Practice Expectation Spotlight

Telepractice (also called virtual practice) is the use of telecommunications technology to deliver health-care services at a distance. Examples of these types of services include telephone assessment, advice and follow-up, videoconferencing and online messaging platforms. Telepractice can break down service barriers related to distance, time, and expense and can be a preferred method service provision for both patients and providers. Despite these benefits, telepractice services have unique risks associated with them. These risks can include: 

  • Miscommunication 
  • Privacy breaches  
  • Poor coordination of care 

Taking time to reflect on your ability to meet the Practice Expectations for RNs and the Practice Expectations for RN(AP) or RN(NP)s (as applicable) when practicing remotely is important to demonstrate accountability and can help you identify and mitigate potential risks in a constructive manner. Consider the following case scenario: 

Nidia Santos RN has just started a new job working from home for a national company providing telephone assessment, monitoring and follow-up services. In this position she is provided with a secure database to store client information, checklists to ensure key information is attained and provided to/ from the client and is made aware of guidelines for referrals to programs associated with her caseload. Before commencing work, Nidia identifies a number of privacy risks working from home including potential computer access and overhearing by other household members. She mitigates these risks by dedicating a private room, ensuring her computer is password protected and setting aside dedicated work hours.   

One evening Nidia phones a new client who resides in another jurisdiction. Nidia explains her role and the purpose of the phone call as well as the limitations in the services she can provide. She gains consent to complete her assessment and begins to ask questions. As she documents the client’s responses, she notes that the client is slurring their speech and taking long pauses between answers. Nidia asks additional questions to gather more assessment data but has difficulty understanding the client due to increasingly low volume of the client’s voice. Nidia explains to the client that she is having difficulty hearing and repeats her question. Suddenly the client hangs up.   

What should Nidia do in this situation? Consider, how can Nidia demonstrate the following practice expectations: 

  • When engaging in the practice of registered nursing, you must apply, as a framework, the nursing process, which is the systematic approach to the practice that encompasses all steps taken by RNs in planning for the needs of your client, including assessment, diagnosis or determination, planning, implementation and evaluation.  
  • Demonstrate critical inquiry in planning for client care needs and evaluating care provided. 
  • Communicate and collaborate with the client and other team members in a timely manner to promote continuity and delivery of safe, competent and ethical care. 

Nidia is aware from her orientation that she should try calling the client back and then call the client’s emergency contact. When she is unable to reach either, she reflects on her responsibility to both ensure the clients well- being and complete her assessment of this client. Unsure of what to do next she calls her supervisor for advice. 

RNs are accountable for all practice expectations while practicing in virtual settings. To support this, assessment of appropriate technology and proactive planning including the development of policies and procedures for a variety of complex case scenarios is recommended. If you find that you are unable to meet practice expectations while doing this work it is considered a professional practice issue. More information about managing professional practice issues can be found here. 

Registration/ Licensure when Manitoba–based RNs Provide Telepractice Services  

All RNs who are physically located in Manitoba must maintain their certificate of practice with the College of Registered Nurses of Manitoba even when providing telepractice services for clients outside of Manitoba. When providing these services, it is expected that RNs inform the client of their full name, professional designation and regulatory body. 

In addition, when clients live outside of the province of Manitoba, it is expected that the employer or RN contact the regulatory body in the other province to see if they need to be registered in that jurisdiction before providing health-care services to the client. When Manitoba RNs provide services to clients in other jurisdictions it is expected that they are aware of applicable legislation and system resources for that jurisdiction. 

Registration/ Licensure when Out-of- Province RNs Provide Telepractice Services to Clients in Manitoba  

Registered Nurses who provide telepractice services to clients in Manitoba must be registered in a Canadian jurisdiction. It is expected that out-of-province RNs provide the client their full name, professional designation and regulatory body at each contact. 

Resources 

Telepractice 
Practice Expectations for RNs 
Registered Nurse Responsibilities Related to Professional Practice Issues  
Canadian Nurses Protective Society. 2009. Telephone Advice: Is it safe?  

For additional tips and considerations when using social media platforms we encourage you to complete the 2020 jurisprudence module Pause Before You Post: Social Media Awareness as soon as able. If you have questions about the module or about meeting practice expectations when providing telepractice/ virtual care services, please feel welcome to contact practice@crnm.mb.ca 

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