Clinical Questions

I manage RNs but am not an RN myself. What considerations should I make when addressing clinical practice questions that I do not have the expertise to answer?

There are several questions that can assist you in obtaining information to inform your decision:

• What is the anticipated safe outcome?
• What is the indication for the medication, treatment or procedure?
• Is there a policy and procedure that supports the practice?
• What is the current best practice evidence?
• Do the RNs have the competencies to safely provide the care required?
• How do the CRNS RN Practice Standards, Entry-Level Competencies and Code of Ethics apply to the situation?
• Are there other CRNS guidelines to refer to?
  • For example:
    • Documentation Guideline;
    • Graduate Nurse Practice Guideline; and/or
    • Medication Management Guideline.
  • Do the RNs have the resources available to them to ensure the practice is carried out safely?
    • For example:
      • Are there sufficient supplies?
      • Are there sufficient staff with the required competencies to safely manage all the patients on the unit?
      • Is there a physician or NP available to be consulted with and who can provide additional orders if needed?
    • What is the best decision in the interest of the patient?

RN clinical practice requires oversight from an RN. What is the process I should follow if I am struggling to come to a decision about clinical practice issues?

Seek out the expert advice of RNs in one or more of these roles to assist you in resolving the issue:

• Experienced RNs from your unit;
• RN manager from another unit;
• Clinical Nurse Educator;
• More senior RN leader; and/or,
• CRNS Practice Advisor.

Is there a CRNS resource for RN clinical practice that I can use on my unit/in my facility?

Yes. There are many documents and pieces of information available to you on the CRNS website. The CRNS has developed RN Specialty Practices (RNSP) that allow for optimization of RN practice in the public interest within the legislated scope of RNs and in alignment with individual RN competence. There are guidelines to support the development of RNSPs that will apply in diverse clinical practice settings.

CRNS Resources

Code of Ethics for Registered Nurses, 2017

Registered Nurse Practice Standards, 2019

Registered Nurse Entry-level Competencies, 2019

RN Specialty Practices Guideline, 2020

Understanding Legislated Scope of Practice