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Professional Standards

FOR
REGISTERED NURSES
AND NURSE PRACTITIONERS

ACCO U NTA B I L ITY


KNOWLEDGE
CO M P E T E N C E
ETHICS
SERVICE
S E L F- R EG U L AT I O N
Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

CRNBC's mandate is to ensure that all individuals seeking entry to practice


and maintaining registration are competent and ethical professionals. The
CRNBC’s College does this by setting standards, supporting registered nurses to meet
Mandate standards and acting if standards are not met.

ABOUT THIS DOCUMENT


C R N B C S TA N D A R DS O F P R A C T I C E This document has been sectioned into four parts to
make it easier for you to find the information you need
CRNBC is responsible under the Health to support your practice as a nurse.1
Professions Act for setting standards of practice
for its registrants. CRNBC Standards include: The Introduction explains the purpose of the
• professional standards; Professional Standards and how they can help you in
• practice standards; and your practice.
• scope of practice standards.
Part two includes the six Professional Standards with
Professional Standards indicators illustrating how each is applied in four main
Professional Standards are statements about areas of practice.
levels of performance that nurses are required
to achieve in their practice. They provide an The third part is a section from the Canadian Nurses
overall framework for the practice of nursing in Association Code of Ethics for Registered Nurses. It
British Columbia. identifies and defines eight nursing values and the
responsibilities associated with each.
Practice Standards
Practice Standards set out requirements related The fourth part of the document includes five helpful
to specific aspects of nurses’ practice. appendices.

Scope of Practice Standards W H E R E TO G E T A SS I S TA N C E


Scope of Practice Standards set out standards, For further information on the Professional Standards
limits and conditions related to the scope of or any nursing practice issue, contact CRNBC Practice
practice for registered nurses and nurse Support at 604.736.7331 (ext. 332) or toll-free in
practitioners. Canada 1.800.565.6505. E-mail practice@crnbc.ca

All CRNBC Standards are available online at


www.crnbc.ca
1 “Nurse” refers to the following CRNBC registrants: registered nurses,
nurse practitioners, licensed graduate nurses, student nurses.

2 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

CO N T E N T S

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Standard 1: Responsibility and Accountability . . . . . . . . . . . . . . . . . . . 6

Standard 2: Specialized Body of Knowledge . . . . . . . . . . . . . . . . . . . . 8

Standards and Standard 3: Competent Application of Knowledge . . . . . . . . . . . . . . 10


Indicators
Standard 4: Code of Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Standard 5: Provision of Service in the Public Interest . . . . . . . . . . . 14

Standard 6: Self-regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Canadian Nurses Association


Code of Ethics for Registered Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Appendix 1 - Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . 26

Appendix 2 - Applying Professional Standards in Practice . . . . 27

Appendix 3 - CRNBC Resources . . . . . . . . . . . . . . . . . . . . . . . . . 29


Appendices
Appendix 4 - Guidelines for Resolving
Professional Practice Problems . . . . . . . . . . . . . . 32

Appendix 5 - Guidelines for Taking Action


on Nurses’ Unacceptable Behaviour . . . . . . . . . . 35

© College of Registered Nurses of British Columbia/July 2010 Pub. No. 128

College of Registered Nurses of British Columbia 3


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

Nursing has a proud history of service to the public, and the public expects
competent nurses to provide safe and ethical nursing care. In British
Columbia, the public has entrusted the College of Registered Nurses of British
Columbia (CRNBC), through the Health Professions Act, with the
responsibility for establishing, monitoring and enforcing standards of practice
Introduction and professional ethics for registered nurses and nurse practitioners.

W H AT A R E T H E P R O F E SS I O N A L S TA N D A R DS Regardless of their primary area of responsibility,


FOR NURSES? nurses may assume responsibilities in other practice
A standard is a desired and achievable level of areas. For example, a nurse whose primary
performance against which actual performance can be responsibility is for clinical practice may at times
compared. It provides a benchmark below which assume responsibilities for education (teaching a
performance is unacceptable. student in practicum), administration (acting manager
or supervisor) and/or research (collecting data for a
The Professional Standards are statements about levels research or quality improvement study). The same
of performance that nurses are required to achieve in diversity in practice may be experienced by nurses
their practice. They reflect the values of the nursing whose primary responsibility is for education,
profession and clarify what the profession expects of administration or research. Nurses in these
nurses. They represent the criteria against which circumstances will find direction for their practice by
nurses’ practice in British Columbia is measured by the referring to indicators related to these other practice
public, clients, employers, colleagues and themselves. areas.

Indicators
Indicators illustrate how each Professional Standard is W H Y H AV E P R O F E SS I O N A L S TA N D A R DS ?
applied and met in each area of practice – clinical, The primary purpose of the Professional Standards is to
education, administration and research. Indicators guide and direct nurses’ practice. Through the
provide specific criteria that are used, when applicable, Professional Standards, CRNBC meets its legal
to measure the actual performance of an individual responsibility to regulate nurses’ practice in the public
nurse. The indicators in this document are not written interest and address incompetent, impaired or
in order of importance, nor are they intended to be an unethical practice among nurses.
exhaustive list of criteria for each Professional
Standard.

4 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

In addition to using the Professional Standards to W H O H A S R E S P O N S I B I L I TY F O R T H E


protect the public through regulation of nurses’ P R O F E SS I O N A L S TA N D A R DS ?
practice, they are used by CRNBC in the process for It is the responsibility of individual nurses to act
reviewing and recognizing entry-level and re-entry professionally and be accountable for their own
education programs for registered nurses and nurse practice. All nurses are responsible for understanding
practitioners in British Columbia.2 The Professional the Professional Standards and applying them to their
Standards are also used to: develop administrative practice, regardless of their setting, role or area of
guidelines; explain expectations of nurses’ practice to practice. The policies of employers or other
the public and other health care professionals; and to organizations cannot relieve individual nurses of
provide a legal reference for reasonable and prudent accountability for their own actions or their primary
practice. obligation to meet these Professional Standards.

The Professional Standards can be used by nurses to CRNBC is responsible for assuring that the profession as
support their individual practice (e.g., as a tool for self- a whole carries out its commitment to the public. This is
assessment). They can also be used to assist agencies achieved in part through establishing and regularly
to develop systems that support nurses to meet CRNBC reviewing the Professional Standards, and providing
Standards (e.g., orientation programs). For more resources to support nurses in understanding and
information, see Appendix 2: Applying Professional applying them. Employers have an obligation to provide
Standards in Practice. essential support systems, including human and
material resources, so that nurses are able to meet these
Professional Standards.

2 New graduates are expected to meet CRNBC’s Professional Standards in their beginning practice. The CRNBC document, Competencies in the Context of Entry-
level Registered Nurse Practice in British Columbia, gives further details of the expectations for entry-level practice.

College of Registered Nurses of British Columbia 5


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

1 R E S P O N S I B I L I TY A N D A CCO U N TA B I L I TY :
Maintains standards of nursing practice and professional conduct determined by CRNBC
and the practice setting.

CLINICAL PRACTICE E D U C AT I O N
I N D I C AT O R S I N D I C AT O R S

1. Is accountable and takes responsibility for own 1. Is accountable and takes responsibility for own
nursing actions and professional conduct.3 nursing actions and professional conduct.3

2. Functions within the legally recognized scope of 2. Functions within the legally recognized scope
practice4 and within all relevant legislation.5 of practice4 and within all relevant legislation.5

3. Follows and/or helps to develop agency or 3. Follows and/or develops agency, department
department policies and evidence-based care or education policies and evidence-based care
standards. standards.

4. Takes action6 to promote the provision of safe, 4. Takes action6 to promote the provision of safe,
appropriate and ethical care to clients.7 appropriate and ethical care.

3 Professional conduct includes demonstrating honesty, integrity and respect. See the glossary for a definition of “professional conduct.”

4 The scope of practice for nurses is set out in the Nurses (Registered) and Nurse Practitioners Regulation under the Health Professions Act and is complemented
by standards, limits and conditions established by CRNBC.

