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 out 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 defense 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.

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.

The COVID-19 pandemic is calling on all health care workers in unimaginable ways, and current practice environments are more challenging than ever before. We have heard that upholding the standards of practice can be challenging in various practice environments which are flexing to meet system demands. Based on practice advice calls and consultations we have received in the last while, the trends are focused on RN Practice challenges, difficult workplace environments, challenges in upholding standards, all aspects of COVID-19 and immunization, as well as scope of practice and safety.

New solutions and ways of working within the interdisciplinary team are essential and emerging to meet the needs of patients and families when resources are stretched to capacity. When discussing these practice questions, our first approach is to acknowledge the stressful environment and difficult circumstances that RNs are experiencing and have endured for many months. The continued perseverance, resilience and leadership is outstanding. After this acknowledgement, we turn our discussion to the solid foundation upon which registered nursing practice is based, and that is in the RN Practice Standards, Entry Level Competencies and CNA Code of Ethics. Going into these resources and reviewing which indicators and competencies speak to registered nursing practice, especially in this difficult time, can be very empowering and provide the basis for important discussions as we collaborate to use all available resources in creative ways to meet the needs of the people of Saskatchewan.

Once in a space where it is safe to think about the possibilities consistent with the knowledge, skill and judgement of registered nursing practice, we can explore the various solutions in their specific practice setting. One of the questions we may pose is: “If you had no more people or money, what would you do?” This question positions the RN or NP as expert at point-of-care, potentially shifts mindsets and prompts a solutions-based approach with the client at the centre.

Utilizing a solutions-based approach in challenging practice and workplace situations promotes:

• RNs as experts at the point of care;
• creative solutions that utilize current resources in new or more efficient ways; and,
• a culture of “we’re all in this together.”

We want to acknowledge the sacrifices that RNs and NPs make. We can assure you, that together with you, we will continue to do our part in answering the call to care.

Workplace violence is a term that represents actions such as harassment, bullying and the attempted, threatened or actual conduct of a person that causes or is likely to cause harm to the psychological or physical safety of others.

The general approach of the CRNS is to work with members on identifying and understanding the situation being focused on, to outline the professional responsibilities and accountabilities of RNs or NPs in that situation, to offer guidance and support on how to resolve professional practice issues such as this at the lowest level, and to support the development or refinement of competencies throughout the process. Advisors can assist by identifying key resources or processes that might be beneficial. There is generally an emotional toll when nurses are involved in situations when workplace violence occurs. It is important to recognize this and to take action on ways to care for yourself to ensure you maintain your fitness to practice in a safe and competent manner.

There are several applicable nursing practice resources, such as the foundational documents of the RN or NP practice standards (PS) and entry-level competencies (ELCs), as well as the Canadian Nurses Association (CNA) Code of Ethics (COE). These documents contain many statements that speak to the professional accountabilities in relation to workplace violence. For example, an entry-level competency is RNs participate in creating and working to maintain healthy workplaces. Further expectations identified in practice standards are RNs are accountable for their actions and behave professionally. Ethically, RNs are expected to treat each other respectfully and refrain from any form of workplace bullying.

Further, as of May 17, 2024, The Saskatchewan Employment Act will require that all workplaces in Saskatchewan implement a policy statement and prevention plan (PSPP) to eliminate workplace violence. As such, the CRNS is launching a series of articles that may be helpful when understanding professional obligations, legislative requirements and practical advice on addressing workplace violence.

Some of the scenarios in the series will highlight when a nurse:

• feels targeted and harassed by others in the workplace;
• witnesses workplace violence towards others such as a colleague, student or other health professional;
• witnesses bullying or harassment directed towards a client, patient or resident in the workplace;
• is accused of perpetrating workplace violence against others, or questions the nature of their own behaviors or actions; or
• is part of a healthcare workplace group connected online or through group texts where overt or covert incidents of cyberbullying occur.

Violence in the workplace is a very challenging issue that can take many forms. We hope that this series will deepen your understanding of the issue and your commitment to ending workplace violence.

