Practice Expectation Spotlight

According to the Practice Direction: Practice Expectations for RNs, we all have a responsibility to identify issues which could have an injurious effect on clients or others and participate in resolving professional practice issues that interfere with our ability to practise according to the College regulations, practice directions, Code of Ethics and other provincial and federal legislation. To explore this responsibility further, consider the following case scenario:

Kim Raider RN works in a community clinic in a rural area. The clinic is facing numerous challenges including frequent staff turnover and the implementation of a new documentation system. Kim is feeling increasingly frustrated as she notices that the clinic is often out of supplies needed to implement evidence based wound care treatments, she feels that she does not have enough time to document comprehensively in the new system and she has noted two instances where clients have called indicating that they have not received appointments for referrals that were supposedly made to the clinic. Kim does not want to leave the clinic but feels that she may need to if the situation does not improve. She realizes that ongoing complaints to other clinic staff about her workload decreases morale and does not help the situation.

What are Kim’s responsibilities in this case scenario?

Kim has a responsibility to work constructively and collaboratively with her employer to resolve professional practice issues. In this case scenario there are three potential professional practice issues:

  • Clients may not be able to receive appropriate care without adequate access to supplies. Consider, from the 2017 edition of the Code of Ethics for Registered Nurses, “When resources are not available to provide appropriate or safe care, nurses collaborate with others to adjust priorities and minimize harm. Nurses keep persons receiving care informed about potential and actual plans regarding the delivery of care. They inform employers about potential threats to the safety and quality of health care” (9).
  • Kim may not be able to appropriately document the nursing care she provides given the current supports.
  • A communication breakdown may be occurring between the clinic and referring agencies that could have an injurious effect on clients waiting for necessary care.

How should Kim bring these issue(s) forward?

Before bringing any issues forward Kim should take time to gather facts. This may include reflecting on her own practice, reviewing College documents, asking questions to clarify concerns and identifying key people who can contribute to resolving the issue. Once the facts are known, Kim can discuss the issues directly with the people involved. She can reference the College’s resources to ensure that the issues are communicated in a professional and meaningful manner.

What happens if the issue(s) remain unresolved?

If the issues remain unresolved, Kim may need to present her concerns to the next organizational level. For more information on how to present professional practice issues to the next organizational level, review the document Registered Nurse Responsibilities related to Professional Practice Issues (updated 2019).

Resources:

Practice Direction: Practice Expectations for RNs
(Note: A complete list of practice directions can be found on the resources page of the CRNM website)
Code of Ethics for Registered Nurses (2017 Edition)

 

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