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How CRNBC works as a regulator

Learn about our regulatory philosophy and framework.

posted July 11, 2012

In 2011 CRNBC launched a series of interviews with partners and colleagues to talk about how we could extend our thinking regarding the delivery of nursing regulation. We initiated these conversations because we want our work to remain current and relevant to nurses and the public. We also want to make sure that our regulatory work is consistent with international best practice.

Registered nursing is a self-regulated health profession. This means that the public, and the governments that represent them, give registered nurses the authority to oversee the quality and safety of the professional services provided by their peers. Professional self-regulation must justify patients’ trust and create the framework needed to make sure that health professionals work effectively together and provide safe, appropriate and effective care.

The College sets the framework for self-regulation. To accomplish this we establish standards, support nurses to meet standards, and act when standards are not met. No matter how we work as a regulator, these responsibilities will not change.

The College Board and staff agree that an approach to meet public safety is well served if we proactively focus on prevention and risk reduction. Based on a review of current literature, conversations with more than 100 people including patient representatives, nurse leaders, nurse educators, representatives from other regulatory bodies, and College Board and staff, we believe that our proactive approach to regulation should reflect the five concepts of:

  • Just Culture
  • Right-touch Regulation
  • Collaborative Self-Regulation
  • Principle-Based Approach
  • Continuing Professional Development

Just Culture

As an organization that subscribes to just culture, we accept that mistakes will occur. But we won’t wait for them to happen before making needed changes. In order to maintain a just culture, as a regulator, we must create opportunities for conversations and maintain an open and on-going relationship with nurses, their employers, and their union so that we remain aware of issues and changes within professional and work environments. As a regulator we will develop and deliver programs to help registered nurses make safe choices and learn if mistakes occur.

Right-touch regulation 

Right-touch regulation is the minimum regulatory force required to achieve a desired result. When regulation is appropriate, it should be simple, regularly reviewed for effectiveness and impact, and used only when necessary. As with just culture, right-touch regulation demands the regulator be aware of the environment in which it is operating, to anticipate changes before they occur, to foresee risks and to take timely action to prevent and lessen those risks.

Collaborative Self-regulation 

Just as we believe there is room for  improvements to achieve greater collaborative, team approaches when delivering health care to clients, we also believe there can be greater oversight by regulatory bodies to reduce duplication, promote meaningful dialogue, plan, and act as partners across professional boundaries. Collaborative self-regulation does not diminish self-regulation; instead, it enhances the individual professions and develops an expectation for partnership and shared accountability while respecting, accommodating, and strengthening the contribution each profession makes to the inter-professional team.

Principle-based Approach

Health care is complex and changing rapidly. Detailed, rules-based systems can create a false sense of security. In a principle-based approach, the professional needs to know how capable they are to manage the risk involved in what they are doing. As a regulator, we need to ask if the professional applied the right priority and judgment to the situation. If the professional thinks that harm could be an outcome, then they should make changes to their practice before waiting for rules and regulations to come in force. A shift from rules-based processes to principle-based dynamics requires us to move from ways to evaluate performance to systems that can demonstrate measurement and accountability for excellent practice. This shift supports excellence both at the point of practice and at the level of the individual nurse.

Continuing Professional Development

Practice, continuous learning and professional development are inseparable and essential. As a regulator we must demonstrate responsibility for promoting the enhancement of professional practice to benefit both the public and the nurse. In addition to continued professional development of broad knowledge, skills and attitudes, nurses as professionals must understand their role and function as a part of a system, as well as with their relationship with clients.

Draft Regulatory Philosophy and Framework: Considerations for CRNBC

  • Be transparent in its processes and outcomes — Essential to reassuring the public of the College’s priorities and demonstrating its competence in the exercise of its duties. 
  • Educate the public and registrants on its role and function — Critical to raising awareness of when and how they should call upon the College. It is also key to inspiring registrants to see the College as critical to the quality and coherence of their profession, to value the College’s role in “protecting the RN brand.”
  • Learn about and engage with other regulatory, oversight and policy-making bodies — Key to ensuring a complementary, consistent, comprehensive, efficient and effective integration of roles and functions and to ensuring the wealth of knowledge that resides with the College effectively informs the policy- and decision-making processes of other oversight and policy-making bodies.
  • Be evidence-informed — In all that it does, CRNBC must be clear on the rationale for new regulatory instruments and mechanisms, carefully planning their deployment, evaluating their effectiveness in achieving desired ends, and making modifications as needed based on the evidence.
  • Be collaborative — Engage with a wide range of other professional groups, agencies and organizations in needed dialogue about healthcare system aims and interprofessional and inter-sectoral action needed to improve quality and safety.
  • Help to ensure “good things happen” — Playing a significant role in professional enhancement and a greater role in continuing professional development.
  • Be seen as accessible to registrants — Overcoming an image of the regulatory body as “Big Brother” and a climate of trepidation and fear of reprisal that leads to suppression of information, failure to seek help when needed, under-reporting of near misses and adverse events and, thus, unfulfilled potential for learning and improvement among nursing professionals and unfulfilled potential for significant contributions to system quality and safety for the College.
  • Work with other provincial nursing organizations — Including the unions and associations that play distinct but critical, and often complementary roles, for the profession of nursing, in efforts to educate the public and registrants.

View the full document and appendices

 Underlying Philosophies and Trends Affecting Professional Regulation

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