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If you witness harassment or workplace violence of any kind, you are expected to take action to stop the violence. In demonstrating professional behaviour, RNs are expected to intervene, and report when others fail to respect the dignity of a person they are caring for or a colleague (including students). It is important to recognize that to be silent and passive is to condone the behaviour. RNs must speak up, facilitate conversation, and adjudicate disputes as appropriate or as required. RNs work toward preventing and minimizing all forms of violence by anticipating and assessing the risk of violent situations and by collaborating with others to establish preventive measures.

All RNs regardless of the type of practice or practice setting, need to comply with the  CNA Code of Ethics, 2017, RN Practice Standards, RN Entry-Level Competencies, The Registered Nurses Act, 1988, CRNS Bylaws 2024, employer policies and other legislation, as relevant. This applies to witnessing bullying or harassment in the workplace.

If you have observed harassment in your workplace, here are ways you can take action:

• Check in with the person who has experienced the violence. Acknowledge what has happened and empathetically assist them to access supports as needed.
• Keep a written account of events including the following information:
  • The date, time and what happened in as much detail as possible.
  • The names of witnesses.
  • The outcome of the event.
• Report the incident to your employer to try to resolve the issue internally. Refer to the organization's harassment policy for information on reporting options and investigation process (Retrieved from saskatchewan.ca, March 4, 2024).

These are a few examples of how you can address workplace violence when you see it happen. Acting and addressing the behaviour is critical to stopping it from occurring again and fostering a healthy workplace environment and team. Supporting the idea of reporting these situations, the Saskatchewan Association for Safe Workers in Health has launched the Campaign for Change of #IWillReport. For more information, you can watch the video here .

Here are a few suggestions for how to resolve the first issue in our series, where the RN is the target of workplace violence. First, keep detailed factual records. Firmly tell the person that their behaviour is not acceptable and ask them to stop. You can ask a person you trust, such as supervisor or union member to be with you when you approach the person (Retrieved from ccohs.ca, March 4, 2024).  If you are unsuccessful in resolving it yourself after a frank and respectful discussion, the next action is generally to report the person’s actions to your manager. Focus on the facts as much as possible and ask for their involvement and collaboration in seeking resolution. Bring a solutions-based approach and be open to suggestions. You are showing leadership by seeking to resolve this.

All RNs, including both of you, are expected to comply with the professional obligations outlined in the practice standards, entry-level competencies and code of ethics. Reviewing these documents will help you to understand, take action on and speak clearly about these obligations as you seek to resolve the issue.

In Saskatchewan, The Employment Act outlines the employer obligation to provide a workplace that is free from harassment or abuse. Most facilities have code of conduct policies that outline expectations. You have a right and a responsibility to contribute to a workplace that is healthy, respectful and psychologically safe. This responsibility also lies with your colleagues and manager. If collaboration with the employer does not bring about a satisfactory resolution, you could utilize the framework outlined in the Resolving Professional Practice Issues: Toolkit for Registered Nurses (2019)to continue to escalate your concerns in a respectful and professional manner as you work towards resolution. The CRNS Nursing Advisors are also available to assist you and can be reached by email at practiceadvice@crns.ca or by calling the toll-free number at 1-800-667-9945. If you work in a unionized environment, union representatives can support and assist you as well.

One of the tools that CRNS can offer to both RN and non-RN managers is the Toolkit for Managers of RNs. Contained within the toolkit are a number of resources that highlight the professional accountabilities and responsibilities of RNs related to scope of practice, professional practice or clinical practice. A new resource focused on workplace violence is being added soon. You can share this information and encourage access of these resources.

Please watch for more articles in this series on workplace violence where we will highlight other aspects of this complex topic.

This is an incredibly difficult situation and is one that requires you to intervene. The actions that you are witnessing could be a result of a lack of understanding of the professional obligations of RNs, professional or personal issues impacting the nurses’ ability to respond in an ethical manner in that moment, or they may be racially motivated. No matter what the contributing factors might be, these actions cannot be condoned.

Some of the professional expectations that specifically apply to this situation focus on nurses being accountable for identifying how their personal values, beliefs and positional power comes into play and making a conscious effort to reduce bias and influence. Nurses also must take action to support culturally-safe practice environments and to advocate for health equity for all, particularly the vulnerable and diverse clients and populations that they care for. These expectations of course, intersect with the responsibility for all nurses to conduct themselves professionally and according to the code of ethics, practice standards and entry-level competencies.

