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Nurses Association of New Brunswick

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Standards of Practice

For Registered Nurses

Standard
1 of 4

Standard 1: Responsibility & Accountability

The registered nurse is responsible for practicing safely, competently, compassionately, and ethically and is accountable to the client, public, employer and profession.

How does this standard apply to your practice?

  • Taking action when a policy or practice is no longer consistent with best evidence
  • Self-assessing your knowledge, skills and abilities to ensure you are able to provide safe and competent care
  • Completing NANB’s continuing competence program
  • Case Study: Advocacy

    Lily is a registered nurse (RN) and she recently started working on a general surgery unit. She has noticed the wound care practices appear to be outdated compared with the last unit she worked. Lily is new on this unit and doesn’t want to “rock the boat” but she is concerned about the wound care practices.

    Question: How can Lily meet standard 1, indicator 1.8? (1.8: advocates for and contributes to the development and implementation of policies, programs and practices that improve nursing practice and/or health care services)

    Answer: Lily would research current evidence informed wound care practices to determine if her past practice actually was best practice. To do this she might contact a wound care specialist, take an on-line course or research recent wound care journal articles.

    If she discovers the wound care practice on her current unit are not evidence based, she has identified a professional practice issue. Lily is legally and ethically required to address a professional practice issue so she will need to meet with her manager to discuss this situation.

    For more information on Responsibility and Accountability, continue to explore Standard 1 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca.

  • Case Study: Keeping Clients Safe – Your Duty to Report

    Meet Erin:

    Erin and Judy are registered nurses (RN) who work in a labor and delivery unit in an acute care tertiary hospital. Erin and Judy work opposite shifts.

    Erin has noted that over the last six months, Judy had been consistently late for her shift, making Erin late leaving work. Erin has also had to work additional hours when Judy has called in sick at the last minute, leaving their unit manager with limited time to find a replacement. The narcotic counts have also been off after some of Judy’s shifts.

    On top of this, Erin has noted a change in Judy’s behaviour. Judy has been drowsier than usual, especially after her night shifts. Erin has considered that Judy might be misusing a substance, but she doesn’t want to jump to conclusions.

    Erin is concerned but is unsure of her accountability to follow up on these concerns with Judy or her unit manager because she does not have any specific evidence that Judy has misappropriated the drugs.

    Later that week, another RN colleague named Alison witnesses Judy misappropriating narcotics and self-administering the medications at work. Alison and the unit manager report Judy to NANB and now Judy is off work on a leave of absence.

    Erin is not sure about what she should have done differently in this situation. Should she have reported Judy? Should Alison have reported Judy? How can Erin learn from Alison in the future? How should she react the next time she works with Alison?

    Reflecting on the 2019 RN Standards of Practice:

    Erin knows that she is obligated to meet the 2019 Standards of Practice for Registered Nurses. Standard 1, indicator 1.7 states: “recognizes and addresses violations of practice, incompetence, professional misconduct, conduct unbecoming the profession, and/or incapacity of nurses and/or other health care providers and complies with duty to report”.

    At the time, Erin was unsure of her obligation to this indicator. She had suspicions but no concrete evidence that Judy was misusing a substance.

    How Can Erin Learn From this Situation?

    Erin did notice a change in Judy’s behavior and that she seemed to be struggling with her professional obligations.

    When there was no concrete evidence but only a suspicion of problematic substance use, Erin may have considered approaching Judy to discuss her concerns.

    This type of conversation can be difficult because individuals who have a problem with substance use may deny that a problem exists and may react negatively to the concerns. If Erin had decided that a conversation was not possible, she needed to ensure client safety and have a conversation with her manager regarding the concerns.

    After the fact, Erin learned that Alison did speak with Judy who admitted to misappropriating the narcotics, but Judy had assured Alison that she had her substance use under control. Alison understood that she had an accountability according to Standard 1, indicator 1.7 to report these concerns.

    As a result, Alison met with the manager and focused the conversation on the specific issues related to Judy’s misappropriating as well as her suspicion that Judy was using narcotics while at work. Alison had also documented her observations of Judy’s behaviours, doing so in an objective and factual way by including information such as times, dates, locations, details of the events, names of witnesses, identification of any clients involved, and actions taken. She provided her manager with a copy of her documentation.

    After taking some time to self-reflect on her actions and meeting with her manager to discuss the situation, Erin understands that both she and Alison have a professional obligation as self-regulating RNs to meet these standards.

    To know more about problematic substances use or duty to report, please refer to Practice Guideline: Duty to Report.

    For more information on Responsibility and Accountability, continue to explore Standard 1 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca.

  • Case Study: Fitness to Practice/Duty to Report

    Julie works full time as a registered nurse (RN) in OR. She is married with two children under four. Three months ago, her partner was diagnosis with end stage cancer. She is holding the family together while working as long as she can before he becomes really sick.

    Her colleagues have noticed lately though that she has made several mistakes at work. They are now worried that clients are at risk.

    What should Julie’s co-workers do about their concerns that Julie is not able to meet this indicator because of her difficult personal circumstances? (Indicator 1.7: recognizes and addresses violations of practice, incompetence, professional misconduct, conduct unbecoming the profession, and/or incapacity of nurses and/or other health care providers and complies with duty to report)

    Answer: Her coworkers can offer their support but need to ensure client safety is not at risk. They will discuss the professional practice issue with their manager. The manager needs to make sure Julie is fit to practice by monitoring the situation, referring her to resources such as EAP or Occ Health and supporting Julie as much as possible.

    For more information on Responsibility and Accountability, continue to explore Standard 1 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca.

  • Standard 1 Quiz: Accountability and Responsibility

    Start Quiz (7 questions)

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