In Ontario, every nurse (NP/RN/RPN) is required by their regulatory College’s professional standards to report professional practice and patient/client/resident care concerns to the employer and attempt to resolve them.
Below are some of the key practice issues that members have identified which may have an impact on quality care and other health-care issues.
As a member, the supporting research can assist you in discussing your Professional Responsibility Workload Report Form(s) (PRWRF) with your manager. As a Bargaining Unit President (BUP) or Professional Practice Workload (PRW) Representative, the supporting research can assist you at your Labour Management meetings in representing members positions. The two main categories explored are staffing/quality of care and the environment.
Past history has proven that completed PRWRFs can result in an increase in registered and support staff, changes in policy and procedures, additional equipment and many other workplace improvements.
Staffing and Quality of Care
Appropriate staffing requires adequate baseline staffing and replacement resources to ensure positive patient outcomes, safety, and quality of care.
Quality of care is measured by many dimensions. High quality care is evidence-based, focused on the patient, safe and timely.
It is very difficult to provide safe, ethical and quality nursing care when faced with issues related to professional practice, including:
- patient/client/resident factors and acuity
- fluctuating workloads
- fluctuating staffing
- patient and staff safety,
Appropriate staffing is not dependent merely upon the numbers of nurses providing care, but involves having nurses with:
- the right skill
- experience
- education
- working within the right type of evidence-based staffing model
- the right mix of other health care providers.
Other health-care providers can include: Auxiliary, Clerical, Housekeeping, Support Workers, Laboratory, Radiology, Support workers and Agency usage.
For years now Ontario has had a nursing shortage and continues well into 2020, recruitment and retention become key issues for organizations when the options are scarce.
Supporting Documents
- Global Shortage of Nurses (McGill University 2019)
- Developing and Sustaining Safe, Effective Staffing and Workload practices (RNAO 2017)
- Nursing Workload and Patient Care (CFNU 2012)
- CNA/CFNU Evidence-based Safe Staffing Tool Kit –(CFNU 2015)
- Nursing Skill Mix (ONA 2017)
- Mind the Safety Gap (RNAO 2016)
- Developing and Sustaining Safe, Effective Staffing and Workload practices – RNAO 2017
- Nursing Human Resources (RNAO 2016)
- The Impact of Heavy Perceived Nurse Workloads on Patient and Nurse Outcomes (2017)
- Mental Disorder Symptoms Among Nurses in Canada (CFNU 2020)
Environment
The Ontario Nurses’ Association believes that it is the right of all of its members to work in a healthy and safe work environment. Unless members inform the employer of care concerns by filling out the PRWRF, the employer will assume patient care is satisfactory and/or that members are willing to tolerate the high-risk work environment.
Work environment is multi-faceted, doesn’t usually involve just one issue but many.
The physical layout can be an obvious issue, but it may be just a fraction of others regarding workplace environment that can lead to PRW issues. Some of these concerns/issues include
- safety,
- violence,
- surge capacity and control,
- infection protection/isolation control,
- equipment and supplies
- organizational policies and procedures.
A healthy work environment includes one in which leaders provide the structures, practices and policies that enable clinical nurses to engage in the work processes and relationships essential to provide safe and quality patient care outcomes.
Supporting Documents
- The Relationship between healthy work environments and retention of nurses in a hospital setting (2010)
- Surge Capacity Management Toolkit – Ontario’s Critical Care Strategy (2009) (Although this document was developed in 2009 the information and tool is still relevant today)
- Routine Practices and Additional Precautions in all Health Care settings, 3rd edition (2012)
- Nursing Workload and Patient Care – CFNU 2012
- Developing and Sustaining Safe, Effective Staffing and Workload practices (RNAO 2017)
- Poll: Patient Safety and Working Conditions (CFNU 2017)
- Joint position statement by the CFNU and the CNA on practice work environments (2014)
Completing a Professional Responsibility Workload Report Form is one of the best ways to meet your professional practice standards. It allows you to document and report concerns and make recommendations to improve the quality of patient/client/resident care. When your workload or working conditions compromise your ability to meet the College of Nurses of Ontario Standards and/or when your ability to provide safe, ethical and quality care is compromised, please complete the form.
The above articles and papers are just a few opportunities to review current literature that may help you and your members to discuss the PRW issues at your meetings. Needing any further assistance and or guidance please don’t hesitate to contact your Labour Relations Officer who then may consult a Professional Practice Specialist here at ONA to support you and your team through this process.
Standards of Practice
ONA members are healthcare professionals who have the privilege to regulate themselves as individual practitioners and to standardize their practice through a health regulatory college. Each college is responsible for governing its members according to the RHPA and enforcing standards of practice and conduct. All healthcare professionals are accountable to ensure their practice is consistent with the standards of practice and guidelines as required by their health regulatory colleges.
- College of Nurses of Ontario (CNO)
- College of Physiotherapists of Ontario (CPO)
- College of Occupational Therapists of Ontario (COTO)
- College of Dietitians of Ontario (CDO)
- College of Respiratory Therapists of Ontario (CRTO)
- College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO)
- College of Medical Radiation & Imaging Technologists of Ontario (CMRITO)
- Ontario Association of Medical Radiation Services (OAMRS)
- Ontario College of Pharmacists (OCP)
- Ontario College of Social Workers and Social Service Workers (OCSWSSW)
It is the responsibility of each healthcare professional to ensure they provide, facilitate, advocate and promote the best possible care for their patient/client/resident. By seeking assistance and reporting concerns related to the workload or practice issues through the completion of PRWRFs, ONA members fulfill their accountabilities in accordance with their health regulatory college standards of practice.