As nurses we strive to incorporate knowledge from many sources so we can continually reflect upon and improve our practice. A professional expectation for nurses is that they refuse to be complicit in any behaviors where actions are inhumane or degrading and are expected to intervene and report such behaviors when they are observed or if reasonable grounds exist to suspect their occurrence.  One of the ways nurses can do this is to develop strong conflict management skills, an ability to de-escalate volatile situations, to have a full awareness of agency policy in managing instances of workplace violence and to uphold organizational commitments that might focus on respectful environments and being courageous. One or more of these could become a learning goal in your mandatory CCP learning plan and should you find certain resources helpful, you could share those within the CRNS Facebook group to assist others with their journey.

All professional obligations matter and make the difference between ethical care and unethical treatment that can have lasting effects on all those involved in the situation. Addressing situations of workplace violence, although generally difficult, actively improves patient experience and impacts patient, health care professional and employee workplace safety. It may even prevent tragic and preventable losses of life such as Joyce Echaquan. Would the outcome have been different for her and her family and the nurses involved if someone had intervened?

One tool that can be utilized in responding is the CPR Racism card. It was specifically developed by Dr. Holly Graham with the intent of it enabling nurses and others to take action when they witness racist behaviors in health care settings. To learn more about the tool, click here.

For more information about responding to workplace violence, please see other CRNS articles within this series. They can be found here.  You can also review these resources on preventing violence in the workplace or register for a courseon recognizing the risk of violence in the workplace and taking action if it occurs. You might also want to check out the resources available on the Saskatchewan Union of Nurses website.

This is a question CRNS Nursing Advisers often receive and, honestly, most times, cannot easily answer. Registrants can become frustrated with the “fuzzy” responses they receive. There is a good reason for the grey or “fuzzy” response. That is because CRNS registrants know their practice areas, clients, resources, team members, employer policies and personal competence better than a nursing advisor possibly could. These elements must be considered when determining if you should or should not perform a specific nursing activity.

To support registrants in decision-making, the CRNS has developed a new online tool that includes resources to support you in understanding your legislated scope of practice. The assessment tool guides you to work through three questions:

1. Is the activity within the legislated scope of practice?
2. Do you have the personal competence, including the knowledge, skill and judgement, to safely perform the activity?
3. Is the activity supported by your employer and practice setting?

The Legislated Scope of Practice Assessment Tool is designed to help you consider if all three steps support the practice and if there is ample current evidence for you to engage in the practice.

One topic that CRNS nursing advisors are presented with frequently is registrants who are interested in working in providing aesthetics or cosmetics services. In addition to the variety of live links included in the assessment tool, you may find value in a previous article written for registrants considering practicing nursing in an area outside the usual areas where RNs work.

• What does it mean to be a camp nurse?
• Do you have any resources or guidance that might support me as a Registered Nurse to do this?

Many Registered Nurses volunteer or get paid to be a Camp Nurse over the summer. That’s wonderful that you’re considering this opportunity! We appreciate and recognize the value and expertise Registered Nurses bring to this role to provide safe, knowledgeable, ethical and comprehensive care. Connecting with the campers, staff, and more can be a unique, challenging and rewarding experience.

What is Camp Nursing?

Camp Nurses are clinicians, educators, counselors, care coordinators and leaders. They have an incredible impact on the health and well-being of campers and their families, who feel reassured that their loved ones will have access to nursing care if needed while away from home.

Camp Nurses often work autonomously but may also work as a team. Camp Nurses may need to manage various acute and chronic health conditions and employ their knowledge, skill and judgment to manage situations. The responsibilities of camp nursing vary from camp to camp, but the Camp Nurse role follows the nursing process and is typically responsible for the following:

• Complying with CNA Code of Ethics, 2017; RN Practice Standards; RN Entry-Level Competencies; and/or NP Practice Standards; NP Entry-Level Competencies
• Following agency protocols and procedures.
• Following and implementing infection prevention and control and emergency processes
• Coordinating and prioritizing routine and emergent care
• Preventing and treating injury and intervening as needed so that the physical, mental, emotional, and spiritual health needs of campers and others are safely met
• Monitoring health conditions, being alert for allergies, managing medications (including ensuring medication security), providing education, providing emotional support, having knowledge of growth and development and common health conditions
• Communicating with families and the agency as needed
• Maintaining boundaries, privacy, confidentiality and ensuring consent and that parental consent is documented
• Completing documentation (Documentation Guideline, 2021)
• Anticipating scenarios, being ready and flexible for anything at any time and referring as appropriate.

