FOR
REGISTERED NURSES
AND NURSE PRACTITIONERS
CO N T E N T S
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Standard 6: Self-regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
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.
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.
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.
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.
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.
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.
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.
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.
Refer to Appendix 3: CRNBC Resources on page 29 for information about resources and services to support your practice.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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
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.
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
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.
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.
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).
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.
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
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.
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.
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).
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.
APPENDICES
1. Glossary of Terms
3. CRNBC Resources
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.
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.
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.
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.
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).
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
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:
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).
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:
• 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 . . .
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
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?
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.
19 Appropriate permission to release documents to CRNBC must be obtained prior to submitting them.
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
N OT E S