Practice Expectation Spotlight: Registered Nurse Responsibilities in New Practice Environments

As we continue to experience unprecedented situations related to the COVID-19 pandemic, many of us are taking on the challenge of working in new practice environments. Working in new environments can be the result of many different initiators including re- entering the workforce, being transferred to a different unit, taking on new roles within the same team, working with different or limited resources and/or changing client care needs. No matter the reason for the change, the practice expectations are there to form the foundation for safe, competent and ethical nursing practice. As such we can use the practice expectations as a guide to both adapt our individual practice and advocate for safe, competent, and ethical care, as situations evolve.

To demonstrate this, let’s explore common changes to practice environments and apply the practice expectations.

1. Changing client care needs

When client care needs change, as a RN you are expected to acknowledge your limitations in skill, knowledge and judgment and must ensure that you practice registered nursing within those limitations. At the same time, you are also expected to take part in development of your continuing competence to maintain and enhance your nursing knowledge, skill, and judgment so your practice is both safe and relevant to your clients’ health-care needs. These two practice expectations work in tandem with each other, requiring us to self-assess our knowledge and skills to be able to accurately communicate the assets we bring to the situation, along with any learning needs we have within the full scope of registered nursing practice (CNPS  2020).

2. Taking on new roles within the interprofessional team

When working as part of an interprofessional team we are expected to understand our own role on the team as well as the roles of others. This is reflected in the collaborative care practice expectations, the Interprofessional Collaborative Care practice direction as well as the Assignment and Delegation to Unregulated Care Providers practice direction. In order to demonstrate accountability to these expectations it is expected that you ask for clarification on your role and others’ roles as needed to facilitate positive team functioning. Questions you can ask to start the discussion include:

• What will be my role here?
• Who else is part of this team and how can I collaborate with them for any questions I have?

3. Working with limited resources

When resources are not available to provide appropriate or safe care, we are expected to collaborate with others to adjust priorities and minimize harm. When doing this, we must keep persons receiving care informed about potential and actual plans regarding the delivery of care. We must also inform employers about potential threats to the safety and quality of health-care (CNA, Code of Ethics, 2017).  When informing employers of concerns it is important to frame the communication in the context of the practice expectations and work constructively towards a solution. More information about managing professional practice issues can be found here.

In order to promote quality practice environments and safe client care, registered nurses at all system levels can demonstrate accountability to the practice expectations by:

• proactively identifying the impact of worst-case scenarios related to client health status and health human resource availability on the ability for RNs to meet practice expectations;
• advocating for planning that incorporates parameters for resource allocation that enable compliance with the practice expectations including, but not limited to, use of the nursing process, timely documentation and communication with clients and their families;
• sharing concerns about their practice environment and constructively working towards solutions;
• supporting Patient Safety Culture. More information here;
• ensuring they understand their professional and legal responsibilities related to the duty to provide care. More information can be found here.;
• acting as a mentor, coach, preceptor and/or resource to students, nursing colleagues and other members of the health-care team.

Questions about applying practice expectations in new practice environments? Contact a Quality Practice Consultant at practice@crnm.mb.ca or ext 301 for a free consultation.

Resources

Canadian Patient Safety Institute. 2020. “Patient Safety Culture”.

CNA. Code of Ethics. 

CNPS.  2020. “Legal Considerations when Nursing in a Pandemic”.

CRNM. Assignment and Delegation to Unregulated Care Providers.

CRNM. Duty to Provide Care.

CRNM. Interprofessional Collaborative Care.

CRNM. Practice Expectations.

CRNM. Registered Nurse responsibilities related to Professional Practice Issues.

CRNM. Scope of Practice.