*Note, this is not an exhaustive list.

Resources

The CRNS self-assessment tool you can use to examine your competence to determine if camp nursing or activity you might engage in is within your legislated scope of practice.

Some foundational resources to review and have available for camp nursing are:

• CNA Code of Ethics, 2017; RN Practice Standards; RN Entry-Level Competencies; and/or
• NP Practice Standards; NP Entry-Level Competencies
• Medication Management Guideline, 2021;
• Guideline for RNs Recommending & Administering Nonprescription Drugs, 2020
• Documentation Guideline, 2021
  RN Specialty Practices Guideline, 2020
• Professional Boundary Considerations for Nurse Client Relationships CRNS, 2021

Key Considerations

Agency Policy, Supportive Documents and Best Practice

It’s important to follow established agency policy or supportive documents, incorporate best practices in nursing being delivered in a camp setting, and follow the nursing process (assessment, nursing diagnosis, planning, implementation and evaluation).

• Is there any conflict of interest with your primary area of employment? You can discuss this with your employer and the camp agency.

Education and Personal Competence

Reviewing these foundational resources, agency policy and best practices listed above can help you determine if you have the competence, knowledge, skill, and judgement to be a Camp Nurse safely and are fit to practice.

• Are there any gaps in your competence? You can address them through orientation, education, etc., to ensure you can provide safe and ethical care relative to that setting.

Legal/Risk

RNs in Saskatchewan have basic liability protection as part of their registration through the Canadian Nurses Protective Society  (CNPS) when working within their scope of practice.

• Does the camp agency have any additional liability protection or insurance?
• Who can you talk to about additional legal considerations/liability?
  To ensure your liability coverage is adequate in your role, it is recommended that you contact the CNPS. Their number is 1-800-267-3390. Remember to have your registration number available before calling; they will ask you for this.

RNs require an order or another authorizing mechanism to administer a medication. In this situation a directive, as outlined in the RN Specialty Practices (RNSP) Guideline and as part of an RN Clinical Protocol, could be provided to enable RN administration of flu shots to a client population in a pharmacy.

RN Clinical Protocols are created by the employer – in this case the pharmacist, approved prior to implementation and contain all essential components where:

1. The RNSP is in the interest of the client in their environment. In this case, the pharmacy.
2. There is evidence to support the RNSP. There is ample evidence to support RNs as part of the health care team administering flu shots.
3. A client-specific or client population authorizing mechanism is in place. The clinical protocol required in this example needs to be signed by a physician or NP. Although pharmacists can administer the flu vaccine under their own authority, they are not considered authorized prescribers for RN practice and cannot sign the directive.
4. The required competencies and which RNs will engage in the RNSP are clearly defined. What education and skills are required to engage in the practice or to respond to an untoward outcome?

With an RN Clinical Protocol including a directive is in place and the RN has the competence to safely perform the required activities, RNs can administer flu shots in a pharmacy setting.

Liability Coverage

All RNs, holding a practicing license with the CRNS have liability coverage. RNs interested in supplemental liability coverage for this practice can reach out to the Canadian Nurses Protective Society at 1-800-267-3390 or https://cnps.ca/.

The CRNS has the following resource available on our website: Advertising Nursing Services for RNs and NPs engaged in non-traditional and/or self-employed practice settings. RNs and NPs may use their professional title when providing services that are approved by the CRNS (See the CRNS Recognition of Practice [ROP] webpage to determine if you require ROP).

Any advertising of nursing services by RNs and NPs must comply with CRNS direction, federal and provincial legislation. Advertising needs to be consistent with the current practice standards, entry-level competencies and the code of ethics. Only products and services authorized for sale by Health Canada may be advertised and provided by RNs and NPs.

Advertising incentives that encourage clients to purchase products or services, such as a 2-for-1 sale or special pricing for specific occasions (i.e., Mother’s Day) are not allowed.

