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Taking Actions On Concerns About Practice Workbook (British Columbia College of Nurses & Midwives)

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Taking Actions
BCCNM LEARNING MODULE — WORKBOOK
On Concerns About Practice
Introduction
This workbook offers activities that allow you to apply ideas presented in the
on-line Learning Module. It includes Workbook Activities that are related to
various topic areas addressed in the Learning Module. As you work through
the module, you will be directed to complete a specific Workbook Activity. It
also includes pages for you to record your thoughts related to learning in this
module. There are two pages: “Thoughts from Reflection Points” provides
a space to jot down your thoughts related to “Reflection Points” included in
the Module, while “Insights and affirmations” provides a space to note new
insights related to taking action to any concerns about practice that you might
have. This information will be useful for you in completing a “Plan For Action”
at the completion of this module.
page 2taking actions on concerns about practice workbook
1
page 3
Workbook Activity # 1:
Our Code of Ethics
Before going further with the module, take the time to read the BCCNM Professional Practice Standards
and the CNA Code of Ethics (links at end of activity).
1. Identify the specific nursing value and the reference, direct or implied, to identify/report unsafe practice or
professional misconduct in the different values. Write the examples below.
2. How many references did you find?
3. What conclusion do you draw from the Professional Practice Standards and the Code of Ethics as regards your
duty to report?
4. How does this information support you as you start to work through a professional practice concern you are
faced with?
BCCNM Professional Practice Standards:
RN: https://www.bccnm.ca/RN/ProfessionalStandards/Pages/Default.aspx
NP: https://www.bccnm.ca/NP/ProfessionalStandards/Pages/Default.aspx
CNA Code of Ethics:
http://www.cna-aiic.ca/en/on-the-issues/best-nursing/nursing-ethics
taking actions on concerns about practice workbook
page 4taking actions on concerns about practice workbook
Workbook Activity # 2:
Reflecting on a Professional
Practice Problem
Use the guiding questions from the “Resolving professional practice problems” web page (link at end of
activity) to reflect on the practice issue you are concerned about. Jot down some notes in answer to the
questions. Do not worry about having ideas to resolve the problem at this stage, just become clear on the risks to
the clients and how the problem can conflict with BCCNM Standards of Practice.
• What are the risks to clients? Describe the problem and the contributing factors.
• Note specific examples (observations, dates, and times) Use initials for names.
• How does the problem conflict with BCCNM Standards of Practice? Which Standards?
• What agency or department policies are you unable to meet? Give examples.
• Who else is affected by the problem? Is this a problem for other health professionals or departments?
• How could you resolve this within the practice team? If you are not able to, who would you go to?
• What resources might give direction to resolution of the problem?
• What ideas can you offer to resolve the problem?
Resolving Professional Practice Problems
Web Page:
http://www.bccnm.ca/RN/learning/professional/Pages/ResolvingProfessionalPracticeProblems.aspx
2
page 5taking actions on concerns about practice workbook
Workbook Activity # 3:
Assessing My Situation
Having completed the Module Introduction and listened to the characters that will guide us through the
module, take 15 minutes to reflect on the potential practice concern you are facing, or one you can anticipate
and answer the below questions:
• What is my understanding of the professional practice concern (or potential) situation I am faced with?
• What are my thoughts about what I should do? E.g. I need to talk to Jason and tell him what I have observed, but I
don’t know how to do that etc.
• What are my feelings about the situation? E.g. I am so conflicted about what to do. I know what I should do, and I
feel scared. What if Jason doesn’t talk to me again…….what if I am making a mountain out of a molehill…..maybe
the charting errors in the last week were just because he was overwhelmed? I feel worried I am going to make things
worse on the unit. I wish I could feel confident about what to do.
