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Professional Practice

Registered nursing competencies in this category focus on personal professional growth, as well as intraprofessional, interprofessional and intersectoral practice responsibilities. Each registered nurse is accountable for safe, compassionate, competent and ethical nursing practice. Professional practice occurs within the context of the Code of Ethics for Registered Nurses (CNA, 2008), provincial/territorial standards of practice and scope of practice, legislation and common law. Registered nurses are expected to demonstrate professional conduct as reflected by the attitudes, beliefs and values espoused in the Code of Ethics for Registered Nurses.

Professional registered nurse practice is self-regulating. Nursing practice requires professional judgment, interprofessional collaboration, leadership, management skills, cultural safety, advocacy, political awareness and social responsibility. Professional practice includes awareness of the need for, and the ability to ensure, continued professional development. This ability involves the capacity to perform self-assessments, seek feedback and plan self-directed learning activities that ensure professional growth. Registered nurses are expected to use knowledge and research to build an evidence-informed practice.

The registered nurse:

PP-1: practises in a manner consistent with the values in the Code of Ethics for Registered Nurses (2008) (e.g., providing safe, compassionate, competent and ethical care; promoting health and well-being; promoting and respecting informed decision-making; preserving dignity; maintaining privacy and confidentiality; promoting justice; being accountable). (CNA, 2008)

PP-2: practises in a manner that recognizes and respects the intrinsic worth of clients (e.g., providing privacy, respecting diversity and vulnerabilities, relieving suffering, respecting and fostering cultural expression, appropriately using chemical and physical restraints, accepting a client’s report of pain). (CNA, 2008)

PP-3: applies ethical and legal principles related to maintaining client confidentiality in all forms of communication: written, oral and electronic (e.g., blogs, social networking sites, camera phones, text messaging, e-documentation, electronic health records). (Jurisdictional Collaborative Process, 2006)

PP-4: uses professional judgment when accessing, organizing and using electronic resources (e.g., for own professional development, nursing practice, text messaging, personal digital assistant).

PP-5: maintains clear, concise, accurate, objective and timely documentation.

PP-6: uses established communication protocols within and across health-care agencies and with other service sectors (e.g., preserving privacy, maintaining confidentiality, following appropriate channels of communication). (Jurisdictional Collaborative Process, 2006)

PP-7: advocates for equitable treatment and allocation of resources for the client (e.g., assisting vulnerable and marginalized clients to gain access to quality health care, facilitating and monitoring the quality of care, facilitating appropriate and timely responses by health-care team members, challenging questionable decisions).

PP-8: demonstrates accountability for own actions and decisions.

PP-9: practises within the scope of practice of the registered nurse.

PP-10: articulates the registered nurse’s scope of practice to others (e.g., the client, health-care team members, the public, community leaders, politicians).

PP-11: provides rationale for nursing actions and decisions based on professional judgment and theoretical and evidence-informed knowledge from nursing and related disciplines.

PP-12: uses professional judgment when following agency policies, procedures and protocols (e.g., when to use chemical and physical restraints, when to consult another member of the health-care team).

PP-13: uses professional judgment in the absence of agency policies, procedures and protocols.

PP-14: integrates continuous quality improvement into nursing practice (e.g., identifying and reporting when a policy, procedure or protocol is unsafe, obsolete or unnecessary; participating in audits; participating in quality improvement committees). (Jurisdictional Collaborative Process, 2006)

PP-15: uses evidence and critical inquiry to challenge, change, enhance or support nursing practice (e.g., questioning accepted practice, participating in research).

PP-16: takes action when aware of potential or actual abuse of the client by health-care professionals, family or others.

PP-17: takes action when aware of potential or actual abusive situations to protect self and colleagues from injury (e.g., aggressive behaviours, bullying, workplace incivility, non-abuse policies). (Jurisdictional Collaborative Process, 2006)

PP-18: recognizes and reports errors, near misses and sentinel events and takes action to minimize harm (e.g., client incorrectly identified, error in drug administration).