5 Relevant legislation is legislation that affects the practice of nursing by: a) setting out the scope of practice of another profession (e.g., regulations under the
Health Professions Act); b) requiring adherence to certain conditions (e.g., Freedom of Information and Protection of Privacy Act); or c) directing the behaviour of
citizens of the province or country (e.g., the Criminal Code of Canada). For a summary of legislation affecting nursing practice, refer to the CRNBC document,
Legislation Relevant to Nurse's Practice.

6 Taking action includes advocacy.

7 See the glossary for a definition of the term “client.”

6 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

1
A D M I N I S T R AT I O N RESEARCH
I N D I C AT O R S I N D I C AT O R S

1. Is accountable and takes responsibility for own 1. Is accountable and takes responsibility for own
nursing actions and professional conduct.3 nursing actions and professional conduct.3

2. Functions within the legally recognized scope 2. Functions within the legally recognized scope
of practice4 and within all relevant legislation.5 of practice4 and within all relevant legislation.5

3. Follows, develops and/or changes organization 3. Follows and/or develops agency or department
policies and evidence-based care standards. policies and evidence-based care standards.

4. Takes action6 to promote the provision of safe, 4. Takes action6 to promote the provision of safe,
appropriate and ethical care. appropriate and ethical care.

Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.

College of Registered Nurses of British Columbia 7


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

2 S P EC I A L I Z E D B O DY O F K N O W L E D G E :
Bases practice on the best evidence from nursing science and other sciences and
humanities.

CLINICAL PRACTICE E D U C AT I O N
I N D I C AT O R S I N D I C AT O R S

1. Knows how and where to find needed 1. Knows how and where to find needed
information to support the provision of safe, information to support the delivery of safe,
appropriate and ethical client care. appropriate and ethical nursing and health
education.

2. Shares nursing knowledge with clients, 2. Shares nursing knowledge with clients,
colleagues, students and others. colleagues, students and others.

3. Interprets and uses current evidence from 3. Interprets and uses current evidence from
research and other credible sources to make research and other credible sources to make
practice decisions. education decisions.

4. Understands and communicates nursing’s 4. Understands and communicates nursing’s


contribution to the health of clients. contribution to the health of clients.

5. Uses relationship and communication theory 5. Uses relevant learning and communication
appropriately in interactions with clients, theory to create a professional learning
colleagues and others. environment.

8 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

2
A D M I N I S T R AT I O N RESEARCH
I N D I C AT O R S I N D I C AT O R S

1. Knows how and where to find needed 1. Knows how and where to find needed
information to support the provision of safe, information to support knowledge development
appropriate and ethical nursing practice and for evidence-based, safe, appropriate and
client care. ethical nursing practice and client care.

2. Shares nursing knowledge with clients, 2. Shares nursing knowledge with clients,
colleagues, students and others. colleagues, students, the scientific community
and others.

3. Interprets and uses current evidence from 3. Interprets and uses current evidence from
research and other credible sources to make research and other credible sources to plan
administrative decisions. and conduct research.

4. Understands and communicates nursing’s 4. Understands and communicates nursing’s


contribution to the health of clients and the contribution to the health of clients.
delivery of nursing services.

5. Uses knowledge of organizational behaviour 5. Uses knowledge of communication theory to


and communication theory to create an share the practice implications and policy
environment in which cooperation, relevance of research in a meaningful way with
professional growth, and mutual respect can nurses and others.
flourish.

Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.

College of Registered Nurses of British Columbia 9


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

3 CO M P E T E N T A P P L I C AT I O N O F K N O W L E D G E :
Makes decisions about actual or potential problems and strengths, plans and performs
interventions, and evaluates outcomes.

CLINICAL PRACTICE E D U C AT I O N
I N D I C AT O R S I N D I C AT O R S

1. Collects information on client status from a 1. Collects information on individual and group
variety of sources8 using assessment skills learning needs from a variety of sources using
including observation, communication and assessment skills including observation and
physical assessment. communication.

2. Identifies, analyzes and uses relevant and valid 2. Identifies, analyzes and uses relevant and valid
information when making decisions about client information when planning education.
status and reporting client outcomes.

3. Communicates client status, using verifiable 3. Communicates learning needs of individuals and
information, in terminology used in the practice groups using verifiable information.
setting.

4. Develops plans of care that include data about 4. Plans education that addresses learning needs
assessments, decisions about client status, and strengths and includes evaluation criteria.
planned interventions and evaluation criteria for
client outcomes.

5. Sets priorities when planning and giving care. 5. Sets priorities when planning and providing
education.

6. Carries out interventions in accordance with 6. Teaches using appropriate instructional methods
policies, guidelines and care standards. and relevant learning theory.

7. Evaluates client’s response to interventions and 7. Evaluates attainment of learning objectives


revises the plan as necessary. using valid and reliable measures and revises
strategies as necessary.

8. Documents timely9 and appropriate reports of 8. Establishes and maintains appropriate


assessments, decisions about client status, education records.
plans, interventions and client outcomes.

9. Initiates, maintains and terminates professional 9. Initiates, maintains and terminates professional
relationships in an appropriate manner. relationships in an appropriate manner.

8 Whenever possible, nurses involve clients in assessment, decision-making about client status, care planning, implementation and evaluation.

9 The timeliness of documentation will be dependent upon the setting. Settings in which the client acuity, complexity and variability is high will require more frequent
documentation than settings in which clients are less acute, less complex and/or less variable.

10 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

3
A D M I N I S T R AT I O N RESEARCH
I N D I C AT O R S I N D I C AT O R S

1. Collects information about organizational status 1. Collects research information from a variety of
from a variety of sources using assessment skills sources using valid and reliable data collection
including observation and communication. instruments and methods.

2. Identifies, analyzes and uses relevant and valid 2. Identifies, analyzes and uses relevant and valid
information when determining organizational information in nursing research projects.
problems or status.

3. Communicates organizational problems and 3. Develops and communicates research questions


status using verifiable information. or hypotheses that are relevant and
researchable.

4. Plans administrative and other strategies to 4. Writes research proposals to address stated
address organizational problems and strengths questions/hypotheses.
with accompanying evaluation criteria.

5. Sets priorities when planning and implementing 5. Sets priorities when planning and conducting
administrative and other strategies. research.

6. Implements administrative and other identified 6. Conducts research in accordance with accepted
strategies. research methods and procedures and/or
supervises research assistants.

7. Evaluates process and/or outcomes of strategies 7. Analyzes and interprets qualitative and
and revises as necessary. quantitative data.

8. Establishes and maintains appropriate systems to 8. Writes appropriate reports and articles for
manage clinical and administrative information. publication.

9. Initiates, maintains and terminates professional 9. Initiates, maintains and terminates professional
relationships in an appropriate manner. relationships in an appropriate manner.

Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.

College of Registered Nurses of British Columbia 11


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

4 CO D E O F E T H I C S :
Adheres to the ethical standards of the nursing profession.

CLINICAL PRACTICE E D U C AT I O N
I N D I C AT O R S I N D I C AT O R S

1. Upholds the values contained in the Canadian 1. Upholds and supports others to uphold the
Nurses Association (CNA) Code of Ethics for values contained in the Canadian Nurses
Registered Nurses,10 namely: Association (CNA) Code of Ethics for Registered
- Providing safe, compassionate, competent Nurses,10 namely:
and ethical care - Providing safe, compassionate, competent
- Promoting health and well-being and ethical care
- Promoting and respecting informed - Promoting health and well-being
decision-making - Promoting and respecting informed
- Preserving dignity decision-making
- Maintaining privacy and confidentiality - Preserving dignity
- Promoting justice - Maintaining privacy and confidentiality
- Being accountable - Promoting justice
- Being accountable

2. Consistently practises according to the ethical 2. Consistently practises and supports others to
responsibilities in the CNA Code of Ethics for practise according to the ethical
Registered Nurses. responsibilities in the CNA Code of Ethics for
Registered Nurses.