3
page 6taking actions on concerns about practice workbook
Workbook Activity # 4:
Coaching Davina
4
1. Imagine Davina comes to you and explains what she is thinking and feeling about the situation. Having read the
Taking Action on Concerns About Practice Web Page complete the Worksheet to Reflect on Concerns About
Practice (links at end of activity), and coach Davina on what she should do next.
• How have clients or others been put at risk or harmed? Note specific examples
(observations, dates, times). Treat all information as confidential. Use initials for names.
• How has this come to your attention?
• Describe the behaviour that concerns you. Is there a pattern of behaviour? Note specific examples.
• How does the behaviour fail to meet professional or ethical standards?
• How does the person respond to feedback regarding the behaviour?
• What action(s) do you need to take? What is your plan?
2. In your opinion, is there a practice issue with Ryan’s behaviour?
3. What would you suggest she does next?
• Raise her concerns with Ryan directly and respectfully, making sure he understands that she has observed a
practice issue that is a pattern. She recommends he reviews the protocols himself, or he requests help from
his manager to get training from a CNE in the protocols.
• Raise her concerns with her manager, before going to Ryan and letting him know what she has observed and
how she has told the manager to provide support.
• Ask her manager to deal with it and not tell Ryan anything.
• Go to BCCNM Practice Support Consultant for advice.
• Wait and see if she notices any other examples of the practice issue.
• Other options?
page 7taking actions on concerns about practice workbook
Workbook Activity # 4:
Coaching Davina (continued)
4
4. You may be thinking you could do any of the above possibilities. Let us run through them.
• Raise her concerns with Ryan directly and respectfully, making sure he understands that she has observed
a practice issue that is a pattern. She recommends he reviews the protocols himself, or requests help from
his manager to get training from a CNE in the protocols.
- This is one way to go, if Davina is comfortable raising her concerns with Ryan and knows he will follow
through
• Raise her concerns with her manager, before going to Ryan and letting him know what she has observed.
- This is another approach, where Davina is demonstrating her concern about the unsafe practice by
involving the manager early and being transparent with Ryan about it.
• Ask her manager to deal with it and not tell Ryan anything
- This approach which will demonstrate she is fulfilling her legal, ethical and professional duty to report,
and if she is uncomfortable being direct with Ryan this is an option. However, will she feel comfortable
not being transparent with Ryan, they are friends after all?
• Go to BCCNM Practice Consultation Services for advice.
- If all of 1 – 3 offer pros and cons and it is hard to decide which option to advise, then this is the perfect
place to start – she could get advice on the specific situation from Practice Consultation Services. She
just needs to give them a call and have a confidential conversation with a consultant who will help
guide her through the decision making on next steps.
• Wait and see if she notices any other examples of the practice issue.
- This option is a “no”. It is clear there is a pattern of unsafe behaviour, therefore, Davina needs to be
advised to take action now and not wait any longer. The safety of the public is at risk and she has a
professional, ethical and legal duty to take action.
Taking Actions
on Concerns About Practice Web Page:
https://www.bccnm.ca/RN/resourcescasestudies/resources/dutytoreport/Pages/taking_action.aspx
page 8taking actions on concerns about practice workbook
Workbook Activity # 5:
The “What Ifs” Approach
5
1. In your workbook write down all the “what ifs”, your mind generates when you think of taking action on
practice concern you have observed
• What if I am direct with her/him and he/she gets defensive and angry?
• What if she/he denies what I have observed, what will I do then?
• What if the manager thinks I am a snitch?
• What if I lose her/his friendship?
• Others?
2. If you haven’t already, consider the questions,
• What if, I do nothing?
• What if this nurse was caring for my mum, dad, child, partner, brother, sister, best friend would I sit
back and not speak up?
3. Notice what you are feeling and thinking as you consider the “what ifs” you have generated and journal
your answers.
• What have you noticed?