PP-19: intervenes when unsafe practice of nursing colleagues and other members of the health-care team is identified (e.g., talking to colleague, stopping the unsafe practice, reporting to appropriate authority).

PP-20: uses conflict resolution strategies.

PP-21: implements strategies for continuing competence based on reflective practice, identified strengths, limitations and learning needs.

PP-22: is accountable when assigning nursing activities to other health-care providers consistent with competence, expertise, education, role description/agency policy, legislation and the client’s needs (e.g., assessment, planning, implementation and evaluation of workload assignment).

PP-23: manages workloads effectively (e.g., time management, prioritizing, assignment).

PP-24: seeks appropriate assistance when unsafe workload is identified.

PP-25: collaborates and builds partnerships with nursing colleagues and other members of the health-care team to provide health services.

PP-26: understands the roles and contributions of other health-care team members (e.g., scope of practice, role description, consultation).

PP-27: shares knowledge and provides constructive feedback to colleagues (e.g., peer assessment, continuing competence, nursing students, mentorship, interprofessional rounds).

PP-28: manages resources in an effective and efficient manner (e.g., human, material, technological, financial).

Nurse-client Partnership

Registered nursing competencies in this category focus on therapeutic use of self, communication skills, nursing knowledge and collaboration to achieve the client’s identified health goals. The nurse-client partnership is a purposeful, goal-directed relationship between nurse and client that is directed at advancing the best interest and health outcome of clients. The therapeutic partnership is central to all nursing practice and is grounded in an interpersonal process that occurs between the nurse and client (Registered Nurses’ Association of Ontario, 2002). The nurse approaches this partnership with self-awareness, trust, respect, openness, empathy and sensitivity to diversity, reflecting the uniqueness of the client.

The registered nurse:

NCP-1: applies the principles of a therapeutic nurse-client relationship and responds appropriately (e.g., openness, non-judgmental attitude, active listening, self-awareness).

NCP-2: uses therapeutic verbal and non-verbal communication techniques with the client.

NCP-3: establishes a therapeutic relationship with the client (e.g., maintaining professionalism, maintaining boundaries).

NCP-4: fosters an environment that encourages questioning and exchange of information.

NCP-5: analyzes the impact of personal values and assumptions on interactions with clients (e.g., cultural safety, ethical issues).

NCP-6: applies principles of effective group processes (e.g., group roles, group phases, group dynamics, establishing group norms).

NCP-7: demonstrates sensitivity to and respect for diversity in health practices and beliefs (e.g., sexual orientation, gender identity, child birth practices, dietary differences, gender, beliefs, values, spirituality, culture, language).

NCP-8: ensures that the client’s informed consent has been obtained prior to providing nursing care, including involving others in the care (e.g., implied consent for nursing care).

NCP-9: supports the informed choice of the client in making decisions about care (e.g., right to refuse, right to request care, right to choose, right to participate in research).

NCP-10: facilitates and respects the client’s informed choice to use alternative or complementary therapies (e.g., aromatherapy, acupressure, therapeutic touch, nutritional supplements, diets).

NCP-11: collaborates with clients in developing strategies to accommodate or modify health practices (e.g., integrating traditional food into a diabetic diet, modifying built environments, promoting healthy choices in schools).

NCP-12: provides care that is supportive to the client experiencing loss (e.g., loss of health, amputation, natural disaster, chronic illness, death).

NCP-13: promotes the client’s positive self-concept (e.g., supporting cultural and spiritual preferences, validating the client’s strengths, promoting the use of effective coping techniques, building community capacity).

NCP-14: uses principles/strategies related to teaching and learning to meet the client’s learning needs (e.g., assessing readiness to learn, identifying strategies for change, establishing an environment conducive to learning, evaluating learning process, using theoretical approaches, using social marketing).

Health And Wellness

Registered nursing competencies in this category focus on recognizing and valuing health and wellness. The category encompasses the concept of population health and the principles of primary health care. Registered nurses partner with clients to develop personal skills, create supportive environments for health, strengthen community action, reorient health services and build healthy public policy. Nursing practice is influenced by continuing competency, determinants of health, life phases, demographics, health trends, economic and political factors, evidence-informed knowledge and research.

