Review of Decisions of Professional Conduct and Appeals Committees

FROM THE ANNUAL REPORT OF THE PRACTICE REVIEW COMMITTEE

The top 10 causes of unprofessional conduct listed by Jim Casey, Q.C. on page 4 correspond with the findings of the most recent review of discipline decisions of the Professional Conduct Committee and the Appeals Committee. This review, conducted by the Practice Review Committee (PRC), identified the following three issues as significant trends that can affect professional competency for registered nurses in Alberta:

* breaching employer policies

* lack of insight and integrity

* stress on staff when a colleague is unskilled in practice

The first two trends, breaching employer policies and lack of insight and integrity, have remained the two most significant trends identified by the committee's review over the past three years.

The results of the latest review were submitted by PRC in its annual report submitted to CARNA Provincial Council in December 2005. The analysis was the result of the review by PRC of all discipline decisions between Oct. 1, 2004 and Sept. 30, 2005 including 32 decisions of the Professional Conduct Committee and two decisions of the Appeals Committee.

Breaching Employer Policies

Lack of professional responsibility and accountability by breaching employer policies is the most significant trend found in the review of decisions of the Professional Conduct Committee and the Appeals Committee. The PRC has discussed at length the importance of holding nurses accountable for their actions and the responsibility of registered nurses to practice to the required standards of their profession.

Some of the breaches of employer policy related to the reconstitution of medications, documentation, medication administration (correct dosages and route of administration) as well as specific procedures.

Lack of Integrity and Insight

Also noted in the decisions of the Professional Conduct Committee were situations where nurses had a lack of integrity and insight about concerns with their practice. This refers to what constitutes acceptable ethical behaviour in nursing practice. In the decisions that were reviewed, nurses often did not recognize their responsibility in the error that was made or their lack of judgment in the situation. Ethical practice must be embedded in nursing practice and the Nursing Practice Standards state that a registered nurse must comply with the Canadian Nurses Association Code of Ethics for Registered Nurses and must practice with honesty, integrity and respect.

Committee members recognize that a nurse's performance is influenced by various factors such as job satisfaction, occupational stress, workload, the nurse's personal characteristics, and the values that may differ with age groups and professional status.

Stress on Staff when a Colleague is Unskilled in Practice

PRC noted, in the decisions they reviewed, instances where registered nurses were affected when they worked with nurses who were not practicing safely or competently.

Although it is often difficult for nurses to address concerns in these kinds of situations, it is important to remember that often the unsafe practice situation could be a result of inadequate staffing; outdated policies or procedures; inappropriate or inadequate supplies and equipment; or inappropriate staff mix decisions and is not always simply a concern with an individual's practice. Developing a quality practice environment is a shared responsibility. There needs to be a commitment by all RNs in the practice setting to take advantage of ongoing educational opportunities and support in order to acquire and maintain their competence.

Future Reviews

PRC, a regulatory committee since 1983 under the Nursing Profession Act, was officially dissolved on Nov. 30, 2005 upon proclamation of the Registered Nurses Profession Regulation under the Health Professions Act. However, Provincial Council has made a policy decision to establish the Conduct Decision Review Committee as a mechanism to continue to identify significant trends and issues that can affect professional competency. The Committee regularly reviews CARNA discipline decisions and shares the findings of the review to encourage RNs to reflect about their practice and understand their ultimate responsibility to practice with honesty, integrity and respect. RN

Practice Review Committee, 2004-2005

Audrey Guthrie (Chair)

Glenna Laing (Vice-chair)

Mahenaz Layton (Public Representative)

Lynne Fischer

Yvonne Ibbotson

Susan Koshy

Patsy McMullin

Debra Allen (Staff Resource)

Copyright Alberta Association of Registered Nurses Apr 2006
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