Regulation of the Nursing Profession

Addressing Complaints

http://www.cno.org/globalassets/docs/prac/41062.pdf
Process

Slide 2
Case Scenario
Olivia, an RPN, is caring for a post-operative client on a
surgical floor. Her client has been taking fluids readily and
is responding well to oral pain medications. Olivia wants
to discontinue the saline lock. The facility policy does not
require a physician’s order and considers this action a
nursing decision based on the assessment of the client’s
hydration and future needs.

Can Olivia, an RPN, remove the intravenous?

a) Yes, if she has the knowledge, skill and judgment
b) No, RPNs do not have the authority to remove an IV
Case Scenario
An RPN is caring for a client who requires an
intramuscular injection of Gravol. Can RPNs
perform this controlled act?

Yes, if the RPN has the knowledge, skill and judgment

to perform the procedure and can manage the possible
outcomes
 No, RPNs do not have access to this controlled act
Case Scenario
Ruth, an RPN, is assigned to a client who has developed
hives shortly after Leonora, an RN, started an IV
medication. Ruth asks Leonora if the medication should
be stopped. Leonora decides to continue the IV
medication and instructs Ruth to monitor the client. Ruth
notices that the client’s hives are getting worse. Ruth
documents that she notified Leonora about the client’s
condition but takes no further action.
Does Ruth’s accountability stop here?
a) Yes. The RN has more knowledge, so Ruth should listen
to Leonora and continue to monitor the client.
b) No. If Ruth believes that further action should be taken,
she is required to take immediate action.
Case Scenario
What are the key differences between RNs and RPNs?
a) Their level of foundational knowledge, which
influences their level of autonomous practice.
b) RNs are accountable for the actions of RPNs.
c) Only RNs have the authority to perform the three
controlled acts authorized to nursing
Case Scenario
An elderly client, Louis, who has had diabetes for several
years, is being treated for an infected foot ulcer that is
responding well to treatment. Louis’s blood glucose
levels have never fluctuated during treatment, and he has
a daughter who is involved with his care.
Are the overall client care requirements considered:
a) Less complex
b) Moderately complex
c) Highly complex
Case Scenario
An elderly client, Louis, who has had diabetes for several
years, is being treated for an infected foot ulcer that is
responding well to treatment. His blood glucose levels
are in the normal range but require frequent monitoring.
Louis has a history of heart failure which is managed by
medication and lifestyle modifications. His daughter,
who was involved with his care, has moved away.
Are the overall client care requirements considered:
a) Less complex
b) Moderately complex
c) Highly complex
Case Scenario
An elderly client, Louis, who has had diabetes for several
years, is being treated for an infected foot ulcer that is
not responding well to treatment. His blood glucose
levels are not well managed and require frequent
monitoring and changes in insulin dosage. He has a
history of heart failure, and the nurse has noted a
decrease in urinary output in the past eight hours. His
daughter, who was involved with his care, has moved
away.
Are the overall client care requirements considered:
a) Less complex
b) Moderately complex
c) Highly complex
Case Scenario
Maude, a 72-year-old client with a history of heart
failure, is admitted to the medical unit during the night
shift for an infected wound. Maude has a saline lock and
is receiving intravenous antibiotics. Maude’s daughter
will remain with her for the rest of the night. There are
standardized assessment tools and an established care
plan in place. There are three senior RNs and two RPNs
familiar with the practice setting working this night shift.
The RNs and RPNs working the shift have the education
and experience to administer intravenous medications.
What category of nurse could be assigned to the
client? a) RPN b) RN c) RPN, in consultation with an
RN
Case Scenario
Maude, a 72-year-old client with a history of heart
failure, is admitted to the medical unit during the night
shift for an infected wound. Maude has a saline lock and
is receiving intravenous antibiotics. The night nurse
notes a decrease in urinary output. There are standardized
assessment tools, and the care plan has been updated to
monitor signs of heart failure. There are two RNs and
two RPNs on the shift. The RNs and RPNs working the
shift have the education and experience to administer
intravenous medications.
What category of nurse could be assigned to the
client? a) RN b) RPN c) RPN in consultation with the
RN
Case Scenario
It’s the night shift on a long weekend. One RN has called
in sick, leaving one RN and two RPNs on shift. Maude, a
72-year-old client with no known history of heart failure,
was transferred from the emergency department earlier in
the day. Maude has diabetes and is being treated for an
infected wound. She has an IV of normal saline running
at 125 cc/hr and is receiving IV antibiotics. Maude is
complaining of shortness of breath and has pain around
her wound. Her blood glucose levels are elevated. The
doctor has been paged, but there has been no response
yet.
What category of nurse could be assigned to the
client? a) RN b) RPN c) RPN in consultation with an
RN
 Summary

It is important for the student to review the regulations

in his or her province

It is essential that nurses understand the expectations

associated with being a member of a regulated
profession and the responsibilities and obligations that
come with the privilege.

These standards are significant not only in the ongoing

evaluation of nurses with respect to safe, competent, and
ethical care but also in measuring the nurse’s behaviour
with respect to legal and professional expectations.

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.