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MICHELLE CARPENTER- NURSING CONSULTANT- POLICY AND PRACTICE
ROLANDA LAVALLEE- NURSING CONSULTANT- POLICY AND PRACTICE
Standards of Practice for Registered Nurses and Nurse Practitioners
Objectives
• Describe the process of updating the standards of practice.
• Highlight some of the changes in the standards.
• Application of the standards in practice.
Standards of Practice
• Broad, authoritative, principled-based statements that articulate conduct or performance expected of RNs & NPs.
• Describe the minimal level of performance expected against which actual performance can be measured and as a legal reference for reasonable and prudent practice.
• All RNs, NPs and interim licence holders are responsible to understand and apply to their practice.
• Describe safe, competent, compassionate and ethical expectations across all practice settings and domains.
New Standards of Practice
• October 2019
Standards of Practice for Registered Nurses and Nurse Practitioners was approved by Council.
New standards were developed as a result of a review of the Standards of Practice for Registered Nurses (2013) and The Standards for Nurse Practitioners Practice in Newfoundland and Labrador (2013) to ensure currency, clarity, and incorporation of regulatory requirements.
Timeline
• In April 2018, a multijurisdictional review of the standards of practice for registered nurses was initiated by staff of the College of Registered Nurses of Newfoundland & Labrador, New Brunswick Association of Registered Nurses, Registered Nurses Association of Northwest Territories and Nunavut and Yukon Registered Nurses Association.
• A review of the standards for nurse practitioners was also occurring.
• In 2019, following the concurrent review of the standards for both groups, a document was created to encompass the standards of practice for both RNs and NPs.
CRNNL’s New Standards
RN/NP:
Standard 1:
Responsibility and Accountability
Standard 2:
Knowledge Based Practice
Standard 3:
Client Centred Practice
Standard 4:
Professional Relationships and Leadership
NP:
Standard 5:
Collaboration, Consultation, and Referral
Standard 6:
Assessment and Diagnosis
Standard 7:
Client Care Management
Standards of Practice for RNs & NPs
What's New
• Standard 2: Knowledge Based Practice
• Minor changes
o Currency
o Indicators more specific
What’s New
2013:
Contributes to, and supports the analysis, development, implementation and evaluation of best practice.
2019: Indicator 2.9
Contributes to the advancement of evidence – informed practice through initiation and/or participation in research and scholarly activities.
Jenny is a clinical educator on a Med/Surg unit and was recently introduced to a new wound care product that is being researched and trialed with positive outcomes for a particular wound.
Jenny had a conversation with the wound care specialist and her manager regarding this product and the benefit of participating in its research. After many conversations within the organization, it was decided to participate in the research by using this new product over the next 8 weeks. As part of the pilot, the NP will be ordering this new product.
In addition, Jenny and the NP has agreed to present on their experience with the new wound care product at the next research symposium.
Question: How are the clinical educator and RN/NP meeting indicator 2.9?
Standard 2Knowledge Based Practice
The registered nurse and nurse practitioner practises using evidence‐informed knowledge, skill, and judgement.
Standard 3: Client Centred Practice
What’s New
2013: Standard 4: Public Trust
Protects client's privacy and confidentiality
2019: Standard 3: Client Centred Care: 3.5
Upholds and protects clients’ privacy and confidentiality in all forms of communication including, but not limited to, e-records, verbal, written, and social media;
Karen RN works in LTC. She has become close to Esther, a client who recently celebrated her 95th birthday. During the celebration, Karen asked Esther’s daughter if she could take a picture with her cell phone. Esther’s daughter said that would be fine.
Later that day, Karen posted the picture to her Facebook with a caption “so happy I work with special people like this”. Karen’s profile identifies her as an RN who works at Shady Lane Nursing Home.
Question: What should have been considered in this scenario based upon Standard 3?
Standard 3Client Centred Practice
The registered nurse and nurse practitioner contribute to and promotes measures that optimize client health outcomes at the individual, employer, and system level.
What’s New
New Indicator: 3.9
Respects diversity and promotes cultural humility and a culturally safeenvironment for clients and members of the health care team.
Lisa, a novice nurse and member of an Indigenous community, receives her patient assignment for her shift. During report Lisa hears about an Indigenous client on the unit who is one day post-op from a lower leg amputation. The night RN’s report indicated the client is lazy, non-compliant, and deserves this outcome. Lisa immediately feels disrespected and wishes she could stop the report and share her disappointment with her colleagues seated around the table.
As the day progresses, Lisa cannot get this experience out of her mind and feels it is impacting the nursing care she is able to provide. She is unsure how her colleagues feel about what happened and does not feel safe asking them or sharing her thoughts. Lisa fears speaking out as she is new to this unit and does not want to affect her career.