10 Part 3 of this document contains the nursing values and responsibility statements from the CNA Code of Ethics for Registered Nurses. The full document is
available on the CNA website www.cna-aiic.ca

12 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

4
A D M I N I S T R AT I O N RESEARCH
I N D I C AT O R S I N D I C AT O R S

1. Upholds and supports others to uphold the 1. Upholds and supports others to uphold the
values contained in the Canadian Nurses values contained in the Canadian Nurses
Association (CNA) Code of Ethics for Registered Association (CNA) Code of Ethics for Registered
Nurses,10 namely: Nurses,10 namely:
- Providing safe, compassionate, competent - Providing safe, compassionate, competent
and ethical care and ethical care
- Promoting health and well-being - Promoting health and well-being
- Promoting and respecting informed - Promoting and respecting informed
decision-making decision-making
- Preserving dignity - Preserving dignity
- Maintaining privacy and confidentiality - Maintaining privacy and confidentiality
- Promoting justice - Promoting justice
- Being accountable - Being accountable

2. Consistently practises and supports others to 2. Consistently practises and supports others to
practise according to the ethical practise according to the ethical
responsibilities in the CNA Code of Ethics for responsibilities in the CNA Code of Ethics for
Registered Nurses. Registered Nurses.

Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.

College of Registered Nurses of British Columbia 13


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

5 PROVISION OF SERVICE IN THE PUBLIC INTEREST:


Provides nursing services and collaborates with other members of the health care team in
providing health care services.

CLINICAL PRACTICE E D U C AT I O N
I N D I C AT O R S I N D I C AT O R S

1. Communicates, collaborates and consults with 1. Communicates, collaborates and consults with
nurses and other members of the health care nurses and others about education.
team11 about the client’s care.

2. Assigns12 and delegates appropriately to other 2. Advocates and provides education for nurses
members of the health care team. and others regarding assignment12 and
delegation.

3. Guides other members of the health care team 3. Guides and supervises educational staff and
as appropriate. students as appropriate.

4. Advocates and participates in changes to 4. Advocates and takes action to implement


improve client care13 and nursing practice. changes that improve client care13 and
educational practice.

5. Reports unsafe practice or professional 5. Reports unsafe practice or professional


misconduct to appropriate person or body.14 misconduct to appropriate person or body.14

6. Assists clients to learn about the health care 6. Assists colleagues, students and others to
system and accessing appropriate health care learn about nursing practice and health care
services. services.

11 Team members may be from more than one practice setting.

12 Nurses are frequently involved in assignment. Delegation, on the other hand, is a legal term used to describe the transfer of authority from one individual to
another and entails distinct responsibilities and accountabilities for all parties involved. For advice regarding delegation from and to other members of the health
care team, contact a CRNBC nursing practice consultant or advisor.

13 Improving client care includes creating and maintaining practice environments that support safe and ethical care.

14 The Health Professions Act requires nurses to report situations in which a health professional’s fitness to practise, competence to practise or sexual misconduct
may pose a significant risk to the public. More information is available in the CRNBC Practice Standard Duty to Report.

14 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

5
A D M I N I S T R AT I O N RESEARCH
I N D I C AT O R S I N D I C AT O R S

1. Communicates, collaborates and consults with 1. Communicates, collaborates and consults with
nurses and other members of the health care nurses and other researchers about research.
team11 about the provision of health care services.

2. Advocates and develops policies that clearly 2. Interprets research evidence to guide policy
outline the responsibility and accountability for all development regarding assignment12 and
involved in assignment12 and delegation. delegation.

3. Guides and supervises staff and others involved 3. Guides and supervises members of the
in the planning and delivery of health care research team as appropriate.
services as appropriate.

4. Advocates, directs and participates in changes 4. Advocates and participates in changes that
to improve client care13 and administrative promote evidence-based client care13 and
practice. improved conduct of research.

5. Takes appropriate action or reports unsafe 5. Reports unsafe practice or professional mis-
practice or professional misconduct to conduct to appropriate person or body.14
appropriate person or body.14

6. Assists clients, colleagues, students and others 6. Assists colleagues, students and others to
to learn about nursing practice and health care learn about the health care system and the
services. influence of research on nursing practice and
health care services.

Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.

College of Registered Nurses of British Columbia 15


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

6 S E L F - R EG U L AT I O N :
Assumes primary responsibility for maintaining competence and fitness to practise.

CLINICAL PRACTICE E D U C AT I O N
I N D I C AT O R S I N D I C AT O R S

1. Maintains current registration. 1. Maintains current registration.

2. Practises within own level of competence. 2. Practises within own level of competence.

3. Meets the requirements for continuing 3. Meets the requirements for continuing
competence,15 including investing own time, competence,15 including investing own time,
effort or other resources to meet identified effort or other resources to meet identified
learning goals. learning goals.

4. Maintains own physical, psychological and 4. Maintains own physical, psychological and
emotional fitness to practice. emotional fitness to practice.

15 Includes a combination of practice hours and personal practice review requirements.

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Professional Standards
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6
A D M I N I S T R AT I O N RESEARCH
I N D I C AT O R S I N D I C AT O R S

1. Maintains current registration. 1. Maintains current registration.

2. Practises within own level of competence. 2. Practises within own level of competence.

3. Meets the requirements for continuing 3. Meets the requirements for continuing
competence,15 including investing own time, competence,15 including investing own time,
effort or other resources to meet identified effort or other resources to meet identified
learning goals. learning goals.

4. Maintains own physical, psychological and 4. Maintains own physical, psychological and
emotional fitness to practice. emotional fitness to practice.

Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.

College of Registered Nurses of British Columbia 17


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

Canadian Nurses Association


Code of Ethics for Registered Nurses
The Code of Ethics for Registered Nurses gives guidance for Standard 4: Code of Ethics requires nurses to uphold the
decision-making concerning ethical matters, serves as a values of, and practise in accordance with the ethical
means for self-assessment and reflection regarding ethical responsibilities in the CNA Code of Ethics for Registered
nursing practice and provides a basis for peer-review Nurses. This section is taken from the CNA Code. The
initiatives. The Code not only educates nurses about their complete Code of Ethics for Registered Nurses document is
ethical responsibilities, it also informs other health care available on the CNA website www.cna-aiic.ca Words or
professionals and members of the public about the moral phrases in bold print in this section are found in the
commitments expected of nurses. It applies to nurses in all glossary included in the CNA Code of Ethics for Registered
practice settings whatever their position or responsibility. Nurses.
CRNBC’s Board has adopted Part 1 of the Canadian Nurses
Association (CNA) Code of Ethics for Registered Nurses. Reprinted with permission of the Canadian Nurses Association

Part I: Nursing Values and Ethical Responsibilities


Nurses in all domains of practice bear the ethical The responsibilities are intended to help nurses apply
responsibilities identified under each of the seven the code. They also serve to articulate nursing values to
primary nursing values.1 These responsibilities apply to employers, other health-care professionals and the pub-
nurses’ interactions with individuals, families, groups, lic. Nurses help their colleagues implement the code,
populations, communities and society as well as with and they ensure that student nurses are acquainted
students, colleagues and other health-care professionals. with the code.

1 The value and responsibility statements in the code are numbered and lettered for ease of use, not to indicate prioritization. The values are related and
overlapping.

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Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

A . P R OV I D I N G SA F E , CO M PA SS I O N AT E , CO M P E T E N T A N D E T H I C A L C A R E
Nurses provide safe, compassionate, competent and ethical care.

ETHICAL RESPONSIBILITIES:

1. Nurses have a responsibility to conduct themselves 6. When resources are not available to provide ideal
according to the ethical responsibilities outlined in care, nurses collaborate with others to adjust
this document and in practice standards in what priorities and minimize harm. Nurses keep persons
they do and how they interact with persons receiving receiving care, families and their employers
care as well as with families, communities, groups, informed about potential and actual changes to
populations and other members of the health-care delivery of care. They inform employers about
team. potential threats to safety.

2. Nurses engage in compassionate care through their 7. Nurses planning to take job action or practising in
speech and body language and through their efforts environments where job action occurs take steps to
to understand and care about others’ health-care safeguard the health and safety of people during the
needs. course of the job action.