The registered nurse:

HW-1: collaborates with clients to identify priority areas for health promotion (e.g., healthy public policy, environmental health, stress management, social justice).

HW-2: assists clients in understanding links between health promotion strategies and health (e.g., education programs regarding cancer risks, health fairs, anti-smoking campaigns, handwashing campaigns, ergonomics).

HW-3: collaborates with key partners in health promotion activities (e.g., community leaders, public- and private-sector organizations, special interest groups).

HW-4: collaborates with clients to prioritize needs and develop prevention strategies (e.g., safe needle exchange, condoms in public places, reading nutritional labels).

HW-5: collaborates with clients and other health-care providers to respond to rapidly changing complex health risks (e.g., SARS outbreak, Norwalk virus, antibiotic-resistant organisms, pandemic).

HW-6: collaborates with clients to identify appropriate groups and resources for mutual aid, support and community action (e.g., poverty, homelessness, marginalized and vulnerable populations).

HW-7: collaborates with other health-care team members to implement strategies that prevent violence, abuse and neglect (e.g., using screening tools, providing information).

HW-8: collaborates with other health-care team members in implementing strategies related to the prevention and early detection of prevalent diseases (e.g., cardiovascular disease, cancer, diabetes, communicable disease).

HW-9: collaborates with other health-care team members in implementing strategies related to the prevention of addictive behaviours (e.g., smoking, substance use, gambling).

HW-10: collaborates with other health-care team members in implementing strategies to promote mental health (e.g., stress management, support groups, coping strategies, public policy, crisis intervention).

HW-11: coordinates activities with the client and others to facilitate continuity of care (e.g., cardiac rehabilitation, breastfeeding support, nutrition program).

HW-12: promotes and utilizes safety measures to prevent injury to clients (e.g., accessibility of a call bell, supervision, diffusion of potentially violent situations, suicide prevention, least restraint, falls prevention, seat belts, bicycle helmets, smoke alarms, infant car seats).

HW-13: promotes healthy lifestyle practices (e.g., physical activity and exercise, nutrition, rest/sleep, stress management, sexual health, family planning, contraception, hygiene, waste disposal, food preparation, infection prevention and control, smoking cessation, mental health).

HW-14: implements strategies related to the safe and appropriate use of medication (e.g., overuse or underuse of antibiotics, polypharmacy, complementary medicine, over-the-counter medication, medication reconciliation).

HW-15: takes action to address actual or potential risk factors related to health (e.g., food access, unsafe sexual practices, inactivity, smoking).

HW-16: takes action to address actual or potential environmental risk factors (e.g., incidents and accidents, environmental contaminants, mechanical equipment, infectious diseases).

HW-17: takes action to address actual or potential risks of abuse (e.g., intimate partner violence, older adult abuse, child abuse, sexual abuse, bullying, substance abuse, workplace incivility).

HW-18: participates in preventive strategies related to workplace safety (e.g., occupational health and safety practice, latex sensitivity protocols, needleless systems, musculoskeletal injury prevention, protective equipment, WHMIS, managing aggressive and violent behaviour, pandemic planning, healthy workplace environment initiative).

HW-19: incorporates determinants of health into the plan of care (e.g., adequate income, food and water safety, adequate housing and shelter).

HW-20: incorporates research about health risks and risk/harm reduction to support evidence-informed practice (e.g., second-hand smoke, Pap smears).

HW-21: uses the appropriate protocol when there is risk of communicable disease transmission (e.g., education on hand hygiene, isolation protocol, adhering to reporting protocols, encouraging needle exchange program, participating in immunization programs).

HW-22: supports the client in role change and/or developmental transitions (e.g., parenting groups, retirement, job loss, puberty, menopause).

HW-23: documents relevant data related to health promotion, risk reduction and injury and illness prevention (e.g., needs assessment, program planning, implementation, evaluation).

