Regulating psychiatric nurses to ensure safe and ethical care December 15, 2014, Revised September 29, 2017 s set out baseline requirements for specific aspects of Registered Psychiatric Nurses practice. They interact with other requirements such as the CRPNBC Code of Ethics, all the CRPNBC standards of practice, the CRPNBC bylaws and relevant legislation. Many statutes have mandatory reporting provisions that are applicable to Registered Psychiatric Nurses (RPNs). RPNs are expected to be aware of and comply with all their legal, professional and ethical reporting obligations. However, this practice standard refers specifically to obligations under the Health Professions Act. In B.C., the Health Professions Act establishes a legal duty for RPNs to report situations in which there is a good reason to believe that a health professional s 1 practice is impaired, incompetent or unethical 2 and may pose a danger to the public. The Health Professions Act also requires RPNs to report any sexual misconduct of a health professional. An ethical duty to report arises from the primary responsibility of RPNs, which is to provide safe, competent and ethical care to clients. This includes understanding how to respond in a situation in which another health professional is not providing safe, competent or ethical care. The obligation to take action is shared by RPNs, employers, regulatory bodies and other healthcare providers. PRINCIPLES The following principles set out the legal and ethical requirements for practice. Legal Duty 1. The legal duty to report under the Health Professions Act can be found in the following sections: Duty to report registrant, section 32.2 Duty to report respecting hospitalized registrant, section 32.3 Duty to report sexual misconduct, section 32.4. 1 In reference to the legal duty to report, health professional refers to a registrant of any health profession college under the Health Professions Act. 2 Words in bold and italics are defined in the glossary at the end. Page 1 of 5
2. RPNs must report in writing to the appropriate regulatory body when the public might be in danger because there is good reason to believe a health professional who is continuing to practice is: Suffering from a mental or physical ailment, an emotional disturbance or an addiction to drugs or alcohol that impairs his or her ability to practice; or Not competent to practice. 3. RPNs must report in writing to the appropriate regulatory body if they have good reason to believe that a health professional has engaged in sexual misconduct. However, if concerns about sexual misconduct are based on information from a client, RPNs must first obtain the client s consent before making a report. If the client does not have the capacity to consent to health care treatment, RPNs must obtain the consent of the client s parent, guardian or committee of the client before making a report under the Health Professions Act. Note: RPNs may have additional employment obligations to report any unprofessional conduct to their supervisor/employer and should also follow applicable employment policies. If the supervisor or employer is also a health professional, the report to the regulatory body may be generated at this level, in which case nothing further needs to be done by the registrant. However, if the supervisor or employer is not a health professional or does not report the unprofessional conduct to the appropriate regulatory body, the RPN must do so. The Health Professions Act protects an RPN from legal liability in circumstances where the nurse has a legal duty to report under the Act and makes a report in good faith. Ethical Duty 2 4. RPNs are attentive to signs that a colleague is unable, for whatever reason, to perform his or her duties, and they are ethically obligated to take the necessary steps to protect client safety. Consequently, RPNs may have an ethical duty to report to a health professional s regulatory body in the following situations: When a health professional has a pattern of incompetent practice (e.g., failing to assess clients; documenting incomplete or inaccurate information or not documenting at all). When a health professional has a pattern of impaired practice (e.g., from fatigue that interferes with the physical or cognitive ability to function or from an addiction to drugs). Signs may include numerous absences/tardiness or frequent quarrels with co-workers. 2 The same concern may invoke both a legal and an ethical duty to report Page 2 of 5
When there are allegations that a health professional has behaved unethically (e.g., has committed theft, fraud, or breach of trust; has had, or is having, an inappropriate relationship with a client or former client; has abused or abandoned a client). When a health professional has been charged or convicted of a crime that may result in that health professional s integrity being questioned or in the public losing confidence in the profession or the health care system (e.g., impaired driving, assault). When an employer has not reported that a health professional s employment has been terminated or a health professional has resigned and there are unresolved concerns about his or her practice. What Happens if a Registrant does not Fulfill their Duty to Report? A registrant with reasonable and probable grounds to report another health professional is violating the law if they do not comply with this duty to report. A registrant who does not fulfill their duty to report may be the subject of a complaint and may be subject to disciplinary measures taken by their college. Understanding the Obligations of Others under the Health Professions Act Employers, health care facilities and those associated with a health professional have a duty to report under the Health Professions Act in certain circumstances: When they terminate a health professional s employment based on the belief that the public might be in danger if the health professional continues to practice while he or she is: Suffering from a physical, mental or emotional condition or an addiction to drugs or alcohol that impairs his or her ability to practice; or Not competent to practice. When they revoke, suspend or impose restrictions on the privileges of the health professional, based on the belief that the public might be in danger (as above). When they dissolve a partnership or association with the health professional based on a belief that the public might be in danger (as above). Note: A report must be made in these cases even when a health professional takes steps to end the situation. For example, if a health professional resigns his or her employment before being terminated, or gives up privileges before the employer removes them, the employer must still report. Page 3 of 5
A report must also be made when a health professional is hospitalized for psychiatric care or treatment for drug or alcohol addiction and is therefore unable to practice. In this case, the chief administrative officer of the hospital and the attending physician must report to the registrar of the appropriate regulatory body. GLOSSARY Abandonment of client: Discontinuing the provision of care after engaging with the client or accepting the client assignment without first: negotiating a mutually acceptable withdrawal of service with the client; or arranging for suitable alternative or replacement services; or allowing the employer a reasonable opportunity for alternative or replacement services to be provided. Competent: Able to integrate and apply the knowledge, skills and judgment required to perform safely, ethically and appropriately within an individual s practice or in a designated role or setting. Inappropriate relationship: Relationship between a health care professional and a client that has a negative effect on meeting the client s therapeutic needs or encroaches on the client s right to receive safe, ethical and competent care. Sexual misconduct: Professional misconduct involving one or more of the following: Sexual intercourse or other forms of physical relations between the health professional and the client Touching of a sexual nature of the client by the health professional Behaviour or remarks of a sexual nature by the health professional toward the client. Note that any touching, behaviour or remarks towards a client that are of a clinical nature appropriate to the service being provided is not sexual misconduct. Unethical conduct: Behaving in a way that contravenes established ethical standards. Examples of unethical conduct include: Committing theft, fraud or breach of trust Having an inappropriate relationship with a client or former client Abusing or abandoning a client. Page 4 of 5
FURTHER INFORMATION CRPNBC s Professional Standards, s, and Scope of Practice for Registered Psychiatric Nurses: Standards, Limits and Conditions set out requirements for practice that registrants must meet. They are available from the Practice Support section of the CRPNBC website: http://www.crpnbc.ca/practice-support/ For more information on this or any other practice issue, contact a CRPNBC Practice Consultant by email at crpnbc@crpnbc.ca or call 604.931.5200 or 1.800.565.2505. Additional Resources BC Health Regulator s website for contact information for all BC Health Regulators http://www.bchealthregulators.ca/ Health Professions Act http://www.bclaws.ca/civix/document/id/complete/statreg/96183_01#section32 Fitness to Practice http://www.crpnbc.ca/practice-support/topics-in-depth/fitness-to-practice/ Copyright College of Registered Psychiatric Nurses of British Columbia 2014 Adapted with permission from the College of Registered Nurses of British Columbia, Duty to Report 2011, pub 436. Page 5 of 5