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Taking action on concerns about practice

Nurses have a responsibility to take action when they see unsafe practice or unprofessional conduct.

What’s my responsibility?

As a nurse, you have a responsibility to take action when you see unsafe practice, neglect or unprofessional conduct that puts client safety or well-being at risk. This includes a legal and ethical duty to report incompetent practice, impaired practice or unethical conduct of regulated health professionals to their professional college.

The professional conduct of CRNBC registrants is guided by the Health Professions Act, the Nurses (Registered) and Nurse Practitioners Regulation, CRNBC Bylaws, and the Standards of Practice.

Understanding when to report, what to report, how to report, who to report to, and what is required of you, both legally and ethically, is important. This includes understanding how to respond in a situation in which another health professional is not providing competent or ethical care

What behaviours are of concern?

Practice or conduct that poses a danger to the public or is otherwise contrary to the standards is concerning. Define the behaviour by asking yourself: 

  • Has the practice or behaviour harmed or put clients at risk? How and when?
  • Is the individual failing to provide competent care? How and when?
  • Is the individual’s behaviour breaching accepted standards for ethical practice? How and when?

If you can answer “yes” to any of these questions, you have a responsibility to take action.

What can I do to take action?

Decide if you want to discuss your concerns with the person involved. This can be a difficult decision. Ask yourself: 

  • If it were you, how would you want the situation addressed?
  • What is your relationship with the person (e.g., reporting relationship, co-worker, personal relationship)? 
  • Can you create an opportunity to discuss your concerns privately? 
  • Can you discuss your concerns objectively? 
  • What is the likelihood of the person being receptive to your concerns?
  • How will you know if your conversation will have the desired effect, and protect clients?

If you discuss your concerns with the person and the matter is resolved, it may not be necessary for you to take further action. If the conversation does not resolve your concerns or you decide that talking to the person involved would not be helpful:

  • Talk to your manager; 
  • Consult resource people in your workplace; or 
  • Contact CRNBC Practice Support for a consultation. 

Share information about the situation only with those who require it.

When should I report to CRNBC?

The Health Professions Act and Duty to Report practice standard require you to report an individual if you have reasonable and probable grounds, based on evidence, that their continued practice might constitute a danger to the public. The Duty to Report practice standard outlines your legal and ethical duties related to reporting.

Reporting in an employment situation

If you are in an employment situation, you should report your observations and concerns to your manager or supervisor as soon as possible. They will then report to the College (or appropriate regulatory body). The employer has the ability to take immediate steps to limit the risk posed by the individual’s ongoing practice. When documenting and reporting your concerns:

  • Treat all documentation as confidential. Do NOT photocopy charts, client records, or other confidential documentation.
  • Provide specific details including date, time, place, who was involved (use initials for client names), what happened and how it affected client care.
  • Request written confirmation that your information was received, your concerns will be investigated, and appropriate action taken. 

Once you’ve reported to your manager, you may not know how the concerns are addressed, as details of internal workplace investigations are confidential. However, you should be advised that the complaint was investigated. Be aware that these problems can take time to investigate and resolve. If concerns are ongoing, continue to document and report to your manager.

If it appears that your concerns are not being addressed and clients continue to be at risk, you may need to report directly to CRNBC. The Duty to Report Practice Standard outlines this process. Inform your manager of your plan.

If you are a manager, supervisor, or employer

Under the Health Professions Act, you must report to the appropriate college if you have reasonable and probable grounds, based on evidence, to believe that an individual’s continued practice might constitute a danger to the public. Employers must report to CRNBC when a nurse’s employment is terminated based on an evidenced belief that the failure to do so might constitute a danger to clients.

Behaviours of concern to the College include those that put clients at risk and are practice related. These include behaviour related to drug use, boundary violations, sexual misconduct, abuse and fraud. Those issues likely to be outside the College’s mandate/authority include interpersonal conflicts, rudeness, employer-employee relations, complaints against health care facilities, clinics or agencies, and other regulated or non-regulated care providers.

How do I report to CRNBC?

Complaints must be in writing and contain enough clear and specific detail to allow CRNBC to evaluate the information and know what specifically to investigate.

As much as possible, the complaint should outline the evidence available to support the allegations. This may include witness reports, results of health records audits/reviews, examples of specific incidents with dates, times and those involved and other relevant, specific information that supports the allegations in the complaint. It should also detail the steps the employer has taken to limit the risks the nurse’s practice poses to clients. Here are some examples of letters of complaint:

See Complaints and concerns to learn more about submitting a written complaint to CRNBC. If you have questions, call the Nursing Concerns Coordinator at 604.736.7331 ext. 202 in Metro Vancouver or toll-free 1.800.565.6505 in Canada.​​​​

Reporting to other regulatory bodies

Reporting to the appropriate regulatory body is required when there is a reason to believe that there is a risk to clients if the person continues to practise. B.C.’s health regulatory bodies each have a process for investigating and resolving complaints about the health care professionals they regulate. Visit the BC Health Regulators website for more information.

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