HW-24: uses safety measures to protect self, colleagues and clients from injury (e.g., non-scented products, harassment, psychological abuse, physical aggression, safe walking buddy system, falls prevention, workplace incivility).

HW-25: provides education about immunization programs.

HW-26: provides evidence-informed health-related information to clients (e.g., credible electronic sources, relevant and current information).

HW-27: uses data collection techniques that are appropriate to the client and the situation (e.g., community assessment, assessment tools).

Changes In Health

Registered nurse competencies in this category focus on care across the lifespan of the client who is experiencing changes in health. The competencies in this category thus focus on health promotion and illness prevention activities, as well as on acute, chronic, rehabilitative, palliative and end-of-life care. Such nursing actions may be delivered across a range of settings. Essential aspects of nursing care include critical inquiry, safety, solution-focused approaches, reflective practice and evidence-informed decision-making. Registered nurses collaborate with clients and other health-care professionals to identify health priorities and empower clients to improve their own health. In responding to and managing health situations, nurses promote optimal quality of life and development of self-care capacity and dignity during illness and during the dying and death process.

The registered nurse:

CH-1: collaborates with clients in a holistic assessment (e.g., physical, emotional, mental, spiritual, cognitive, developmental, environmental, meaning of health). (Jurisdictional Collaborative Process, 2006)

CH-2: involves clients in identifying their health needs, strengths, capacities and goals (e.g., the use of community development and empowerment principles, networking strategies, understanding of relational power, community capacity assessment).

CH-3: collects assessment data from a range of appropriate sources (e.g., the client, previous and current health records, nursing care plans, collaborative plans of care, family members, significant others, substitute decision-makers, census data, epidemiological data, evidence-informed data, referrals, other health-care providers).

CH-4: uses appropriate assessment techniques for data collection, (e.g., observation, inspection, auscultation, palpation, percussion, selected screening tests, pain scales, interview, consultation, focus group, measuring and monitoring).

CH-5: validates data collected with the client and appropriate sources (e.g., medication reconciliation, health history, consultations, referrals).

CH-6: analyzes data to establish relationships and draw conclusions from the various data collected (e.g., determining relationship between health assessment and laboratory values).

CH-7: applies knowledge from nursing and other disciplines concerning current health situations (e.g., the health-care needs of older adults, vulnerable and/or marginalized populations, health promotion and injury prevention, pain prevention and management, end-of-life care, addiction, blood-borne pathogens, traumatic stress syndrome). (Jurisdictional Collaborative Process, 2006)

CH-8: applies knowledge from the health sciences (e.g., physiology, pathophysiology, psychopathology, pharmacology, microbiology, epidemiology, genetics, immunology, nutrition, sociology). (Jurisdictional Collaborative Process, 2006)

CH-9: identifies actual and potential changes in health (e.g., pain management, disability, immobility).

CH-10: collaborates with the client in developing and implementing the plan of care (e.g., setting priorities, establishing target dates, selecting relevant interventions, developing teaching plans, administration of insulin, home IV and TPN programs, referring to self-care groups).

CH-11: incorporates the client’s personal strengths and resources in meeting self-care needs (e.g., healthy habits, personal beliefs, complementary and alternative therapies, social supports, coping strategies).

CH-12: uses evidence-informed knowledge to assist the client to understand interventions and their relationship to expected outcomes (e.g., possible risks and benefits, discomforts, inconveniences, costs).

CH-13: individualizes the plan of care to apply interventions consistent with the client’s capacities, identified priorities and health situation (e.g., geriatric care, palliative care).

CH-14: collaborates with the client during the care process to prepare for transfer and discharge (e.g., discharge teaching and planning, transfer of care).

CH-15: documents nursing practice (e.g., assessment data, written plan, actual care, evaluation).

CH-16: applies technology in accordance with available resources and the client’s needs (e.g., relevant web-based material, e-documentation, telehealth, patient lifts, home IV pumps).

CH-17: supports the client through transitions related to health situations (e.g., new diagnoses, chronic illness, dying process).