Overstated claims of the effectiveness of products or the expertise of the RN, or NP in administering products and services are not allowed in any advertising. RNs and NPs are to provide accurate information regarding products used, and the risks and benefits associated with the product/service. Advertising of products and services must be accurate, factual, evidence-based, verifiable, ethical and professional.

Advertising that contains false, misleading or sensationalized information can compromise the public's trust, and harm the profession’s integrity, may be considered professional misconduct and could be the subject of an investigation by the CRNS.

Examples of advertising that may result in a complaint to Professional Conduct include, but are not limited to:

• Exaggerating results or making unverified claims about the effectiveness of a product or treatment.
• Promoting a medical treatment or service without having the appropriate qualifications to provide the treatment or service.
• Promoting the treatment of conditions with alternative medications that are not based on scientific evidence as an effective treatment.

Graduate Nurses (GN) are those who have recently graduated and are waiting to complete the necessary requirements to become a Registered Nurse (RN). As an employer, prior to hiring a GN, there are a few areas that must be considered and are outlined in the Graduate Nurse Practice Guideline.

GN scope of practice is narrower than that of an RN. Given that a GN cannot replace an RN, as they are continuing to develop their individual competencies, they require supervision. It is important to ensure there is sufficient staff available to perform the duty of supervising, as well as directing the work actions of the GN in a collaborative manner. There may also be situations and activities that a Graduate Nurse is not authorized to perform independently and should be supported to gain the skills necessary to practice in those areas. This can be done by working alongside experienced RNs in areas such as RN Specialty Practices (RNSP) or as a Charge Nurse.

It is especially important to provide support to new nurses and provide them an environment where they can grow and thrive as they transition to providing safe, competent and ethical care as a licensed RN in Saskatchewan. As they await their appointment to write their licensure exam, it is important to support them in being successful. There are various resources available for new nurses to aid in completing their examination successfully.

Graduate Nurse licenses are unique to each individual GN and are based on the date of their exam appointment and the waiting period allocated for results. These licenses are limited to four months and can only be renewed up to a maximum of two times, with completion of the Continuing Competence Program required for the second and final extensions. There are specific requirements and an application process for the first license and subsequent extension(s). It is the responsibility of the GN to ensure their application is completed and their license is up to date.

Supporting a new RN colleague can sometimes require simple actions. Sometimes, it's the simple gestures that make a significant impact:

1. Offer Guidance and Advice: Be approachable and available for your new RN colleague. Offer to answer questions, provide guidance on hospital protocols or local practices, and share your experiences to help them navigate their new role more smoothly.
2. Create a Supportive Environment: Foster a welcoming and supportive atmosphere. Encourage open communication, actively listen to their concerns, and validate their experiences. Simple acts of kindness, like inviting them to join lunch or coffee breaks, can make them feel more included and supported.
3. Share Resources and Insights: Offer resources you've found helpful in your practice. This could include the CRNS Nursing Advisors, CRNS website, study materials, functional websites, or tips for managing workload effectively. Sharing insights and lessons from your experiences can be immensely valuable to someone starting.

These small yet impactful actions can create a supportive foundation for a new RN colleague, helping them feel more confident and empowered in their new role in Saskatchewan.

The CRNS works closely with RN Nursing Managers to equip them with the tools and skills necessary to effectively manage RNs and NPs. You can find relevant resources below:

• Practice Standards, Entry-Level Competencies and Code of Ethics apply to all CRNS registrants, including RNs or NPs who are in manager roles. These foundations for RN practice can be used to support discussions with RNs and NPs you manage as well as colleagues and supervisors who are not RNs or NPs themselves and could benefit from a better understanding of the professional expectations of RNs.
• Managers who are not RNs or NPs themselves may benefit from reading our Fast Facts for Managers of RNs.
• The Top 10 List for New Managers of RNs is full of nuggets of information for any manager of RNs and may benefit new managers the most.
• The Toolkit for Managers of RNs aligns the foundations of RN practice with situational topics to assist managers in identifying responsibilities of RNs in the workplace and the crucial role of managers of RNs in supporting RNs to meet those responsibilities.

Providing telehealth to a Saskatchewan resident

To provide telehealth to a Saskatchewan resident, you must be registered and hold a practicing license with the CRNS. The Registered Nurses Act, 1988  in Saskatchewan outlines the need to be registered to engage in the practice of registered nursing and to use protected titles. Information about registration can be found here.