Question: How can Lisa meet indicator 3.9?
Standard 3Client Centred Practice
The registered nurse and nurse practitioner contribute to and promotes measures that optimize client health outcomes at the individual, employer, and system level.
Standard 4: Professional Relationships & Leadership
What’s New
New Indicator: 4.1
Provides nursing leadership in informal and formal roles.
Randy has been a dedicated CCU RN for 20 years. Over the years, Randy has provided nursing care to many clients who have experienced a myocardial infarction. Randy has been vocal about the lack of access to health promotion programs in his community which has led him to integrate comprehensive teaching related to healthy lifestyle choices. Due to his leadership in this area, his Nurse Manager has invited him to represent their unit as part of a cardiac wellness pilot project.
Question: How can Randy meet indicator 4.1?
Standard 4Professional Relationships and Leadership
The registered nurse and nurse practitioner establish professional relationships and demonstrates leadership to deliver quality nursing and health care services.
What's New
New Indicator: 4.7
Practises both independently and in collaboration with members of the health care team while understanding and respecting other team members’ scope of practice and contributions in the delivery of safe, competent, compassionate, and ethical care;
Rachel, a NP, and Patsy, a RN, work in a busy primary care clinic. Their manager, Joelle, also an RN, has decided to add another staff person to address work load issues. After completing a job analysis, she decided a licensed practical nurse would be the best fit.
Question: How will Rachel and Patsy ensure they meet indicator 4.7 when the LPN is hired? How could Joelle, the manager, meet this indicator as well?
Standard 4Professional Relationships and Leadership
The registered nurse and nurse practitioner establish professional relationships and demonstrates leadership to deliver quality nursing and health care services.
NP Standards
What’s New: NP Standards
• Standard 5
o 5.8: Closure of practice or an extended period of leave
o 5.9: Discontinuation of a NP therapeutic relationship with a client
What’s New: NP Standards
• Standard 6
• New indicators that provide greater detail on the expectations/elements of assessment, diagnosis and follow up
o 6.1: Performs an appropriate assessment
o 6.5 Orders diagnostic, laboratory, and other tests when indicated
What’s New: NP Standards
• Standard 7: Incorporates clinical procedures and interventiono 7.1- Obtains and documents Informed consent
o 7.8: Participates in mandatory drug/intervention monitoring and reporting programs e.g., PMP, reporting adverse drug reactions.
o 7.9: Uses drug information systems (current med profile) when prescribing-PMP, best practices.
o 7.10 & 7.11: Addresses the treatment of self, family members and others close to them.
o 7.12-7.17: Addresses NPs’ CDS prescriptive authority.
Application of Standards of Practice
How Can I Apply the Standards of Practice?
• RNs in Direct Care
o Take action when a policy or practice is no longer persistent with best evidence.
o Self-assess knowledge, skills and abilities/judgment to provide safe and competent care.
o Ensure client relationships are outcome focused and centered on their needs.
o Communicate with clients, family and team members effectively and respectfully.
Continued….
RNs in Direct Care
o Supports clients, colleagues, and students by sharing nursing knowledge and expertise by acting as an effective role model, resource, preceptor, or mentor.
o Understand and respect the scopes of practice and contributions of all team members.
o Take action to resolve professional practice issues.
o Ensure the use of social media does not violate confidentiality.
How Can I Apply the Standards of Practice?
• RNs in Administration
o Support RNs in the provision of care.
o Establish and maintain communication to support quality nursing service and research.
o Make administrative decisions about nursing service delivery.
o Plan, implement, and evaluate workplace strategies to address organizational problems and strengths.
Continued…
RNs in Administration
o Establish and maintain documentation systems to manage clinical and other relevant information.
o Create an environment in which collaboration, professional growth and mutual respect can flourish.
o Participate in the identification and resolution of professional practice issues, conflicts and ethical dilemmas.
How Can I Apply the Standards of Practice?
• RNs in Education
o Focus on educating nurses and nursing students.
o Develop nursing education programs, courses and in-services.
o Integrate evidence- based theory and best practices into educational activities.
How Can I Apply the Standards of Practice?
• RNs in Research
o Conduct or participate in relevant research to support knowledge development for nurses in practice.
o Analyze and interpret research findings and write appropriate reports and articles for publication.
o Share practice implications and policy relevance of the research in a meaningful way with nurses and others.
o Promote and contribute to environments that encourage the application of research findings to practice.
How Can I Apply the Standards of Practice?
• RNs in Policy
o Focus on integrating research into policy to facilitate evidenced-informed practice.
o Plan, implement, and evaluate policy to address systemic health care needs and shape larger public policy outcomes.
o Promote and initiate measures that encourage innovation and input into changes within the health care system to optimize client outcomes.
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