CH-18: facilitates physical, psychological and psychosocial adjustment (e.g., therapeutic communication, counselling, appropriate referral, chronic disease management).

CH-19: facilitates the involvement of family and significant others in collaboration with the client.

CH-20: prevents and minimizes complications (e.g., turning and positioning, early detection and intervention).

CH-21: evaluates changes in the client’s health status (e.g., decreased oxygen saturation, decreased urine output).

CH-22: manages multiple nursing interventions simultaneously (e.g., prioritizing and organizing interventions).

CH-23: communicates accurate and relevant information about the client’s health situation to appropriate health-care team members.

CH-24: intervenes in a timely manner to changes observed in the client’s health situation.

CH-25: evaluates the effectiveness of nursing interventions in collaboration with the client (e.g., learning needs, comparing actual outcomes to anticipated outcomes).

CH-26: modifies plan of care based on an ongoing holistic assessment of the client’s changing health situation.

CH-27: initiates urgent inclusion of the health-care team members in response to the client’s changing health status (e.g., hemorrhage, imminent birth, low blood pressure, drug reactions).

CH-28: coordinates activities with the client and other members of the health-care team to promote continuity and consistency of care within and across settings (e.g., referrals, unit reports, community health centres, air and ground transport).

CH-29: consults with other health-care team members to analyze and plan care in complex health situations (e.g., obesity, comorbidities, chemical exposure, burns, cancer, complex family situations). (Jurisdictional Collaborative Process, 2006)

CH-30: prepares the client for diagnostic procedures and treatments (e.g., explanation, evidence-informed information, tests, obtaining specimens).

CH-31: provides preoperative and postoperative care.

CH-32: promotes oxygenation (e.g., positioning, deep breathing and coughing exercises, oxygen therapy, oral and nasal suctioning).

CH-33: promotes circulation (e.g., active or passive exercises, positioning, mobilization, cast care).

CH-34: promotes and monitors fluid balance (e.g., intake and output, weight, non-invasive hemodynamic measurement, measuring abdominal girth).

CH-35: promotes and manages adequate nutrition (e.g., burns, inflammatory bowel disease, diabetes, HIV/AIDS, infant gastric reflux, obesity, malnutrition).

CH-36: administers and manages parenteral and enteral nutrition (e.g., TPN, nasogastric tube).

CH-37: promotes and manages adequate urinary elimination (e.g., stoma care, bladder retraining, self-catheterization, bladder irrigation, bladder catheterization, pharmacological measures).

CH-38: promotes and manages adequate bowel elimination (e.g., bowel retraining, ostomy care, enema, rectal tubes, pharmacological measures, dietary measures).

CH-39: promotes and ensures a client’s proper body alignment (e.g., proper positioning, external immobilizing devices).

CH-40: promotes mobility (e.g., active and passive exercises, early ambulation, activities of daily living, prosthetic and mobilizing devices, use of ergonomics).

CH-41: promotes and maintains tissue integrity (e.g., providing skin and wound care).

CH-42: promotes and maintains comfort (e.g., the nurse’s presence, warm and cold application, touch, positioning).

CH-43: determines and implements appropriate sensory stimulation for the client’s health situation (e.g., touch with unconscious client, minimizing environmental stimuli, sensory stimulation for premature infant in isolette, adolescent in isolation).

CH-44: evaluates safe use of prescribed and non-prescribed medication (e.g., safe dosage and route, food–drug interactions, drug–drug interactions, age, weight).

CH-45: takes action with unsafe medication packaging and/or orders.

CH-46: calculates medication dosage.

CH-47: administers medication (e.g., right client, drug, dose, route and time; documentation; client’s rights; right reason; allergies).

CH-48: evaluates client’s response to medication (e.g., desired effects, adverse effects, interactions).

CH-49: assesses when a p.r.n. medication is indicated (e.g., analgesics, inhalers, antihypertensives, antianginals, laxatives, antianxiety agents).

CH-50: takes action when desired responses to medication are not attained.

