Responding to Professional Practice Issues (PPIs)

I am an RN who recently came from another province to become a nursing unit manager. At the first unit meeting, I was made aware of an ongoing professional practice issue the staff want to be resolved as soon as possible. They informed me that they are following the steps in the resolution process outlined by the CRNS. Please help me understand the process and my ethical and professional obligations as an RN in this situation.

The resolution process you mentioned is described in the CRNS’s Resolving Professional Practice Issues: A Toolkit for Registered Nurses. It provides guidance to RNs who believe they may have identified a professional practice concern in the workplace that needs to be addressed. This document is utilized with the Registered Nurse Practice Standards (2019) and the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses (2017). Links to CRNS resources are included below.

Some managers are RNs themselves and their responsibilities and accountabilities are the same. Some managers are not RNs and may have their own professional responsibilities and accountabilities as part of a regulated profession. All managers of RNs are required to understand the professional responsibilities and accountabilities of the RNs they manage and to support the RN to comply with the standards of RN practice.

The responsibilities and accountabilities of RN practice that apply to this situation are:

• RNs are accountable and accept responsibility for their own actions and decisions (1).
• RNs demonstrate effective collaborative practice, including communication, problem-solving strategies, decision-making and conflict resolution (2).
• RNs challenge and take action on unclear or questionable orders, decisions or actions made by other health care team members (3).
• RNs utilize knowledge of the health care system to improve health care services (4).
• RNs practice in accordance with the current CNA Code of Ethics for Registered Nurses (5).
• RNs take action to create a safe work environment that contributes to healthy teams and optimal client outcomes (6).
• RNs participate and contribute to health care team development by [...] contributing registered nursing perspectives on issues being addressed by the health care team (7).
• RNs practice in accordance with The Registered Nurses Act, 1988, other current relevant legislation, bylaws, scope of practice, standards, entry-level competencies, guidelines and employer policies (8).
• RNs collaborate with the employer and other organizations as needed to resolve professional practice issues (9).
• When the integrity of RNs is compromised by patterns of institutional behaviour or professional practice that erode the ethical environment and the safety of persons receiving care (generating moral distress), RNs express and report their concern individually or collectively to the appropriate authority or committee (10).
• RNs utilize practice standards, best practice guidelines, policies and research to minimize risk and maximize safety, well-being and/or dignity for persons receiving care (11).
• RNs work collaboratively to develop a moral community. As part of this community, all RNs acknowledge their responsibility to contribute to positive and healthy practice environments. RNs support a climate of trust that sponsors openness, encourages the act of questioning the status quo and supports those who speak out in good faith to address concerns (e.g. whistleblowing). RNs protect whistleblowers who have provided reasonable grounds for their concerns (12).

CRNS Resources

Code of Ethics for registered nurses (2017)

Registered Nurse Practice Standards (2019)

Registered Nurse Entry Level Competencies (2019)

Resolving Professional Practice Issues: A Toolkit for Registered Nurses (2019)

Ask a Nursing Advisor: A Solutions-Based Approach for Practice Questions