• How is this reflection going to help you take the next steps?
page 9taking actions on concerns about practice workbook
6
Workbook Activity # 6:
Identifying the Standards of Practice
When you describe the practice concern you are observing, what standards of practice is it
contravening? Write your insights below. Don’t forget to go to review the BCCNM Web Site for
more information on these Standards. (link at end of activity)
1. Describe the Practice Concern
2. Describe the Standards of Practice and/or Ethical requirments it contravenes
page 10taking actions on concerns about practice workbook
Workbook Activity # 7:
Assessing and Identifying the
Practice Issue
7
1. Put yourself in the shoes of Edel, and review the web page on "Taking actions as concerns about
practice" as if you were considering Analise’s behaviour (link at end of activity).
• What behaviours concern you?
• What workplace problems are created by the behaviour?
• What is the actual or potential harm resulting from the behaviour?
• Is client or staff safety an issue? If so, How?
• What are the events or situational factors surrounding the behaviour that might be contributing
to or reinforcing the behaviour?
• What is the nurse’s level of awareness of the problem?
2. After reviewing the web site examples of practice problems in relation to the Standards, if you
agree that Analise is contravening a Standard which one could it be? Write this down below.
3. Now apply this learning to the practice concern you have -
If you are a manager/employer concerned about a nurse who may have a professional practice
issue, complete the “Questions to Consider” and jot down your thoughts below….
• What behaviours concern you?
• What workplace problems are created by the behaviour?
page 11taking actions on concerns about practice workbook
Workbook Activity # 7:
Assessing and Identifying the
Practice Issue (continued)
7
• What is the actual or potential harm resulting from the behaviour?
• Is client or staff safety an issue? If so, How?
• What are the events or situational factors surrounding the behaviour that might be contributing
to or reinforcing the behaviour?
• What is the nurse’s level of awareness of the problem?
What have you learned from this assessment? Is it a practice issue?
Taking Actions
on Concerns About Practice Web Page:
https://www.bccnm.ca/RN/resourcescasestudies/resources/dutytoreport/Pages/taking_action.aspx
page 12taking actions on concerns about practice workbook
Workbook Activity # 8:
Preparing to Act
8
1. Now, review the web page on "Taking actions on concerns about practice"
before we hear about how Edel has prepared herself for a conversation with Analise.
(link at end of activity).
2. Start to complete your own assessment of the practice concern you want to address with a registrant
Taking Actions
on Concerns About Practice Web Page:
https://www.bccnm.ca/RN/resourcescasestudies/resources/dutytoreport/Pages/taking_action.aspx
page 13taking actions on concerns about practice workbook
9
Workbook Activity # 9:
Learning Plan and Practice Review
Dry Runs
T
ake the time now to complete a Learning Plan for a person who has a practice issue, and input the
feedback you would like to give someone on their practice ready for a review.
Don’t forget to look back at the assessments and activities you have already completed in your
workbook so far.
page 14taking actions on concerns about practice workbook
Workbook Activity # 10:
Action Planning
10
Nursing Process Framework
Well done on completing the Work Through Professional Practice Issues module!
Now take some time and create your comprehensive action plan to assist you take the next steps. Answer the
questions below and remember to look back at all the activities you have completed in this workbook already
that will contribute to your work plan.
1. What is my assessment of the situation? Is there a practice or environment issue here, or both? (Assessment)
2. How would I describe the practice problem? (Identify)
Assessment
Planning &
Intervention
Evaluation
Identify
Problem
page 15taking actions on concerns about practice workbook
Workbook Activity # 10:
Action Planning (continued)
10
3. What will you plan to do? (Plan)
4. How will you carry out the action? (Implementation)
5. What support do you need? i.e. how will you prepare yourself?
6. How will you know you have successfully worked through this practice issue? i.e. what measures of success will
I look for? (Evaluation)
Notes from Reflection Points
page 16taking actions on concerns about practice workbook
Taking Action On My Concerns
About Practice:
Affirmations and Insights:
page 17taking actions on concerns about practice workbook
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Completed 27 February 2021

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