CH-51: assists the client to manage pain with non-pharmacological measures (e.g., applying heat and cold, touch, massage, visual imagery, turning and positioning).

CH-52: assists the client to manage pain with pharmacological agents or devices (e.g., non-opiates, opiates, epidural analgesia, patient-controlled analgesia [PCA]).

CH-53: collects and communicates accurate medication information (e.g., medication reconciliation upon admission, at transfer of care, at discharge).

CH-54: administers blood and blood products safely.

CH-55: manages central venous access devices (e.g., implanted devices, PICC lines, infusion pumps).

CH-56: manages drainage tubes and collection devices (e.g., chest tubes and vacuum drainages).

CH-57: inserts, maintains and removes nasogastric tubes.

CH-58: inserts, maintains and removes peripheral intravenous therapy.

CH-59: applies routine/standard precautions.

CH-60: intervenes in a rapidly changing health situation: acute cardiovascular event (e.g., myocardial infarction, unstable angina).

CH-61: intervenes in a rapidly changing health situation: acute neurological event (e.g., brain attack [stroke], trans-ischemic attack [TIA], seizure, head injury).

CH-62: intervenes in a rapidly changing health situation: shock (e.g., hypovolemic, anaphylactic, neurogenic, cardiogenic, septic and hemodynamic deterioration).

CH-63: intervenes in a rapidly changing health situation: acute respiratory event (e.g., acute asthma, pulmonary embolus, pulmonary edema).

CH-64: intervenes in a rapidly changing health situation: cardiopulmonary arrest.

CH-65: intervenes in a rapidly changing health situation: perinatal (antepartum, intrapartum, postpartum, newborn).

CH-66: intervenes in a rapidly changing health situation: diabetes crisis (e.g., diabetic coma, hyperglycemia, hypoglycemia, ketoacidosis).

CH-67: intervenes in a rapidly changing health situation: mental health crisis (e.g., psychotic episode, neuroleptic malignant syndrome, suicide ideation, delirium, acute onset of extrapyramidal side-effects).

CH-68: intervenes in a rapidly changing health situation: trauma (e.g., burns, fractures).

CH-69: intervenes in a rapidly changing health situation: postoperatively (e.g., malignant hyperthermia, hemorrhage, wound dehiscence).

CH-70: intervenes in a rapidly changing health situation: acute renal failure (e.g., nephrotoxins).

CH-71: provides supportive care to meet hospice, palliative or end-of-life care needs of dying clients (e.g., symptom control, spiritual care, advocacy, family counselling, support for clients and significant others, advance care planning, grief and bereavement counselling). (Jurisdictional Collaborative Process, 2006)

CH-72: intervenes to meet spiritual needs (e.g., assessing for spiritual distress, providing time for prayer or meditation, appropriate referral, cultural safety).

CH-73: facilitates with the client to explore and access community resources (e.g., self-help groups, geriatric day programs, respite care, finances, transportation, social networks).

CH-74: facilitates the client’s development of independence and safety in activities of daily living (e.g., removal of scatter rugs, keeping essential furniture on one level of the house, raised toilet seat, ordering specialized equipment such as a walker and special utensils, consulting with other health-care team members).

CH-75: facilitates social well-being of the client (e.g., encouraging and creating opportunities for social participation, encouraging development of new interests and support systems, facilitating of peer-to-peer helping model).

CH-76: facilitates the client’s reintegration into family and community (e.g., adaptation to role transitions, physical mobility, self-help groups).

CH-77: provides supportive care to clients with chronic health situations (e.g., outpatient clinics, adult day care, respite care, pain management, symptom management, polypharmacy, group therapy, addictions counselling).

CH-78: demonstrates understanding of organizational responses and appropriate nursing roles in emergency community disasters and emerging global health issues (e.g., mass casualty response, bioterrorism, pandemic, emergency preparedness/disaster planning, food and water safety).

CH-79: takes appropriate nursing actions in disaster situations (e.g., mass casualty response, bioterrorism).