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Regulatory supervision

What is your role?

You remember the nurse – perhaps it was many nurses – who guided your learning as a student. Sometimes an instructor, sometimes a preceptor, sometimes someone else, that nurse was there, watching over your practice when you needed it most. As a nursing student dealing with patients, a professional stood by to ensure you provided safe, competent care to your clients.

You may not know why that nurse acted as they did. Perhaps it was the often unspoken rules of nursing professionalism that guided their actions. These actions are directed by the values and standards of the profession. Supporting and supervising nursing students is a professional responsibility. How nurses fulfill this obligation can leave lasting memories. 

The College recently took a look at the relationship between nurses and students with a view to formalizing what supervision looks like for protection of the public. We’d like to map out the process so that nurses know what’s expected of them when working with students. The process can be broken down into parts for analysis, but as with all processes, the parts are interrelated. Communication is key to the success of the process.

The process 

1. Know the student’s competence

You need to reasonably know the competence of the student you are working with. This information can come from their nursing education program, clinical instructor, a skills checklist, an outline of activities taught and observed to date, and very importantly, by talking directly to the student. The student may have learned a skill, but not have had enough practice to feel comfortable or no recent experience with the skill. You need to know this before proceeding.

2. Authorize activities

Depending on the student’s level of competence, authorize client care activities you expect the student can safely perform. Talk with the student about activities they’ll do, with which clients, and where they need support.

3. Set conditions

At times, you will identify an activity that the student may perform, that requires you to be physically present or in frequent contact with the student. Alternatively, perhaps the activity may benefit from oversight by another health professional (e.g., LPN, RPN, social worker). This is considered, “setting a condition” for performance of the activity. This part of the process requires communication between you and the student and with whoever will oversee the student while they perform the activity.

4. Manage risks

At all times you consider risks to the client and take steps to ensure safe care.  This could include checking with the student to see if care went as planned, as well as evaluation of the client’s experience.

As an example…

Karyn is an RN working in Home and Community Care. She is assigned a student, Rick, who is taking his third year community nursing course.

Karyn talks to Rick about his knowledge and skills gained in the nursing program so far. She asks to see his course outline and the skills checklist that has been signed off by his instructors. Karyn has had students before and knows that this information will help her identify appropriate clients and care activities. She also asks Rick about what skills he feels he needs more experience with to assess when it will be important for her to review a procedure with him or to directly observe his performance. There may also be opportunities for Rick to go on a visit with another nurse to practice his skills.

Together they work out a plan for the first week together; with Karyn planning for close supervision and observation of Rick’s performance of activities. If the week goes well, she will consider sending Rick out with the LPN to provide care to the more stable clients on the roster, with the LPN to oversee the care Rick provides.

Karyn recognizes that as the RN, it is her decision which activities to authorize Rick to perform; also that by asking the LPN to oversee, she is setting a condition for performance of the care. She needs to talk to the LPN about what is expected.

At all times, Karyn monitors the outcomes of care and is responsible to intervene or to change the plan as needed to ensure client safety.

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