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 colleaguestruggling 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

• 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 foundational resources, agency policy and best practices listed above can help you determine if you have the competence, knowledge, skill, and judgment to be a safe Camp Nurse.

• 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.

Connect

If you become a Camp Nurse, we invite you to share your experiences and learning with other nurses on our Facebook page, CRNS Connects.

If you have any questions, contact us, and we’d be happy to connect and provide guidance tailored to your unique context and situation.

Reference

CRNA (2023). Camp nursing guidelines. Retrieved from https://www.nurses.ab.ca/media/mtffwn4q/camp-nursing-guidelines-2022.pdf.

Accessing health care virtually is becoming a new normal in Saskatchewan. As such, as an RN or NP, you may be asking, “What are my responsibilities when providing virtual care?”

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.

To discuss this topic or other nursing practice issues, CRNS Practice Advisors are available by email at practiceadvice@crns.ca

We recognize the incredibly tough working conditions many of you are facing on the front lines, and we acknowledge that practice settings are under immense pressure. We appreciate the continued dedication of all registrants to the nursing profession and recognize the critical role you all have in the ongoing pandemic and subsequent health care working conditions.

We’ve outlined a few ways RNs, NPs and RN(AAP)s can best meet RN expectations while working in challenging conditions:

Communicate effectively 

• Prioritize and coordinate care with all health care providers the best you can.
• Talk with your manager and bring forward ideas for addressing concerns.
• Fill out workplace-based communication forms, such as Work Situation Reports, to document and establish data for future decision-making.
• Keep personal notes should you be asked to comment on decisions you made.

Recognize your own fitness to practice and competence

• Know when to say “no” to extra or extended shifts – it’s more than OK to say no if you question your ability to provide safe care.
• Assess your individual competence to take on new nursing activities. What are you competent to do? If you are uncomfortable, what do you need to be more comfortable? Be specific when discussing with your manager.

Recommendations to comply with practice standards and ethical responsibilities

• Review practice standards, entry-level competencies and the code of ethics for specific expectations of practice related to topics such as addressing unsafe situations, advocating for your clients and personal competence.
• Use open and respectful communication with your manager and use the Resolving Professional Practice Issues: A Toolkit for RNs to support you as you work towards improving the workplace environment.
• Take time for yourself. It’s essential for your overall health and contributes to better patient and family care. The CRNS Mental Health Professional Practice Group has many ideas and resources to support RNs in prioritizing mental well-being.

For RNs seeking support during these difficult times, CRNS Practice Advisors are available during regular business hours by emailing practiceadvice@crns.ca or calling 306.359.4227 and leaving a message. Your call will be returned within one business day.

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 RNsis full of nuggets of information for any manager of RNs and may benefit new managers the most.
• The Toolkit for Managers of RNsaligns 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.

We will also be hosting a virtual meeting on Thursday, August 4, 2022, from 12 to 12:45 pm for all managers of RNs. CRNS staff will be available to answer questions and provide resources in a group setting. We encourage all RN managers to invite a non-RN manager colleague to join as well. Register by 4 pm on July 26 to be entered into a draw for your choice of a CRNS swag item (charcuterie board included!). You must attend the meeting to win the prize.

To support managers in working through specific situations, CRNS Practice Advisors are available during regular business hours by emailing practiceadvice@crns.ca or by calling 306-359-4227 and leaving a message. Your call will be returned within one business day.

Before looking at the intersection between an RN’s professional and personal life, let’s start with the expectations for RNs. RN Practice Standards, RN Entry-Level Competencies and the CNA Code of Ethics set the expectation for RNs to establish and maintain professional boundaries with clients and the health care team (ELC 2.6, p.8; PS  30, p. 5; COE D7, p.13; COE E11, p.15). Boundary violations take place when the RN prioritizes their own needs above the needs of the client and move the nurse-client relationship from therapeutic and professional to personal jeopardizing the nurse-client relationship and exposing the client to unnecessary distress.

It is important for RNs to consider and discern what behaviors are professional and therapeutic from behaviors that compromise the therapeutic relationship and are unprofessional. Every nurse-client relationship exists on a continuum of professional behavior.

A few examples of where we know RNs have crossed the professional boundary line and have been reported include:

• Nontherapeutic relationships with patients and maintaining communication with patients once no longer in their care;
• Nurses working and living in small communities where blurring lines between work and personal life can occur more easily;
• Confidentiality breaches when not in the circle of care;
• Using RN status for personal purposes; and,
• Treating family members.

Tips for avoiding boundary violations:

• Be aware of situations where you may be moving towards over or under involvement.
• Listen to what your client needs and work with them to identify solutions within your professional boundaries.
• Be clear on your boundaries and clearly communicate them when situations arise.

More information can be found in the Professional Boundary Considerations for Nurse-Client Relationships resource.

For a conversation about professional boundaries in your practice, CRNS Nursing Advisors are available by email practiceadvice@crns.ca or phone 1.800.667.9945.

The following are a few key considerations regarding practicing in non-traditional roles.

1. If you are considering a non-traditional nursing role (i.e., cosmetics, aesthetics), reach out to connect with a Nursing Practice Advisor to begin the conversation and explore any further action that may be required.
2. If more information is required, the CRNS has a process in place to determine if an RN’s practice falls within the definition of nursing practice that is provided in section 2k of The Registered Nurses Act, 1988. That process is called recognition of practice and a Regulatory Services Nursing Advisor will guide you.
3. Completing the recognition of practice process is important for several reasons. When the registered nursing practice that you are planning to work in is assessed and determined to be approved practice, the following is possible:
   • You can use the RN title when practicing.
   • You can include hours worked in the area in self-reported RN or NP practice hours.
   • You have liability protection through the Canadian Nurses Protective Society (CNPS).
4. If the non-traditional role you are exploring will also involve you establishing a business of your own, the CRNS Self-Employed Practice Guideline, 2021 will provide you with important information. The CNPS also has great information from the legal perspective. You may find this article helpful.
5. Keeping the focus on what is in the best interest of the patient and the environment surrounding them, and complying with the Practice Standards, Entry-Level Competencies and Code of Ethics will be guiding lights in your call to care in a new way.

CRNS Nursing Advisors are available by emailing: practiceadvice@crns.ca