3. Nurses build trustworthy relationships as the 8. During a natural or human-made disaster, including
foundation of meaningful communication, a communicable disease outbreak, nurses have a
recognizing that building these relationships duty to provide care using appropriate safety
involves a conscious effort. Such relationships are precautions.
critical to understanding people’s needs and
concerns. 9. Nurses support, use and engage in research and
other activities that promote safe, competent,
4. Nurses question and intervene to address unsafe, compassionate and ethical care, and they use
non-compassionate, unethical or incompetent guidelines for ethical research3 that are in keeping
practice or conditions that interfere with their ability with nursing values.
to provide safe, compassionate, competent and
ethical care to those to whom they are providing 10. Nurses work to prevent and minimize all forms of
care, and they support those who do the same. violence by anticipating and assessing the risk of
violent situations and by collaborating with others to
5. Nurses admit mistakes2 and take all necessary establish preventive measures. When violence
actions to prevent or minimize harm arising from an cannot be anticipated or prevented, nurses take
adverse event. They work with others to reduce the action to minimize risk to protect others and
potential for future risks and preventable harms. themselves.

2 Provincial and territorial legislation and nursing practice standards may include further direction regarding requirements for disclosure and reporting.

3 See Ethical Research Guidelines for Registered Nurses (CNA, 2002) and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans
(Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, & Social Sciences and Humanities Research Council, 1998).

College of Registered Nurses of British Columbia 19


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

B . P R O M OT I N G H E A LT H A N D W E L L- B E I N G
Nurses work with people to enable them to attain their highest possible level of health and well-being.

ETHICAL RESPONSIBILITIES:

1. Nurses provide care directed first and foremost 3. Nurses collaborate with other health-care providers
toward the health and well-being of the person, and other interested parties to maximize health
family or community in their care. benefits to persons receiving care and those with
health-care needs, recognizing and respecting the
2. When a community health intervention interferes knowledge, skills and perspectives of all.
with the individual rights of persons receiving care,
nurses use and advocate for the use of the least
restrictive measures possible for those in their care.

C . P R O M OT I N G A N D R E S P EC T I N G I N F O R M E D D EC I S I O N - M A K I N G
Nurses recognize, respect and promote a person’s right to be informed and make decisions.

ETHICAL RESPONSIBILITIES:

1. Nurses, to the extent possible, provide persons in 5. Nurses are sensitive to the inherent power differentials
their care with the information they need to make between care providers and those receiving care. They
informed decisions related to their health and well- do not misuse that power to influence decision-making.
being. They also work to ensure that health
information is given to individuals, families, groups, 6. Nurses advocate for persons in their care if they believe
populations and communities in their care in an that the health of those persons is being compromised
open, accurate and transparent manner. by factors beyond their control, including the decision-
making of others.
2. Nurses respect the wishes of capable persons to
decline to receive information about their health 7. When family members disagree with the decisions
condition. made by a person with health-care needs, nurses assist
families in gaining an understanding of the person’s
3. Nurses recognize that capable persons may place a decisions.
different weight on individualism and may choose to
defer to family or community values in decision- 8. Nurses respect the informed decision-making of
making. capable persons, including choice of lifestyles or
treatment not conducive to good health.
4. Nurses ensure that nursing care is provided with the
person’s informed consent. Nurses recognize and 9. When illness or other factors reduce a person’s
support a capable person’s right to refuse or capacity for making choices, nurses assist or support
withdraw consent for care or treatment at any time. that person’s participation in making choices
appropriate to their capability.

20 College of Registered Nurses of British Columbia


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10. If a person receiving care is clearly incapable of 11. Nurses, along with other health-care professionals
consent, the nurse respects the law on capacity and with substitute decision-makers, consider and
assessment and substitute decision-making in his or respect the best interests of the person receiving
her jurisdiction (Canadian Nurses Protective Society care and any previously known wishes or advance
[CNPS], 2004). directives that apply in the situation (CNPS, 2004).

D. P R E S E R V I N G D I G N I TY
Nurses recognize and respect the intrinsic worth of each person.

ETHICAL RESPONSIBILITIES:

1. Nurses, in their professional capacity, relate to all 7. Nurses maintain appropriate professional boundaries
persons with respect. and ensure their relationships are always for the
benefit of the persons they serve. They recognize the
2. Nurses support the person, family, group, potential vulnerability of persons and do not exploit
population or community receiving care in their trust and dependency in a way that might
maintaining their dignity and integrity. compromise the therapeutic relationship. They do not
abuse their relationship for personal or financial gain,
3. In health-care decision-making, in treatment and in and do not enter into personal relationships (romantic,
care, nurses work with persons receiving care, sexual or other) with persons in their care.
including families, groups, populations and
communities, to take into account their unique 8. In all practice settings, nurses work to relieve pain and
values, customs and spiritual beliefs, as well as suffering, including appropriate and effective symptom
their social and economic circumstances. and pain management, to allow persons to live with
dignity.
4. Nurses intervene, and report when necessary4, when
others fail to respect the dignity of a person 9. When a person receiving care is terminally ill or dying,
receiving care, recognizing that to be silent and nurses foster comfort, alleviate suffering, advocate for
passive is to condone the behaviour. adequate relief of discomfort and pain and support a
dignified and peaceful death. This includes support for
5. Nurses respect the physical privacy of persons by the family during and following the death, and care of
providing care in a discreet manner and by the person’s body after death.
minimizing intrusions.
10. Nurses treat each other, colleagues, students and other
6. When providing care, nurses utilize practice health-care workers in a respectful manner, recognizing
standards, best practice guidelines and policies the power differentials among those in formal
concerning restraint usage. leadership positions, staff and students. They work
with others to resolve differences in a constructive way.

4 See footnote 2

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E . M A I N TA I N I N G P R I VA C Y A N D CO N F I D E N T I A L I TY
Nurses recognize the importance of privacy and confidentiality and safeguard personal, family
and community information obtained in the context of a professional relationship.

ETHICAL RESPONSIBILITIES:

1. Nurses respect the right of people to have control 6. Nurses advocate for persons in their care to receive
over the collection, use, access and disclosure of access to their own health-care records through a
their personal information. timely and affordable process when such access is
requested.
2. When nurses are conversing with persons receiving
care, they take reasonable measures to prevent 7. Nurses respect policies that protect and preserve
confidential information in the conversation from people’s privacy, including security safeguards in
being overheard. information technology.

3. Nurses collect, use and disclose health information 8. Nurses do not abuse their access to information by
on a need-to-know basis with the highest degree of accessing health-care records, including their own, a
anonymity possible in the circumstances and in family member’s or any other person’s, for purposes
accordance with privacy laws. inconsistent with their professional obligations.

4. When nurses are required to disclose information for 9. Nurses do not use photo or other technology to
a particular purpose, they disclose only the amount intrude into the privacy of a person receiving care.
of information necessary for that purpose and
inform only those necessary. They attempt to do so 10. Nurses intervene if others inappropriately access or
in ways that minimize any potential harm to the disclose personal or health information of persons
individual, family or community. receiving care.

5. When nurses engage in any form of communication,


including verbal or electronic, involving a discussion
of clinical cases, they ensure that their discussion of
persons receiving care is respectful and does not
identify those persons unless appropriate.

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F. P R O M OT I N G J U S T I C E
Nurses uphold principles of justice by safeguarding human rights, equity and fairness and by
promoting the public good.

ETHICAL RESPONSIBILITIES: intervene, and they report such behaviours.

1. When providing care, nurses do not discriminate on


the basis of a person’s race, ethnicity, culture, 4. Nurses make fair decisions about the allocation of
political and spiritual beliefs, social or marital resources under their control based on the needs of
status, gender, sexual orientation, age, health persons, groups or communities to whom they are
status, place of origin, lifestyle, mental or physical providing care. They advocate for fair treatment and
ability or socio-economic status or any other for fair distribution of resources for those in their
attribute. care.

2. Nurses refrain from judging, labelling, demeaning, 5. Nurses support a climate of trust that sponsors
stigmatizing and humiliating behaviours toward openness, encourages questioning the status quo
persons receiving care, other health-care and supports those who speak out to address
professionals and each other. concerns in good faith (e.g., whistle-blowing).

3. Nurses do not engage in any form of lying,


punishment or torture or any form of unusual
treatment or action that is inhumane or degrading.
They refuse to be complicit in such behaviours. They

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Professional Standards
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G . B E I N G A CCO U N TA B L E
Nurses are accountable for their actions and answerable for their practice.

