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Workplace

Working with students
As an instructor, what are my responsibilities for students working at a flu clinic?

Along with your teaching responsibilities, you would be responsible for regulatory supervision of those students. Your role in providing regulatory supervision would include:

  • knowing each student’s competence
  • authorizing the activities each may carry out
  • setting appropriate conditions
  • managing any risk to clients

You may share this responsibility with the clinic RNs. Discuss the supervision process with the clinic RNs, and decide who will be responsible for what and how others might be involved. For instance, you may decide to set a condition that the students check with a clinic RN before immunizing. Be sure to communicate the supervision model and practice expectations to each student and all clinic staff.

The Regulatory Supervision of Nursing Student Activities Practice Standard can provide more information about the process and your responsibilities.

What are we supervising when we provide regulatory supervision?

When you provide regulatory supervision for a student’s activities, you are responsible for:

  • knowing the student’s competence level
  • authorizing activities the student may carry out
  • setting appropriate conditions
  • managing risk to the clients

This applies whether the student is a learner or employed student nurse (ESN).

You are not responsible for the student. Both you and the student are accountable for your own decisions and actions. Depending on their role, students will also have to practice within the polices and expectations set by their education program and placement agency or employer. Students in an ESN role must also meet the principles of the Employed Student Registrant practice standard.
You’ll find more information about the regulatory supervision process and your responsibilities in the Regulatory Supervision of Nursing Student Activities practice standard.

What are my responsibilities if I am providing regulatory supervision and the student does something that causes harm?

Your first responsibility is ensuring client safety. Take the necessary actions to manage client outcomes and get assistance as needed.

As the RN providing regulatory supervision, you’re accountable for using your professional judgement when deciding to authorize student activities. This includes minimizing risks to the client by planning for situations you can reasonably expect might occur. You’re not accountable for those situations you could not foresee.

Employers are responsible for providing workplace resources so that nurses can meet standards. Education programs and placement agencies have agreements related to student liability. You are responsible for following your employer’s policy and practicing to CRNBC Standards.

You’ll find more information about the regulatory supervision process and your responsibilities in the Regulatory Supervision of Nursing Student Activities practice standard.

Within regulatory supervision, what is meant by "an activity with the potential to affect a client"?

Assessing a client, planning and providing care or writing an operational policy are all activities that could affect a client If you can reasonably anticipate that an activity could have an impact on a client, the activity is subject to regulatory supervision if performed by a student.

The amount and type of supervision needed requires professional judgment and will depend on the student, activity and risk to the client.

You’ll find more information about the regulatory supervision process in the Regulatory Supervision of Nursing Student Activities practice standard.

Acting on concerns
I know an RN who works a lot of overtime. I am concerned because she is often short-tempered, looks tired and forgets to document care. What should I do?

Fatigue can impair practice. You are obligated to act on your concerns about her ability to provide competent care. Depending on the circumstances, you could:

  • discuss your concerns with your colleague
  • report to your manager
  • contact CRNBC

If discussing your concerns with her resolves the matter you do not have to take further action. If the concern is not resolved and/or you decide to report to your manager, document and share your specific observations. Ask the manager to let you know when he or she has dealt with the concern and report to your manager again if practice does not improve.

You may need to contact CRNBC if your concerns are not dealt with and clients are at risk.

See Taking Action on Concerns About Practice for more information.

If you see unsafe, unethical or incompetent practice you have an obligation to address the issue immediately. The CRNBC resource Acting on concerns about practice can help you identify and document behaviors of concern and guide you through the process to take action.

What is my responsibility if I see unsafe, unethical or incompetent practice?

You have an obligation to address this type of practice by any health professional. Our resource Acting on Concerns About Practice will help you identify and document behaviors of concern and decide what to do.

Can I make an anonymous complaint or report to CRNBC?

Generally, formal complaints or reports must be in writing and signed. In our Professional Conduct Review Process, the registrant reported receives a copy of the complaint including the complainant’s name. In some circumstances, such as when there is an immediate concern for public or personal safety, CRNBC may withhold a name or act on an anonymous complaint. More information about making a complaint.

Professional practice issues
When we have to work over census or short-staffed, I’m concerned that client care may be compromised. What should I do?

Situations where the need for health care is greater than the available resources require your professional judgment and ethical decision making. You are responsible for providing safe, appropriate and ethical care to the best of your ability.
The following strategies may help you:

  • Work with the care team to assess client needs, staff capacity and available resources. Be sure to consider environment safety needs such as oxygen, suction, and access to call bells.
  • Set priorities, adjust client plans of care and care delivery as needed. This may include moving clients to ensure appropriate access to equipment or monitoring.
  • Identify and communicate any immediate safety concerns to the appropriate person, such as your supervisor or manager.
  • Explore whether discharging or transferring clients is an option. Include physicians in the discussion when appropriate.
  • Check in with the care team regularly throughout the shift to reassess and adjust care plans as needed.
  • Document the situation and communicate any concerns to your manager.

Working with limited resources and 10 tips may provide further information and guidance for these situations.  For further assistance contact practice@crnbc.ca

When we work short-staffed, we’re not always able to meet all our clients’ care needs. Can we be reported for not meeting standards?

In this type of situation it is very unlikely that you would be reported to CRNBC. For CRNBC to become involved, a formal written complaint must be received, describing how a nurse’s unethical, impaired or incompetent practice puts clients’ at risk.
 
It’s important to remember that even in situations where you cannot provide optimal client care, you can still meet the Professional Standards. These situations are usually beyond your individual control and often require a systems approach for resolution. You are responsible for providing the best care possible under the circumstances. In these situations:

  • Start by assessing client needs, available staff and mix.
  • Communicate any immediate safety concerns to your manager or supervisor.
  • Work with the care team, set priorities, and adjust client plans of care and care delivery as needed.
  • Check in with the care team frequently during the shift. Reassess and adjust client plans of care as appropriate.
  • At the end of your workday, document the situation and your concerns and share with your manager.

By following these steps, you are likely meeting the Professional Standards and your obligation to provide clients with safe, competent, ethical care.
You’ll find more information and guidance in in the resource Working with limited resources.

For further assistance contact practice@crnbc.ca.

I’m expected to work in an unfamiliar practice area. Can I refuse?

Your employer has a right to reassign you to another area. You were likely hired by an agency or health authority and cannot refuse to be reassigned.

Consider what care you can safely provide, while practicing within your level of competence. Clearly communicate this to the most appropriate person such as your immediate supervisor and discuss any concerns about your reassignment.  Refusing a reassignment is generally justified only when the risk of harm to clients is greater if you accept than if you refuse. If you don’t have the competence to work in the assigned area, collaborate with others to determine the best option and follow up in writing.

Working in an unfamiliar practice area can be challenging and anxiety provoking. Using these strategies may help:

  • Ask for an orientation to the clients, environment and resources.
  • Review your assignment with the charge nurse and discuss the care requirements for your assigned clients.
  • Outline your competencies as they relate to the client care required, indicating what care you can safely provide and what you cannot.
  • Communicate regularly with the charge nurse/team leader about changes to your clients and their plan of care.
  •  Ask for nurse to be assigned as your resource person.

You’ll find more information and guidance in the resource Working with limited resources.

For further assistance contact practice@crnbc.ca.

 Need help?

For further information on the Standards of Practice or professional practice matters, contact us:

  • Telephone 604.736.7331 ext. 332
  • Toll-free in Canada 1.800.565.6505
  • Email practice@crnbc.ca
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