News Bulletin VO. 26 NO. 4

Ask a Nursing Advisor: Discontinuing or Declining to Provide Care

What do I need to consider if I think I need to discontinue or decline to provide nursing care in situations where I do not feel safe or when I can’t provide safe care?

There are many situations that could lead an RN or NP to consider discontinuing or declining to provide client care. These situations could be filled with emotion and a desire to ‘protect one’s license’. Nurses must consider their decisions’ potential impacts on the client and must consider discontinuing or declining to provide care only once all other viable options are explored. It is important to maintain professionalism, effective communication, and safety for all involved.

Professionalism

Professionalism is a foundational principle of nursing practice, encompassing a range of conduct, behaviour, and practice accountabilities that shape a nurse’s interactions within the health care setting. RNs and NPs need to ensure they are always displaying professionalism even in situations where they have a conscientious objection. Conscientious objection refers to a situation when a nurse objects to certain medical procedures or aspects of care, based on the nurse’s religion or conscience. This objection must not be based on fear, prejudice, or convenience. Ideally RNs and NPs have a conversation with their manager prior to a situation occurring in order to minimize risk to the client and establish processes to support safe and efficient care delivery.  Nurses are accountable to:

  • Apply their clinical judgement in assessing situations of conflict and collaborate with the client and the employer to determine the most appropriate solutions.
  • Carefully navigate potential conflicts arising from differences of opinion, as they cannot stop or decline to provide care solely based on differences of opinion.
  • Prioritize continuity of care and seamless transitions ensuring an effective referral when needed, while providing accurate, impartial health information without moral judgment.

Communication

Effective communication facilitates continuity of care by providing essential information to clients, the health care team and employers. When employers know about situations where RNs and NPs are not comfortable with a practice situation, all parties can work together to find a solution in the client’s best interest. Nurses are accountable to:

  • Discuss with their employer, health care team and the client any actual or potential occupational health or safety issues, conflicts, or differences of opinion in a timely and effective manner.
  • Work to develop and implement strategies to resolve issues that may impact the therapeutic nurse-client relationship or the health care team.
  • Inform the client and work with the health care team when discontinuing or declining care.

Safety

Occupational Health and Safety (OHS) Legislation and employer policies are in place to support safe work environments. A safe practice setting supports nursing practice and promotes the delivery of quality care. Nurses are accountable to:

  • Provide inclusive and culturally safe care to all clients.
  • Participate in fostering an inclusive and culturally safe work environment for health care providers.
  • Recognize the limits of their competence and collaborate with the health care team and employer in a timely manner to determine how best to increase the nurse’s competence and meet the client’s needs.
  • Advocate for quality practice settings and promote and support strategies for safe client care.
  • Refer to OHS legislation and employer policies for direction on resolving work environment concerns.

Maintaining a professional and solutions-based approach, communicating effectively, and taking action to ensure client and health care provider safety are actions all RNs and NPs can take to comply with legislation, regulations, and employer policies. When actions also align with the expectations outlined in the entry-level competencies, practice standards and the code of ethics, RNs and NPs can be confident they are providing safe care and acting in the best interest of clients.

Nursing Advisors for Practice and Education 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

Client Abandonment

Ending the NP-Client Therapeutic Relationship

Code of Ethics for registered nurses

RN Entry-Level Competencies

RN Practice Standards

 

 

 

 

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