ETHICAL RESPONSIBILITIES:

1. Nurses, as members of a self-regulating profession, 5. Nurses are attentive to signs that a colleague is unable,
practise according to the values and responsibilities for whatever reason, to perform his or her duties. In
in the Code of Ethics for Registered Nurses and in such a case, nurses will take the necessary steps to
keeping with the professional standards, laws and protect the safety of persons receiving care.
regulations supporting ethical practice.
6. Nurses clearly and accurately represent themselves
2. Nurses are honest and practise with integrity in all with respect to their name, title and role.
of their professional interactions.
7. If nursing care is requested that is in conflict with the
3. Nurses practise within the limits of their nurse’s moral beliefs and values but in keeping with
competence. When aspects of care are beyond their professional practice, the nurse provides safe,
level of competence, they seek additional compassionate, competent and ethical care until
information or knowledge, seek help from their alternative care arrangements are in place to meet the
supervisor or a competent practitioner and/or person’s needs or desires. If nurses can anticipate a
request a different work assignment. In the conflict with their conscience, they have an obligation
meantime, nurses remain with the person receiving to notify their employers or, if the nurse is self-
care until another nurse is available. employed, persons receiving care in advance so that
alternative arrangements can be made.
4. Nurses maintain their fitness to practise. If they are
aware that they do not have the necessary physical, 8. Nurses identify and address conflicts of interest. They
mental or emotional capacity to practise safely and disclose actual or potential conflicts of interest that
competently, they withdraw from the provision of arise in their professional roles and relationships and
care after consulting with their employer or, if they resolve them in the interest of persons receiving care.
are self-employed, arranging that someone else
attend to their clients’ health-care needs. Nurses 9. Nurses share their knowledge and provide feedback,
then take the necessary steps to regain their fitness mentorship and guidance for the professional
to practise. development of nursing students, novice nurses and
other health-care team members.

24 College of Registered Nurses of British Columbia


Professional Standards
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APPENDICES

1. Glossary of Terms

2. Applying Professional Standards in Practice

3. CRNBC Resources

4. Guidelines for Resolving Professional Practice Problems

5. Guidelines for Taking Action on Nurses’ Unacceptable Behaviour

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A P P E N D I X 1: G LO SSA R Y O F T E R M S

Assignment: Allocation of clients or client care activities Health care team: Clients, families, health care
among care providers in order to meet client care needs. professionals, paraprofessionals, students, volunteers and
Assignment occurs when the required care falls within the others who may be involved in providing care.
employing agency’s policies and role descriptions and
within the regulated health care provider’s scope of Indicator: Indicators illustrate how a Professional Standard
practice. Assignment to unregulated care providers occurs is applied and met. Indicators provide specific criteria that
when the required care falls within the employing agency’s are used, when applicable, to measure the actual
policies and role description. performance of an individual nurse.

Client: An individual, family, group, population or entire Nurse practitioner: Registered nurses who have achieved
community who requires nursing expertise. In some clinical the competencies required for additional registration as a
settings, the client may be referred to as a patient or nurse practitioner with CRNBC. The competencies required
resident. of nurse practitioners are usually achieved through
graduate nursing education and substantial nursing
Competence: The integration and application of knowledge, practice experience. Nurse practitioners provide health care
skills, attitude and judgment required for safe, ethical and services from a holistic nursing perspective combined with
appropriate performance in an individual’s nursing practice. a focus on the diagnosis and treatment of acute and chronic
illnesses, including prescribing medications.
Delegation: Sharing authority with other health care
providers to provide a particular aspect of care. Delegation Nursing science: Knowledge (e.g., concepts, constructs,
among regulated care providers occurs when an activity is principles, theories) of nursing derived from systematic
within the scope of practice of the delegating professional observation, study and research.
and outside the scope of the other professional (includes
both the right to order a restricted activity and carrying out Professional conduct: Behaving in a way that upholds the
the restricted activity). Delegation to unregulated care profession. This includes, but is not limited to, practising in
providers occurs when the required task is outside the role accordance with relevant legislation, CRNBC Standards of
description and training of the unregulated care provider. Practice and the Canadian Nurses Association Code of
Ethics for Registered Nurses.
Ethical: The fundamental disposition of the nurse toward
what is good and right and action toward what the nurse Scope of practice: Activities nurses are educated and
recognizes or believes to be the best good in a particular authorized to perform as set out in the Nurses (Registered)
situation (Benner, Tanner and Chesla, 1996).17 and Nurse Practitioners Regulation under the Health
Professions Act and complemented by standards, limits and
Evidence-based practice: Practice based on successful conditions established by CRNBC.
strategies that improve client outcomes and are derived
from a combination of various sources of evidence, Standard: A desired and achievable level of performance
including client perspective, research, national guidelines, against which actual performance can be compared. It
policies, consensus statements, expert opinion and quality provides a benchmark below which performance is
improvement data. unacceptable. The Professional Standards are statements
about levels of performance that nurses in B.C. are required
Fitness to practice: All the qualities and capabilities of an to achieve in their practice and represent the criteria against
individual relevant to his or her capacity to practise as a which the performance of all nurses in the province is
nurse, including, but not limited to, any cognitive, physical, measured.
psychological or emotional condition, or a dependence on
alcohol or drugs, that impairs his or her ability to practise
nursing.

17 Benner, P.E., Tanner, C.A., & Chesla, C.A. (1996). Expertise in nursing practice: Caring, clinical judgment and ethics. New York: Springer.

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A P P E N D I X 2: A P P LY I N G P R O F E SS I O N A L S TA N D A R DS I N P R A C T I C E

Use the Professional Standards to support your own - if you are concerned that a client has not been
nursing practice and to assist your agency to develop provided with enough information to make an
systems that support nurses to meet CRNBC Standards informed choice, use the Professional Standards to
of Practice. support your actions to ensure the client receives
adequate information to make an informed choice.
AS AN INDIVIDUAL NURSE, USE THE
P R O F E SS I O N A L S TA N D A R DS TO : TO I M P R OV E N U R S I N G P R A C T I C E W I T H I N YO U R
- assess your practice as part of meeting continuing A G E N C Y, U S E T H E P R O F E SS I O N A L S TA N D A R DS :
competence requirements; - as a framework to identify agency strengths and areas
- define and resolve professional practice problems for improvement (CRNBC Practice Support can help
(see Appendix 4); with this process - see Appendix 3); and
- advocate for improvements to promote quality client - to develop systems that create more effective practice
care and nursing practice; environments, including providing essential support
- determine what role you can take in program and systems so that nurses are able to meet the
policy development and evaluation; Professional Standards.
- articulate nursing’s contributions to the health of
clients and to the work of multidisciplinary teams; Examples of ways in which the Professional Standards
and can be used in clinical practice include developing,
- inform others about the professional practice of modifying and evaluating:
nursing. - specific expectations for practice that are relevant to
the clinical area, role and setting; and
Examples of situations in which the Professional - client documentation systems.
Standards may assist you:
- if you are concerned about a client and others are not Examples of ways in which the Professional Standards
taking your concerns seriously, you are meeting the can be used in education include developing, modifying
Professional Standards by pursuing your concerns and evaluating:
and advocating for resolution through the appropriate - education programs;
channels on behalf of your client; - orientation programs;
- if you believe there are practice concerns on your - preceptorship and mentorship programs; and
unit, use the Professional Standards to articulate the - nursing rounds.
nature and seriousness of the concerns and bring
them forward for action and resolution; Examples of ways in which the Professional Standards
- if you are asked to provide information about a client can be used in administration include developing,
to someone not involved in his or her care, use the modifying and evaluating:
Professional Standards to support your decision - role descriptions;
regarding release of this information; - policies and procedures; and
- if other nurses or health care providers tell you to do - performance appraisal tools.
something you know you are not competent to do,
suggesting that they will be accountable, use the Examples of ways in which the Professional Standards
Professional Standards to support your position that can be used in research include developing, modifying
only you can be accountable for your practice; and and evaluating:
- quality improvement initiatives; and
- evidence-based decision support tools.

