I have concerns about the practice or conduct of an RN, RN(AAP), and/or NP colleague and have heard the term ‘fitness to practice’ used. What is fitness to practice? What are my responsibilities in addressing these concerns? What is my colleague responsible for?

When RNs and NPs think of fitness to practice, they often think that it means being able to manage the physical and psychological aspects of client care during a workday. While being fit to practice in both of those areas is important, it is also important for each RN and NP to assess their skills and ability to provide safe, competent, and ethical care each day.

The demands on RNs, RN(AAP)s and NPs are many. Additionally, the health care field is ever-changing, with new, evidence-informed practices being introduced regularly. RNs and NPs engage in lifelong learning through professional learning opportunities to help maintain, enhance and develop competence in an ever-evolving profession. The expectation for lifelong learning is highlighted in the RN Practice Standards (Standard 1, Indicator 3) and the CNA Code of Ethics for Registered Nurses (pg. 9).

Clients may be put at risk when RNs and NPs lack personal insight into their practice and are not able to or choose not to reflect on feedback provided to them, assess their level of competency, keep current with evidence-informed practices, or seek learning opportunities to address gaps in their knowledge, skills, and abilities. “That’s how we have always done it,” or “We have done it that way for 40 years,” is not a reasonable or acceptable defence for incompetent or unethical nursing practice.

All RNs and NPs have the professional responsibility to ensure RN and NP colleagues working with them are competent and provide safe client care (CRNS, 2017, pg. 4; CNA, 2017, pg. 17). If you see a nursing colleague struggling in the workplace and there is a risk of client harm, you have a duty to intervene. For example, you may need to act quickly in the moment to protect a client or have a respectful conversation with your colleague, sharing your observations. It may also mean talking with your manager about your concerns. The important takeaway is that you are responsible for intervening and taking action to interrupt a professional practice situation where client safety could be compromised and to promote safe care.

Over the past few years, RN practice has faced many challenges. The lasting impact of the pandemic has added stress that has the potential to impact client safety. As a registrant of the CRNS, self-reflecting on your practice regularly is essential. The risk to clients is too great if your fitness to practice in any area is uncertain.

Here are a few questions that may help you determine if you are safe to practice:

• Are you missing subtle observations or elements of client care that you haven’t in the past?
• Have colleagues or clients raised practice or conduct concerns with you? Have you been open to receiving the information/feedback?
• Are you struggling to make clinical decisions that used to come quickly? Has this impacted the outcomes for any of your clients?
• Do you find that regularly meeting your clients' care needs is hard due to a lack of knowledge about new processes or procedures on the unit?
• Are there times when you avoid making clinical decisions because you are unsure how to manage something?
• Do you have an illness/condition or symptom of an illness/condition that might affect your conduct, ability and/or performance of nursing care?
• Are you currently taking any prescription and/or over-the-counter medications that might affect your conduct, ability and/or performance?
• Are you overly worried about other factors in your life? Psychological, environmental, and physiological stress can be powerful distractions and may affect your conduct, ability and/or performance.
• Do you get sufficient sleep and adequate nutrition?
• Have you recovered from any extremely upsetting event that could affect your conduct, ability and/or performance?

If you are seeing signs that you may not be providing the level or quality of care that you previously did, and you want to continue as a safe, competent, and ethical practitioner, here are some possible things you can do:

• Identify what areas are out of alignment with safe and competent nursing practice and determine what you need to improve or whether improvement is possible given your situation.
• If you have one, talk with your health care practitioner and/or access your Employee Assistance Program (EAP).
• Talk with your manager and/or educator to explore learning opportunities to support your growth and improvement as a safe, competent, ethical practitioner. Also, talk to your manager about a plan to support you with the tools to work safely while improving your practice.
• Lean on your colleagues and ask them to share their expertise and provide feedback to you.
• Talk with your manager about your strengths and challenges in your current practice environment and if it is the best place for you to be. What environment would support you to use your strengths and skillset in providing safe, competent, and ethical care if it isn't?

For clients to have the best possible outcomes, they need to receive care from safe, competent, and ethical RNs and NPs and use evidence-informed practice when providing care. Practice Advisors are available to discuss your situation and provide confidential advice and coaching to support you in being accountable for your professional practice. They can be reached by phone at 306.359.4227 or 1.800.667.9945 or by email at practiceadvice@crns.ca.

Resources

• RN Practice Standards, CRNS, 2019
• RN Entry-Level Competencies, CRNS, 2019
• Code of Ethics for Registered Nurses, CNA, 2017
• Resolving Professional Practice Issues: A Toolkit for Registered Nurses, 2019