Resolving Professional Practice Issues - A Toolkit for Registered Nurses
© 2012, College of Registered Nurses of Nova Scotia
Suite 4005 – 7001 Bayers Road, Halifax, NS B3L 2C2 info@crnns.ca www.crnns.ca
All rights reserved. Individual copies of this document may be downloaded from the College website. Portions of this publication may be reproduced for personal use. Reproduction of this document for other purposes, by any means, requires permission of the copyright owner.
This document replaces the brochure, Professional Practice Issues Resolution Framework (2009).

Introduction ....................................................................................................................................... 4
Definition ........................................................................................................................................... 4
Purpose .............................................................................................................................................. 4
STEP 1: Identify the Issue ................................................................................................................. 5
STEP 2: Define how and when Client Care and/or Service is Affected .......................................... 5
STEP 3: Resource Identification ....................................................................................................... 6
STEP 4: Discuss and Document ....................................................................................................... 7
STEP 5: Evaluation ............................................................................................................................ 7
Appendix A - Professional Practice Issues Resolution Framework ................................................. 9
Appendix B – Is it a Professional Practice Issue? ............................................................................. 10
Appendix C – Organizational Chart ................................................................................................. 11
Appendix D – Sample Letter ............................................................................................................. 12

As a registered nurse you are held accountable and responsible for making decisions that are consistent with safe, competent, and ethical practice on a daily basis. At the same time, you face diverse and complex issues that impact the delivery of your nursing care.
The following resource has been designed to help identify, communicate and resolve professional practice issues you may encounter in your clinical area/practice environment.
A professional practice issue is any issue or situation that either compromises client care/service by placing a client at risk, or affects a nurse’s ability to provide care/service consistent with the Standards of Practice for Registered Nurses , Code of Ethics , other standards and guidelines, or agency policies or procedures.
This toolkit consists of a framework for you to use when considering professional practice issues and provides tools to communicate your concerns. This five-step framework is intended to provide registered nurses with an approach to develop solutions to issues in any context of practice. Each step of the framework is described in writing and is represented by a graph in the appendix. The communication tools are designed to help you communicate your concerns with the management team in your organization .
If further assistance is needed in interpreting this framework please don’t hesitate to contact a College Practice Consultant for support. Please call (902) 491-9744 or email practice@crnns.ca.
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The following questions will help determine if you are dealing with a professional practice issue:
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Does the issue present a risk to clients?
Does the issue conflict with standards, guidelines, and/or policies?
Does the issue make it difficult or impossible to practice according to the provincial
Standards of Practice for Registered Nurses , the Registered Nurses Act , the CNA Code of Ethics for Nursing other acts or legislation, agency policy/procedures?
Does the issue interfere with your individual level of competence?