College of Registered Nurses of British Columbia 27


Professional Standards
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EXEMPLARS Administration
In an urban community hospital, a nurse consultant
Clinical Practice
was hired to develop nursing practice expectations
Nurses understand that the Professional Standards
consistent with the hospital’s mission, values and
apply to all registered nurses, licensed graduate nurses
strategic plan. The consultant involved managers and
and nurse practitioners and must, therefore, be quite
nurse representatives from each area of practice in the
generic. However, the Professional Standards can also
hospital in a series of workshops in which they used
be a framework for the development of more specific
the Professional Standards to describe their practice.
criteria. For example, a patient care coordinator on a
medical unit in a small rural hospital reviewed Standard
Then they moved on to define expectations for their
2: Specialized Body of Knowledge and Standard 3:
practice in each clinical area. Working documents with
Competent Application of Knowledge and identified
unit-specific practice criteria were then circulated to all
several criteria related to each indicator that would be
nurses for feedback. The managers met with the
specific to the medical unit. She developed a draft and
consultant to make sure the content was valid and
posted it for feedback from other nurses on the unit.
consistent across clinical areas. The criteria were then
After several drafts, unit-specific practice expectations
finalized and work began on the development of
were circulated. These criteria were then used to
competency-based education modules and a new
develop an orientation program for the unit. The same
performance appraisal tool.
process could be applied to any clinical area.
Research
Education
Recognizing the importance of research findings demon-
Nurses working in community mental health identified
strating the impact of the practice environment on nurse
the need for additional information about resolving
and patient outcomes, a university-affiliated nurse
ethical dilemmas in their practice area. They informed
researcher contacted a nurse administrator at a large terti-
their clinical educator who used Standard 4: Code of
ary care hospital to propose a collaborative research proj-
Ethics as a starting place for the development of
ect. Nurses within the hospital reported they were, at
inservice education sessions. These inservices were
times, unable to provide care in a manner that met the
grounded in the Canadian Nurses Association Code of
Professional Standards, in particular because of a lack of
Ethics for Registered Nurses, but were tailored to meet
nursing leadership within their programs. The nurse
the specific learning needs of these nurses using
administrator indicated that the hospital planned to re-
clinical examples from their practice in community
introduce head nurses on several units. She and the
mental health.
nurse researcher agreed that this presented an ideal
opportunity to study the difference in nurse and patient
outcomes before and after implementation of this change.
They planned to use the Professional Standards to pro-
vide a framework for collecting and reporting some of the
data.

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A P P E N D I X 3: C R N B C R E S O U R C E S
W W W.C R N B C .C A Continuing Competence
Use CRNBC’s website to view or print CRNBC documents, A Short Guide to Meeting Continuing Competence
access library services, register for workshops and Requirements
teleconferences, and access the latest CRNBC news and Step-by-step guide to assist you to meet the continuing
information. competence requirements for registration renewal.

PUBLICATIONS Continuing Competence Journal


Keep track of professional development activities.
CRNBC publishes a variety of publications that can
support you in your practice. They are available to
Continuing Competence Checklist
registrants at no cost and can be downloaded from the
To ensure that all continuing competence requirements
CRNBC website www.crnbc.ca
have been met.
Practice Standards
Online Tutorial
CRNBC’s Practice Standards are a series of short
Examples of how nurses from different practice areas
documents that set out requirements related to specific
have chosen to complete their personal practice review.
aspects of nurses’ practice. Like Professional Standards,
It shows how to make the personal practice review
Practice Standards guide and direct nursing practice.
relevant to your own practice.
Topics in the series include administration of
medications, assignment between nurses,
OTHER RESOURCES
confidentiality, consent, documentation, duty to provide
Assisting Nurses with Significant Performance Problems
care, duty to report and nurse-client relationships.
Assists managers and other resource people who work
with nurses experiencing significant performance
Scope of Practice Standards
problems. It presents a framework for approaching this
Scope of Practice Standards set out standards, limits
work and offers practical suggestions.
and conditions related to the scope of practice of
registered nurses and nurse practitioners. CRNBC limits
Competencies in the Context of Entry-level Registered
on scope of practice specify what nurses are not
Nurse Practice in British Columbia
permitted to do. CRNBC conditions on scope of practice
Profiles the practice of a newly graduated registered
set out the circumstances under which nurses may carry
nurse and lists the generic entry-level competencies
out an activity.
expected of a new graduate.
Practice Support Books
Fitness to Practice
This series of publications provides in-depth information
Provides easy-to-understand information about stressors
on topics related to the practice of nurses. Topics
in the work environment, emotional, physical and
include administration of medications, nurse-client
behavioural responses to chronic stress, and healing
relationships, documentation, confidentiality, and
from chronic stress. It includes a self-assessment tool
assigning and delegating. Available in the Nursing
for chronic stress and a list of additional resources.
Standards section of the CRNBC website www.crnbc.ca

College of Registered Nurses of British Columbia 29


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Profile of a Newly Graduated Registered Nurse W O R K P L A C E R E P R E S E N TAT I V E P R O G R A M A N D


Provides an overview of the practice of new graduate S T U D E N T R E P R E S E N TAT I V E P R O G R A M
registered nurses. The practice profile is based on In most health care agencies, CRNBC workplace
CRNBC’s Professional Standards and highlights basic representatives are available to assist nurses to
competencies that graduates of B.C. nursing programs understand and use CRNBC’s Standards of Practice.
are expected to demonstrate. Similarly, in B.C. schools of nursing, student
representatives can help nursing students become
Workplace and Quality Practice Environments aware of how the Standards should guide their practice.
Answers to question related to Standards of Practice that These volunteers can put you in touch with CRNBC’s
come up in the workplace and provides information regional nursing practice advisors and other resources
about quality practice environments. that support good nursing practice.

P R A C T I C E S U P P O RT Contact the workplace representative or the student


Individual and Group Consultation representative directly in your agency or school or
Practice support is available to you from nursing contact CRNBC Practice Support at 604.736.7331
practice advisors in offices throughout B.C. or from (ext. 332) or 1.800.565.6505 (Canada).
nursing practice consultants in the Vancouver office. E-mail practice@crnbc.ca
These registered nurses work on a confidential basis to
assist you to resolve professional practice problems LIBRARY SERVICES
and workplace issues affecting your ability to meet Library and reference services are available to you
Standards of Practice. Consultations are provided wherever you live in B.C. The CRNBC Helen Randal
through telephone, individual appointments and on- Library has one of the best collections of nursing books,
site visits. journals and audiovisual materials in Canada. Most
items can be borrowed by phone, mail, e-mail
Consultation and education are also available on issues or in person from the library, which is located at
associated with fitness to practice, such as addiction or 2855 Arbutus Street, Vancouver. Other services include
mental health, or conflicts that may affect practice. inter-library loans, photocopying and online journal and
catalogue searches. See CRNBC’s website for full
Contact CRNBC Practice Support at 604.736.7331 details.
(ext. 332) or 1.800.565.6505 (Canada). E-mail
practice@crnbc.ca Contact information for CRNBC’s For general enquiries, telephone 604.736.7331
nursing practice advisors can be found on the CRNBC (ext. 456) or 1.800.565.6505 (Canada).
website www.crnbc.ca For reference enquiries, telephone 604.736.7331
(ext. 119) or toll-free 1.800.565.6505.
E-mail reflib@crnbc.ca

30 College of Registered Nurses of British Columbia


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W O R KS H O P S A N D CO U R S E S P R O F E SS I O N A L CO N D U C T R E V I E W
CRNBC’s workshops and courses focus on the The primary focus of CRNBC’s Professional Conduct
professional aspects of nursing, such as clinical Review Program is protection of the public. Assistance is
decision making in nursing practice, understanding available if anyone is concerned about the practice or
registered nurses’ scope of practice and communication conduct of a CRNBC practising registrant. CRNBC’s
in nursing. CRNBC provides learning through web Nursing Concerns Coordinator works to help resolve
modules, online courses and blende learning that these concerns.
incorporates self-learning and workshops. Learning
programs can also be custom designed for specific Contact CRNBC’s Nursing Concerns Coordinator at
groups and work settings. 604.736.7331 (ext. 202) or 1.800.565.6505 (Canada).

