I am a nurse. - College & Association of Registered Nurses of Alberta

must have insight into their own practice and need to help
others gain insight about any concerns with their practice.
In the decisions reviewed, nurses frequently did not recognize
their own responsibility in an error that was made or their
lack of judgment in the situation.
There were instances where the complacency about meeting
professional standards was a boundary issue. In some situations,
employer policy was violated when an RN did not consider the
appropriateness of entering their agency or facility when they
were off duty and/or using equipment and supplies for their
personal use. There were instances where an RN used the
computer inappropriately for their personal use. For example,
doing an Internet search not related to the care of their patients,
visiting Internet sites not appropriate to the practice setting
and accessing the electronic health record of clients out of
curiosity or some other personal motive not related to their
assignment of care.
2
FAILURE TO MAINTAIN CURRENCY OF PROFESSIONAL
knowledge and competence was the second trend found in
the review of conduct decisions. This trend was identified
most often in those situations where the RN had not maintained
their competence, had not kept pace with the changes in their
practice setting or they were not familiar with their employer’s
policies and procedures.
They had not maintained their competence in skills due
to many factors, including the lack of opportunity to perform
the clinical skill in the practice setting, not keeping current
on best practices or relying on past clinical experience or skills
previously learned in their nursing education program that
are now outdated.
Examples of failing to maintain currency of professional
knowledge included not knowing best practices for diabetes
management and use of insulin, failing to attend required
in-services that the employer had arranged to inform nurses
of new procedures in the practice setting and not being aware
of legislation for the prescribing of medication and the CARNA
guidelines for medication administration that are outlined in
the document Medication Administration:
Guidelines for Registered Nurses. Noted in
the decisions that were reviewed was
that RNs were prescribing medications,
though not authorized to do so.
Examples of situations where nurses
were prescribing included when they
suggested the use of over the counter
medications without an order from an
authorized practitioner, or relying on an
outdated prescription and the inappropriate
use of a standing order, rather
than the use of a medical protocol.
SUMMARY OF THE REVIEW BY CDRC
OF HEARING TRIBUNAL DECISIONS
OCT. 1, 2006 - SEPT. 30, 2007
Total number of decisions reviewed 71
Of total decisions reviewed,
per cent of RNs who:
practiced in a direct-care provider role 98%
practiced in an acute-care setting 69%
practiced in an urban area 84%
Medical protocols are evidence-based, apply to a range of
clients who meet certain conditions or criteria, are pre-approved
by the appropriate medical and nursing authority within
an agency and are supported by agency and nursing policy.
The RN must use professional judgment in the consideration
of the parameters outlined in a medical protocol to determine
if a particular client meets or does not meet the criteria for
implementation.
The committee noted some of the factors that may
have influenced the ability of a nurse to practice safely and
competently were fatigue, financial pressures, family issues and
substance abuse. Although these factors are important, ultimately,
an RN must maintain their fitness to practice. Competent
and ethical practice must be embedded in nursing. The CARNA
Nursing Practice Standards state that the RN must comply with
the Canadian Nurses Association Code of Ethics for Registered
Nurses, must practice with honesty, integrity and respect, must
practice competently and regularly assess their practice and
must take the necessary steps to improve personal competence.
Our scope of practice is defined as that which we are
authorized, educated and competent to do and emphasizes
that nursing practice is more than just a list of skills or
interventions that we perform. Critical thinking and accurate
interpretation of complex information from a variety of sources
are essential to the clinical decision-making required for safe
and effective patient care. RNs have a responsibility to maintain
their competency in those skills and interventions that are
required in their role in the practice setting. The Nursing
Practice Standards state that the RN applies nursing knowledge
and skill in providing safe, competent, ethical care.
3
FAILURE TO DOCUMENT APPROPRIATELY WAS THE
third trend. In reviewing the conduct decisions, CDRC
identified situations where documentation of nursing care
was incomplete and inaccurate. In some instances, this inaccurate
documentation or absence of documentation was identified as
part of a chart audit when the concern was related to possible
substance abuse by the RN.
A key feature of professional practice
is the personal accountability of the
practitioner. Indicator 1.1 of the CARNA
Nursing Practice Standards states “the
registered nurse is accountable at all
times for their own actions.” Being
accountable includes being responsible
for something or someone and being
answerable for one’s actions and
omissions. Practitioners must be
able to justify their actions and
decision-making. Documentation
is part of that responsibility.
www.nurses.ab.ca April 2008 Volume 64 No 4 Alberta RN 7