If you answered “yes” to any of these questions, you may have a professional practice issue. If you answered “no”, your issue is not likely a professional practice issue and it should be discussed with your first-line manager.
Other questions that may help to clarify if you are dealing with a professional practice issue include:
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Does the absence of policy/procedures/guidelines contribute to this issue?
Are there common factors associated with this issue (people/settings/situations)? If so, what are they?
Is the issue recurring?
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If a concern is identified with a colleague’s practice you should attempt to discuss it and resolve it with the individual involved. If you do not feel comfortable to have that conversation, or if practice is unchanged after having the conversation, the manager should be involved. Depending on the potential for risk to a client, you may have to notify the manager immediately.
Once you have identified that you are facing a professional practice issue, and before you can describe how client care and/or service is affected, you will need to isolate the issue.
You can do this by identifying factors in the practice environment that are contributing to the development of the issue. Colleagues and nurse-managers can contribute significantly to the successful identification of issues.
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Common practice issues are listed below. Review the list and determine those that describe, influence, or are contributing to your situation. For example, is the issue related to the Standards? Is it an ethical issue? When you have identified the practice issue, develop a detailed statement about the issue, describing its impact on the client and on nursing practice.
There are a number of resources available to help resolve issues, including human and practice environment resources. Working collaboratively with others in your work environment can help. Review the examples of resources listed below and identify those that may be of help to you.
Managers Colleagues
Other health professionals
QA/QI departments
Department of Health
CRNNS staff
Unions
Canadian Nurses Protective
Society (CNPS)
Educational institutions
Human Rights Commission
Department of Labour
Risk Management department
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Standards for Nursing Practice
Agency policies and procedures
RN Act
Code of Ethics
Occupational Health and Safety Act Union contracts
CRNNS guidelines and position statements
After discussing your issue with the individuals/resources identified in Step 3, communicate the issue to your manager or other appropriate individual(s) verbally and in writing. Provide an objective and detailed description of the issue (date, time, place, persons, and data gathered in Step 2), expanding on how it affected/impacted client care.
Also include your actions in relation to the issue and proposed solutions. Request a written response from your manager or others involved by a specific date. Keep a copy of all documentation. (See Appendix D for a sample letter).
When considering if the professional practice issue has been successfully resolved, it is important to evaluate both how the framework was implemented and the outcome of the issue.
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Process
The following questions may be helpful as you consider if the professional practice issue has been successfully resolved. If the issue/concern has not been resolved it would be helpful to consider contributing factors and your next step(s). Were you able to clearly identify the issue? Could you define how and when client care/service was affected? Have the right people been involved in the discussions and the attempt to resolve the issue? If not, what could you do differently?
Outcome
Depending on the issue, it may not be resolved immediately and this should be considered in the evaluation of the outcome. If the issue has not been resolved, a discussion with your manager may be helpful to determine:
a) if the issue has been addressed, and
b) when resolution is likely.
If the issue has not been resolved, consider addressing the issue with the next level of management in your agency.
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It is not always easy to determine what a professional practice issue is. The following questions should assist you in considering if you are dealing with a professional practice issue that must be acted upon. It may be helpful to discuss these questions with colleagues to clarify issues and potential resolutions. During these discussions, it is imperative that the confidentiality of client information is always maintained.
If you answer ‘yes’ to any of the following questions you should meet with your manager to discuss your concerns.
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Is client safety compromised?
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Does the issue impact your ability to meet your Standards of Practice, Code of Ethics or organizational policies?
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Do other colleagues have the same concerns?
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Does the issue interfere with your individual level of competence?
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Does the absence of policy/procedures/guidelines contribute to this issue?

Are there common factors associated with this issue (people/settings/situations)?
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Is the issue recurring?
Adapted from the College of Registered Nurses of British Columbia – Worksheet to Reflect on a
Professional Practice Problem , 2011
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The hierarchical structure in health care settings can sometimes be confusing. The following chart is a tool to help you document the flow of communication to different members of the administrative team in your practice setting.
Date Notified
Date Notified
Date Notified
Date Notified
Charge Nurse
Supervisor
Manager
Director
Date Notified
Date Notified
Chief Nursing Officer
Vice President of Service
Area or Department
Date Notified
Date Notified
Chief Executive Officer
Practice Consultant
CRNNS (call at any point)
Date Notified Other
Adapted from the Saskatchewan Registered Nurses’ Association – Tools for Resolving Professional
Practice Issues, 2008
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Date
Manager Name
Title
Employer Address
Dear X,
I am writing this letter in follow up to our discussion on <date> regarding the professional practice concern we discussed, the impact of the issue on my ability to meet the <Standards of
Practice for Registered Nurses/Code of Ethics/organizational policies> and potential solutions.
My concern is <state concern>.
The incident occurred on <be specific, objective and factual, include exactly what happened, when it happened, and any other relevant information>.
The issue has impacted my ability to meet the <Standards of Practice for Registered Nurses/Code of Ethics/organizational policies> in the following ways <include relevant standards and indicators or other details as applicable>.
Based on our discussion when we met, I know you understand the seriousness of this situation and the potential impact on our ability to provide safe patient care. Possible resolutions we discussed were:
In closing I would like to thank you for taking the time to meet with me and discuss these concerns. As we discussed, I look forward to a response from you by <date>.
Sincerely
Name RN
Unit, Hospital
Adapted from the College of Registered Nurses of British Columbia – Getting Started: A Sample
Letter to Address Professional Practice Problems , 2011
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