Contact CRNBC Education Services and Communications


at 604.736.7331 (ext. 341) or
1.800.565.6505 (Canada).
E-mail conted@crnbc.ca

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Professional Standards
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A P P E N D I X 4: G U I D E L I N E S F O R R E S O LV I N G
P R O F E SS I O N A L P R A C T I C E P R O B L E M S

As a nurse, you face diverse and complex problems that E M P LOY E R S A R E R E S P O N S I B L E F O R E N S U R I N G


have an impact on your practice. At the same time, you T H AT :
are held accountable and responsible for making • action is taken to examine situations and resolve
decisions that are consistent with safe, appropriate and problems once they have been informed about them;
ethical nursing practice. The process described below
can be used as a resource by nurses in all settings to • there is a sufficient number of competent nursing staff;
help identify and resolve problems that affect and
professional practice.
• there are adequate resources and support services so
W H AT I S A P R O F E SS I O N A L P R A C T I C E P R O B L E M ? that nurses are able to meet the Standards of Practice.

A professional practice problem is any problem or H O W C A N T H E S E G U I D E L I N E S H E L P R E S O LV E


situation that: P R O F E SS I O N A L P R A C T I C E P R O B L E M S ?
• interferes with a nurse’s ability to practise in a These guidelines can be used to help you confirm,
manner consistent with CRNBC’s Standards of communicate, document and resolve professional
Practice, workplace policies or procedures, or other practice problems. They can assist you to protect clients
relevant standards and guidelines; from harm and ensure that they receive safe and
appropriate care. CRNBC nursing practice consultants
• has or could put clients at risk; and regional nursing practice advisors can assist you to
clarify any of the four steps in this process.
• is beyond the ability of an individual nurse to resolve.

N U R S E S A N D E M P LOY E R S E A C H H AV E
RESPONSIBILITIES IN THE WORKPLACE. EXAMPLES OF PROFESSIONAL
PRACTICE PROBLEMS
Nurses are accountable to:

• clients for any actions or non-actions;


• staff that is inadequate in number, education or
experience
• the public, through CRNBC, for maintaining accepted
standards of practice; • lack of written policies or guidelines to provide
direction for nursing practice
• the employer for working to accepted standards and for • lack of required medical or other health care
using appropriate routes of communication to inform professionals
the employer when unable to meet those standards. • conflict between professionals
S T E P 1 : CO N F I R M T H E P R O B L E M
• communication problems

• lack of supplies or equipment

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S T E P 1 : CO N F I R M T H E P R O B L E M S T E P 2 : CO M M U N I C AT E T H E P R O B L E M
These questions can help to identify and confirm the
Once it is clear that you are facing a professional practice
problem:
problem, communicate the problem so that it can be
Yes No examined and action taken:
  Does the problem present a risk to clients?
• First, contact your manager or person to whom you
What are the risks or effects on client care?
report to discuss the problem.
  Does the problem conflict with standards, • Explain what CRNBC Standards or other standards are
guidelines, policies/procedures? not being met and what effect this is having on clients
or how the problem prevents you from practising
  Does the problem make it difficult or impossi-
according to these standards.
ble to practise according to policies or proce-
dures, care plans, CRNBC’s Standards of • Be specific and factual, include all relevant information.
Practice and/or the Canadian Nurses
• Offer to work together to resolve the problem.
Association Code of Ethics for Registered
Nurses? Following your discussion, record in writing everything
you verbally reported and the response received.
  Does the problem interfere with your ability to
practise competently?
STEP 3: DOCUMENT THE PROBLEM
  Does the absence of policies/procedures/
When documenting the problem:
guidelines contribute to this problem?
• Treat all documentation as confidential.
  Are other factors associated with this problem?
If so, what are they (e.g., people, situations, • Use the proper form for this purpose. If there is no such
settings, shifts/times)? form in your workplace, write it as a letter or a memo
(see examples on page 34).
  Does the problem occur frequently?
• Begin with the date then indicate the name and title of
  Do other nurses have similar concerns? the person to whom you are sending the
documentation.
If you answered “yes” to most of these questions, you
may have a professional practice problem. You may • Start with a general opening statement such as: “This
wish to consult a CRNBC nursing practice consultant or is a follow-up to our discussion of the professional
regional nursing practice advisor on a confidential practice problem . . . ”
basis. • Describe the problem in detail: date, time, place, who
If you answered “no,” your problem is not likely a was involved (use initials for client names), what
professional practice problem. It may be a labour happened, how it affected/impacted client care, what
relations issue or relate to employment conditions such standards were not met.
as hours of work, vacation, etc. You may wish to consult • Describe what your actions were in relation to the
with your manager and, if appropriate, your union problem and proposed solutions.
representative.
• Request a written response by a specific date (be sure
the date is reasonable for the problem).

• Sign your name. Keep a copy for your records.


• If you do not receive a response by the

College of Registered Nurses of British Columbia 33


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

specified date, ask what progress is being made. If steps you have taken to confirm, communicate,
the problem is not being addressed: document, and resolve the problem within your
workplace. Include dates and copies or a description of
- Send a second memo or letter to the same person.
all the responses and results received.
State that this is in follow-up to your earlier memo.
Restate the problem or attach the first memo. • Arrange a meeting with the senior manager in your
Request assurance that the problem will be workplace to discuss the letter to CRNBC and give the
addressed right away. manager a copy.
- Forward copies to all levels of administration in the • Forward your letter and all documentation in an
workplace and note this by writing “c.c. Jane Doe, envelope marked “Confidential” to the CRNBC
John Doe” at the bottom of the last page of the Registrar/CEO, 2855 Arbutus Street, Vancouver, BC V6J
memo. 3Y8. Keep a copy of everything for your records.
- Keep a copy for your records. Once formally involved, CRNBC staff will contact you and
the senior manager to assist in resolving the problem.
S T E P 4 : R E S O LV E T H E P R O B L E M CRNBC may involve other appropriate organizations such
as other professional regulatory organizations, government
Most professional practice problems can be resolved
ministries and health authorities.
within the workplace. Usually, you will receive
responses to your letter or memo either in writing or
verbally. Often, a meeting will be arranged. During the SAMPLE LETTER
meeting:

• Listen with an open mind to the manager’s CONFIDENTIAL


perspective of the problem and response to it. Pay
Day/month/year
attention to any new information the manager
provides. Jane Doe, RN
• Be prepared to work together to resolve the problem. Manager, Program W
Some negotiation and compromise may be necessary XYZ Health Region
as long as clients are not in danger. Anywhere, BC

• If the problem and your concerns are not being Dear Ms. Doe:
addressed to your satisfaction, say so. Be prepared to This letter is a follow-up to our discussion today of the
take your concerns further, indicating why you think professional practice problem related to communication
further action is necessary. If the problem has not difficulties among . . .
been resolved, consider repeating the necessary
steps and addressing the problem with the next level
of management. If the problem remains unresolved SAMPLE MEMO
and you believe you have exhausted all avenues for
resolution within your workplace, request formal CONFIDENTIAL
involvement from CRNBC. The College has a legal
mandate to ensure that nurses maintain standards of To: Donald Black, RN, Manager, Program X
practice and provide safe and appropriate nursing From: Jane Doe, RN
care. Date: Day/month/year
Subject: Professional Practice Problem
• Review documents to assure accuracy and client
confidentiality. This memo is a follow-up to our discussion today of the
professional practice problem related to inadequate
• Write a letter asking CRNBC for assistance. Outline the
staffing . . .

34 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

A P P E N D I X 5: G U I D E L I N E S F O R TA K I N G A C T I O N
O N N U R S E S ’ U N A CC E PTA B L E B E H AV I O U R

P R O F E SS I O N A L CO N D U C T The following questions can help you assess the


behaviour of a nurse:
The professional conduct of all CRNBC registrants is
guided by the Health Professions Act, Nurses (Registered)
Yes No
and Nurse Practitioners Regulation, CRNBC Bylaws and
Standards of Practice. ❑ ❑ Is the nurse failing to provide safe and appro-
priate nursing care?
CRNBC is responsible for establishing and enforcing
Standards of Practice so that the public receives safe ❑ ❑ Does this behaviour involve theft, falsification
and ethical nursing care from competent nurses. While of records, or a breach of accepted ethical
CRNBC has the statutory responsibility to take action standards in some other way?
when a registrant’s ability to provide safe and
❑ ❑ Has there been a pattern of questionable
appropriate nursing care is questioned, all registrants
behaviour and is it likely to continue?
have a responsibility to report unsafe practice or
unacceptable behaviour18 to the regulatory body in ❑ ❑ Is the nurse unable or unwilling to recognize
certain situations. and correct the problem behaviour?