Providing telehealth to clients who are residents of another province or territory

Each province, territory and/or country are governed by differing legislation, regulations and bylaws. We encourage you to contact the nursing regulator in that jurisdiction before providing telehealth services to their residents.

Varying forms of digital communication have become increasingly utilized in both our personal and professional lives. This includes the use of smartphones, iPads, tablets, etc. While the first consideration that comes to mind may be around privacy, several other points exist.

Privacy

Legislation and employer policies hold RNs and NPs responsible for maintaining and safeguarding patients' information. You must consider the risk of having your phone stolen, lost, or accessed by someone outside the circle of care. Factors such as the wi-fi connection and network security also play a part and can add to the risk of privacy breaches. Entry-Level Competency 2.4 mandates that RNs and NPs adhere to regulations, practice norms, ethical guidelines, and organizational protocols to safeguard client privacy, confidentiality, and security. Standard 3, Indicator 30 of the RN Practice Standards underscores the importance of maintaining professional boundaries, privacy, and confidentiality with clients. Additionally, the Code of Ethics emphasizes privacy protection across various domains, including in Section E. #7, which highlights RNs and NPs' adherence to policies aimed at preserving the privacy of individuals receiving care, including measures within information technology systems.

Professional Boundaries and Expectations

Aside from privacy issues, expectations and boundaries between the RN or NP and the family or colleague they are texting must be considered. If using your own cell phone to text, are patients accessing you outside work hours? When is it appropriate to respond? What are the expectations and assumptions when utilizing text messaging as a form of communication? Are there clear guidelines put in place to preserve and protect the professional relationship?

Employer Policies and Best Practices

Employer policies must also be referenced and followed. RNs and NPs must ensure they follow procedures and utilize best practices for communication and infection control. For example, does the employer have its own smartphone on a secured network with specific safeguards and instructions on when and how to erase the data or ensure it is properly stored? Are there policies around how to ensure proper cleaning of cell phone devices? We must consider employer direction and expectations for what is acceptable within each setting and follow best practice guidelines.

Documentation Standards

Finally, consider that texts surrounding patient care should be captured in the patient's medical record. RNs and NPs may face challenges complying with professional and legal obligations for documentation when providing care through text. How are you documenting text conversations or photos? What is the policy around how to safely and securely do it, or is it acceptable at all?

Key Points to Take Forward

• Each employer and practice setting will have a specific direction and policy for using personal smartphones. It is important to know what these are and always practice within the Code of Ethics, Entry-Level Competencies, and Practice Standards.
• Consider utilizing an employer-provided device and always use a secured network with safeguards in place, such as an app that encrypts data being sent.
• Proper processes should be in place, such as how to clean them, how to transfer data to the client’s medical record, when to delete texts, and password/access updates.
• Reducing the risk of privacy breaches is important. Always take precautions, such as not using personal identifiers when sending messages. Make sure you are utilizing strong passwords and finger scans or face scans and all other available safeguards to protect the privacy and confidentiality of the patient.

This is a great question. There are a few key considerations, whether providing nursing advice over the phone, virtual care through an application, videoconferencing or any other manner where you cannot assess a client in person.

1. You must hold a practicing license with the CRNS to provide nursing care, including virtual care, to Saskatchewan residents in Saskatchewan. Exceptions apply to those registered with the CRNS through the AB/NT/SK memorandum of agreement. If your practice falls within this agreement, email register@crns.ca for more information.
2. You are responsible for complying with RN Practice Standards, Entry-Level Competencies and Code of Ethics and carrying out the nursing process, including assessment, care planning, implementation of the care plan and evaluation. If you cannot obtain the information you require to make sound clinical decisions, the client must be assessed by another health care provider or seen in person.
3. Nursing care, including virtual, must be documented within an approved documentation system that reasonably assures client confidentiality and continuity of care.
4. Differing legislation/regulations/bylaws govern each province/territory and country. We encourage you to contact the nursing regulator in that jurisdiction before providing virtual care to their residents.

A couple of resources that may be helpful as you consider practicing virtually include, but are not limited to:

• Twelve Things to Consider Before Joining a Virtual Care Practice, Canadian Nurses Protective Society; and,
• Nursing Use of Information and Communication Technologies, CRNS.