awareness of key performance indicators relevant to quality assurance.
• 6.6 MLPS participate in external and internal QA programs.
• 6.7 MLPs shall participate in workflow analysis initiatives.
• 6.8 MLPs ensure that Quality Control data is retained in accordance with established policy and legislation.
• 6.9 MLPs recognize non‐conformances, determine cause and appropriate corrective action, and participate in process improvement activities.
• 6.10 MLPs evaluate new procedures and validate the procedures to ensure effectiveness.
• 6.11 MLPs ensure that unlicensed personnel under their supervision are assigned only tasks that align with their training and comply with relevant legislation, regulations, and policies.
• 6.12 MLPs must keep current with best practices in radiation safety, positioning, and client-centred care.
• 6.13 MLPs promptly assess the accuracy and reliability of outputs (images, data, tests) prior to the client’s departure.
• 6.14 MLPs place radiopaque lead markers (R/L, weight-bearing, decubitus, time) at the time of exposure whenever feasible. If a marker cannot be used, add a clear digital annotation and document reasoning per policy.

• 7.1 The MLP is responsible for promoting and adhering to safe work practice to minimize the risk to themselves and others.
• 7.2 MLPs adhere to legislative regulations and employer polices to establish routine practices and implement additional precautions to ensure the safety of oneself, healthcare professionals, clients, and the community.
• 7.3 MLPs remain current in practices and standards related to safety and infection control, and work to include updated practices and standards in workplace guidelines.
• 7.4 MLPs exercise the right to refuse unsafe work practices.
• 7.5 MLPS use protective equipment, safety devices (fume hood etc), and adhere to radiation safety protocol.
• 7.6 MLPs understand and recognize the various biological hazard groups and their associated containment levels.
• 7.7 MLPs properly store, dispose, transport and handle hazardous materials.
• 7.8 MLPs maintain an inventory of hazardous reagents and sharps and handle and dispose of them appropriately when they are no longer in use, adhering to safety guidelines.
• 7.9 MLPs use approved methods for disinfection, spills and sterilization of equipment.
• 7.10 MLPs respond to safety emergencies and incidents appropriately.
• 7.11 MLPs use proper shielding devices when necessary.
• 7.12 MLPs use appropriate ergonomic principles in the workplace.
• 7.13 MLPs report adverse events, unsafe work practices, and ergonomic deficiencies promptly and comprehensively.
• 7.14 MLPs are engaged in occupational health, including being aware of immunization requirements and mandates.

• 8.1 MLPs maintain and manage comprehensive, thorough and accurate records in compliance with relevant legislation, laboratory protocols, and guidelines.
• 8.2 MLPs results are recorded accurately and according to established laboratory policies.
• 8.3 MLPs recognize, communicate, and understand the risks and potential consequences associated with errors and omissions.
• 8.4 MLPs correctly identify and document anatomical orientation for image/series following workplace standard operating procedures.
• 8.5 MLPs store all images and related data per organizational policy and device requirements, including: identifiers, date/time, modality, laterality, and series descriptions, retention schedules, backup routines, and downtime procedures.

• 9.1 MLPs adhere to the principles of professionalism in all forms of communication, including electronic and social media platforms.
• 9.2 MLPs select and use effective verbal, non‐verbal, listening, and written communication skills tailored for the intended audience.
• 9.3 MLPs use information, communication and digital technologies that are relevant to their practice.
• 9.4 MLPs recognize barriers that may hinder effective communication.
• 9.5 MLPs understand the importance of supporting the communication needs of clients and caregivers, including the use of appropriate interpreter services or technology when necessary.

• 10.1 MLPs maintain and protect the confidentiality of all client and organizational information.
• 10.2 MLPs maintain a work environment that upholds client privacy.
• 10.3 MLPs recognize and respond to situations in a timely manner where it is necessary to share information to protect clients, carers and/or the broader public.
• 10.4 MLPs report any breach of confidentiality following workplace policies and procedures.
• 10.5 MLPS protect electronic records by protecting passwords and log in information.
• 10.6 MLPs do not share or allow others to perform data entry under their sign in.

• 11.1 MLPS promote an understanding of their professional role to other health care professionals.
• 11.2 MLPs facilitate the sharing of knowledge with students, peers, other health care professionals, and clients.
• 11.3 MLPs collaborate with and show respect for all members of the health care team to ensure best practice, client-centred care and interdisciplinary work practice.
• 11.4 MLPs manage all conflicts, including issues related to conflicts of interest, in a professional manner.
• 11.5 MLPs provide timely, constructive, and thoughtful feedback to learners and colleagues.
• 11.6 MLPs recognize mental and physical wellbeing in clients, carers ,colleagues, and self and adapt practice, to ensure safe work practices and to seek assistance as needed.

• 12.1 MLPs recognize the importance of the principles of equity, diversity, inclusivity, reconciliation and accessibility (EDIRA) in professional practice and ensure that services are provided in a non-discriminatory and inclusive manner.
• 12.2 MLPs acknowledge that the principles of EDIRA must be integrated throughout the application of all standards across various practice areas.
• 12.3 MLPs have an understanding of Canadian equality legislation designed to protect against discrimination and promote equality, such as the Canadian Charter of Rights and Freedoms, the Canadian Human Rights Act, and the Employment Equity Act and apply these principles in their practice.
• 12.4 MLPs respond appropriately to the needs of all groups and individuals in practice, recognizing that differences—including characteristics, intersectional experiences, and cultural backgrounds—can influence these needs.
• 12.5 MLPs understand how social, economic and environmental factors (wider determinants of health) can impact a person’s health and wellbeing.
• 12.6 MLPs recognize the potential influence of their own values, beliefs and unconscious biases on practice, and take proactive steps to ensure that all clients and caregivers are treated with respect and dignity.
• 12.7 MLPs understand the obligation to make reasonable adjustments in practice and possess the ability to implement and support such adjustments in their own practice and that of others.
• 12.8 MLPs identify the characteristics and consequences of barriers to inclusion, including those affecting socially isolated groups, and advocate for change whenever possible.

• 13.1 MLPs take responsibility for their health and wellbeing, seeking appropriate support when necessary.
• 13.2 MLPs recognize the significance of their mental and physical health strategies in maintaining fitness for practice.
• 13.3 MLPs develop and implement clear strategies for mental and physical well-being, ensuring high professional effectiveness and a safe work environment.
• 13.4 MLPs effectively manage the emotional challenges associated with working in a high pressured environment.
• 13.5 MLPS understand how to take appropriate action if their health may impact their ability to practice safely and effectively, including seeking help and support when necessary.

• 14.1 MLPs acknowledge the significance of reflective practice and the necessity of documenting the outcomes of such reflections to foster continuous improvement and professional development.
• 14.2 MLPs recognize the value of multi-disciplinary reviews, case conferences and other laboratory review methods.