❑ ❑ Have clients been harmed by this behaviour or


The following guidelines can help you to meet your
are they likely to be in the future?
legal and ethical obligations to protect the public both
within and beyond the workplace. ❑ ❑ Is there documentation or other evidence of
problem behaviour?
S T E P 1 : D E F I N I N G U N A CC E PTA B L E B E H AV I O U R

Unacceptable behaviour may be unethical behaviour, If you answered “yes” to any of these questions, you
impaired practice or incompetence. Incompetence is a should take action.
pattern of behaviour that demonstrates a failure to
meet the Standards of Practice because of lack of S T E P 2 : D EC I D I N G TO TA K E A C T I O N O N
ability, capacity or fitness to practise. It results from U N A CC E PTA B L E B E H AV I O U R
repeatedly making the same or similar mistakes, not Consider whether the most appropriate action is for you
from an isolated act or a single error. to discuss your concerns directly with the nurse. This is
often a difficult decision and the following questions may
Nurses demonstrating unacceptable behaviour may help you decide what to do:
have no idea of wrong doing. They may rationalize that
what they are doing is all right, or they may attempt to • What would you want done if you were the nurse with
cover up something that jeopardizes client welfare. unacceptable behaviour?

• What is your relationship with the nurse involved (e.g.,


credibility, reporting relationship, personal
relationship)?

18 Nurses are required under the Health Professions Act to report situations in which a health professional’s fitness to practise, competence to practise or ethical
conduct may pose a risk to the public. More information is available in the CRNBC Practice Standard Duty to Report.

College of Registered Nurses of British Columbia 35


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

• What are the usual procedures for dealing with these


issues in your workplace? M I N I M I Z I N G CO N F L I C T I N G F E E L I N G S
ABOUT REPORTING
• Can you discuss the facts of the situation objectively
and without emotion? Nurses may have feelings of conflict between
loyalty to the profession and clients, and loyalty
• Can you create an opportunity to discuss the to colleagues and the employer. These feelings
behaviour privately with the nurse? may discourage appropriate action because
nurses may believe they are letting colleagues
• What is the likelihood of the nurse understanding and down. The following practices can prevent this
responding to what you say? situation from occurring and minimize the
feelings of conflict:
If you discuss your concerns directly with the nurse and
the matter is resolved, it may not be necessary for you to • focus on decreasing risks to client safety, not
take further action. If your concerns are not addressed on penalizing nurses;
or if you decide that it is not wise for you to discuss your
observations and concerns directly with the nurse or if a • use CRNBC’s Standards of Practice to evaluate
report is required, then you should use the reporting performance based on measurable
mechanisms in your workplace so others can take expectations;
action. Talk to your manager or the person to whom you
report.
• adhere to principles of fairness, dignity,
respect, and honesty in the workplace; and
S T E P 3 : R E P O RT I N G U N A CC E PTA B L E B E H AV I O U R
TO YO U R M A N A G E R
• maintain confidentiality and share information
Document your concerns and discuss them with your about the situation only with those who require
manager. When documenting and reporting
it.
unacceptable behaviour:

• Describe the unacceptable behaviour in detail. Give


the date, time, place, who was involved (use initials
for client names), what happened, how it affected • Request acknowledgment that your information has
client care, what standards were not met. been received and assurance that the problem will be
investigated and appropriate action taken.
• Obtain support. Consult resource people in the
workplace or call a CRNBC nursing practice consultant • Be patient, as long as clients are not in danger, as
to assist on a confidential basis regarding appropriate these problems often require time to resolve.
standards of practice (this is not reporting a colleague;
you don’t have to name the nurse). • If the unacceptable behaviour has not been dealt with
appropriately within a reasonable time frame, inform
• Sign your name. Anonymous reporting is less credible. your manager that you are considering reporting to
CRNBC.
• Treat all documentation as confidential.

36 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

S T E P 4 : R E P O RT I N G U N A CC E PTA B L E B E H AV I O U R • A detailed description of the unacceptable behaviour


TO C R N B C with examples of specific incidents that support the
complaint. For each incident provide date, time, place,
When to Report to CRNBC who was involved, names of nurses and others who
have direct knowledge of the behaviour, what
Reporting to CRNBC is required when there is a reason
happened, how it affected client care, as well as
to believe that there is a danger to the public if the
specific standards, workplace policies, procedures or
nurse continues to practise.
guidelines that have not been met.
Who to Contact at CRNBC
• Copies of documents19 supporting the complaint. This
You will receive confidential guidance about your may include copies of incident reports, chart pages,
concerns by contacting: narcotic records, performance appraisals or other
reports of nursing performance, written statements
Nursing Concerns Coordinator from co-workers, other staff, clients or clients’
CRNBC Registration, Inquiry and Discipline relatives.
2855 Arbutus Street
Vancouver, BC V6J 3Y8 • An outline of any action taken by the employer and
604.736.7331 (ext. 202) others since the unacceptable behaviour was first
1.800.565.6505 (ext. 202) noticed, and a description of the nurse’s responses to
those actions.
The Nursing Concerns Coordinator will work with you and
assist you in resolving your concerns. Together, you will • The date the nurse started working for the employer
look at various options for action. Your identity during and, if applicable, when the employment was
this consultation process is kept confidential. Should you terminated.
decide to submit a complaint, you will be asked to
provide detailed information about your complaint (see Complaints should be submitted to:
below) and you may be asked to participate in the
Director
process to resolve the concerns.
CRNBC Registration, Inquiry and Discipline
2855 Arbutus Street
How to Submit a Complaint
Vancouver, BC V6J 3Y8
A letter of complaint is most useful when it includes the
information listed below. If you do not have all of the
information or access to it, do not let this stop you from
submitting the complaint.

• Full name and, if possible, registration number of the


nurse whose behaviour is unacceptable.

19 Appropriate permission to release documents to CRNBC must be obtained prior to submitting them.

College of Registered Nurses of British Columbia 37


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

W H E N A CO M P L A I N T I S R EC E I V E D
SAMPLE LETTER
When CRNBC receives a complaint, it may be dealt
with through consensual resolution, or it may require
CONFIDENTIAL
further investigation and possible inquiry.
Day/Month/Year
Once a complaint has been accepted by the CRNBC
Inquiry Committee, CRNBC may negotiate directly with Jane Doe
the nurse in question to determine appropriate action Anywhere BC
to address the concern.
Dear Director, Registration, Inquiry and Discipline:
Alternatively, CRNBC may gather evidence and hold a
formal hearing before the Discipline Committee. This This letter is a submission of a formal complaint concern-
method is judicial in nature, similar to a court ing the professional practice of . . .
proceeding. - Give full name of nurse and registration number (if
known).
Both processes are designed to deal with complaints - State the nurse’s employment history, including start
in a way that is effective and fair to all concerned, to date and dates of performance appraisals (if known).
carry out CRNBC’s responsibility to the public, and to
maintain the integrity and standards of the profession. Provide a factual description of incidents causing practice
concerns . . .
As far as is possible, CRNBC will let you know about - Identify what standards, policies, procedures or guide-
the outcomes of action related to the complaint you lines were/are not being met.
have submitted. - Indicate what supporting documentation is available to
support the complaint.
If you have questions regarding the procedures for
submitting a complaint, contact CRNBC’s Nursing Outline actions taken to address the concern and the
Concerns Coordinator at 604.736.7331 (ext. 202) or response to these actions . . .
1.800.565.6505 (ext. 202). - Where applicable include the date the nurse
started suspension, was terminated, etc.

Sincerely,

Signature
(note: an original signature is required in order for
CRNBC to follow up the complaint)

Jane Doe

38 College of Registered Nurses of British Columbia


Professional Standards
FOR REGISTERED NURSES AND NURSE PRACTITIONERS

N OT E S

College of Registered Nurses of British Columbia 39


2855 Arbutus St.
Vancouver, British Columbia
Canada V6J 3Y8
Tel: 604.736.7331
Toll-free: 1.800.565.6505 (Canada)
www.crnbc.ca