celebrating the evolution of nursing regulation in british columbia 100 Years of Nursing Regulation 1912 - 2012

Quality Assurance

Quality assurance can mean many things and varies according to industry, profession and even consumer product.

Before the 1970s, quality assurance in the nursing profession referred to the quality of nursing care provided. Today it is synonymous with reflecting on practice, assessing practice and professional growth – all of which are important aspects of registered nursing practice and an obligation of all registered nurses practising in British Columbia.

Although the need for nurses to upgrade their skills was recognized in the 1940s – driven by the combination of changes in patient care, the use of antibiotic drugs and the growing complexity of new medical and surgical techniques and procedures – continuing education came of age in the early 1970s.

For example, in the late 1960s RNABC began investing $5,000 a year in continuing nursing education through the University of British Columbia School of Nursing. In 1973, the Association published the Continuing Nursing Education component of an extensive plan for the development of nursing education in B.C. This document included a recommendation, among others, that individual nurses should “assume primary responsibility and accountability for maintaining competence in nursing practice (including recognition of the continuing financial investment necessary).”

In 1977, RNABC began implementing a five-year Safety to Practice program. The program represented a broad approach to assuring nursing competence and touched on nearly every aspect of the nursing profession. The program included evaluating registration procedures, promoting effective performance evaluation programs, helping nurses to ensure their work settings made competence possible, and continuing support of the RNABC Quality Assurance Program. The Quality Assurance Program was developed to evaluate and modify the quality of nursing care. A one-year pilot project at the Matsqui Sumas-Abbotsford Hospital demonstrated the program could be used to evaluate the outcome of nursing care as reflected in a patient’s condition; nursing procedures performed; and the organizational structures necessary for the support of these practices.

By 1986, after 12 years of making significant contributions to the development of continuing nursing education in B.C., RNABC’s Continuing Education Approval Committee was disbanded. This was attributed, in part, to the “improved qualifications and planning capabilities of educators in the continuing education field.”

In 1993, changes to the Nurses (Registered) Act required RNABC to “establish and maintain a continuing competency program to promote high practice standards amongst members” – a requirement of all provincial health regulatory bodies. In 1996, the Association distributed the discussion paper, Continuing Competence: A Shared Responsibility, to begin dialogue with nurses and other key stakeholders on various approaches to continuing competence.

Following extensive consultation and a three-year implementation process, a personal practice review component of the continuing competence requirements for registration renewal went into effect in January 2000.

Due to downsizing and restructuring of the health care system in the 1990s, many nurses were unwilling to work in practice environments that put clients at risk. To help resolve the problem, in 2002 RNABC published Guidelines for a Quality Practice Environment for Registered Nurses in British Columbia. The guidelines were developed to assist registered nurses and their employers evaluate and improve practice environments in all practice settings in B.C. Considerable effort was made to bring this initiative to an actionable level through workshops to address issues of workload, nursing leadership, control over practice, professional development and organizational support.

The Quality Assurance Program we know today promotes high practice standards through a proactive approach to improving nursing practice. Its three parts — reflect, assess and grow — help registrants learn, study their own practice, and ultimately improve their practice. While the methods used for reflection, assessment and growth may change over time, CRNBC is committed to quality assurance as an important part of profession-led regulation and professional development.