Application for Registration With the CRNNS

Registered nurses regulating their profession to promote excellence in nursing practice. 1

4005-7071 Bayers Road, Halifax NS B3L 2C2 Canada 902-491-9744 ext 252 Toll-free (NS): 1-800-565-9744 ext 252 Fax: 902-491-9510

Email: [email protected] Website: www.crnns.ca

Dear Sir/Madam: The College of Registered Nurses of Nova Scotia (the College) is pleased to learn of your interest in working in Nova Scotia. We are committed to providing information and resources to help you successfully complete your applicant process for registration and licensure. In partnership with a number of organizations, such as the Immigrant Settlement & Integration Services (www.isisns.ca), and the Registered Nurse Professional Development Centre (rnpdc.nshealth.ca), we have developed resources that can be accessed through the above websites or by contacting these organizations. For your convenience, we have included a brochure entitled, Partnering for Internationally Educated Nurses. The brochure gives an overview of the partnership developed by the College with these other organizations and describes a number of resources that you may find helpful. On the website: www.NursingAtlanticCanada.com, you will find the Registration and Licensure Flowchart. The flowchart outlines the steps in the College’s application process leading to registration and licensure in Nova Scotia. To practice nursing in Nova Scotia a person must be entered on the College's Register, the roster of active-practicing registrants and hold a current licence (or a temporary licence while awaiting the results of the Canadian Registered Nurse Examination).

There are three main steps for applicants who wish to become registered and licenced in Nova Scotia. i) Complete the Application Download the Application for Initial Registration in Nova Scotia for internationally educated nurses who have never been registered in Canada from our website by selecting www.crnns.ca > International Nurses > Initial Registration in Canada > Application for Initial Registration Assessment. The application consists of several parts:

• Part I and Assessment Fee: Application for initial registration in Nova Scotia; • Proof of legal name and photo identification; • Part II: Verification of original nurse registration and examination scores; • Part III: Verification of all current / most recent nurse registration (if different from Part II); • Part IV: Statement from current/most recent employer; • Part V: Verification of graduation from the school of nursing; • Transcripts to be sent to either the College or World Education Services (see Part V for details); and • English Language Proficiency test as applicable (included is a list of acceptable tests).

The College of Registered Nurses of Nova Scotia (the College) only accepts official documents for Parts II, III, IV, V, and transcripts. The College only accepts official documents for the English Language Proficiency Test except, with The IELTS version of the English Language Proficiency Test, where the College can confirm test scores online if the applicant provides their Test Report Form Number. An official document is one that has been sent in a sealed envelope directly to the College by the issuing authority and has never been in possession of anyone other than the institution that issued it. Translations from a certified translator will also be accepted. The College does not accept certified true copies.




Part I and the assessment fee is required before an application can be started. The College has an online IEN Application Status Search that allows applicants to check the status of their application at any time. Once your Part I and initial assessment fee have been processed you will receive information about the status search, along with a username and password. See Part I of the application form for the current assessment fee. Applicants are advised that registration requirements and fees are subject to change. Assessment of the Application Following receipt of all the required documents, the College will assess the application to determine one of three options:

1. Confirm that the regulatory requirements are met and you are eligible to write the Canadian Registered Nurse Examination (CRNE) and received a temporary licence;

2. Confirm you are required to complete a competence assessment and/or additional education; or 3. Deny your application because you are unable to meet the regulatory requirements.

Temporary Licence (optional) Upon confirmation of eligibility to write the CRNE, applicants are then eligible to apply for a temporary licence in Nova Scotia. The applicant is responsible to provide the College with a clear criminal record check (CRC) from their country of origin, any other country in which the applicant worked as a nurse, and for Canada once arrived, before a temporary licence can be issued. The Canadian and International CRCs may be obtained through CSI if you choose. Applicants are advised to allow six to eight months for step i) to be completed. Also, applicants should allow additional time for them to study for and write the CRNE. ii) Write the Canadian Registered Nurses Examination (CRNE) All applicants must write the CRNE in order to be eligible for registration and licensure. The RN Exam is offered three times a year in Halifax, NS: February, June and October. There is also a writing centre in Sydney, Nova Scotia for the June writing only. A guide to assist candidates prepare for the examination is available and the Registered Nurses Professional Development Centre in Halifax, NS offered workshops to help you prepare for the CRNE. You may wish to review material on the Canadian Nurses Association’s website related to registration in Canada and the writing of the CRNE: http://www.cna-aiic.ca/CNA/nursing/becoming/international/default_e.aspx. We will provide more information when you become eligible to write the CRNE. iii) Apply for Registration/Licensure With the notification of success on the CRNE, you will receive the Application for Licence to Practice Nursing. Upon receipt of this application, applicable criminal record checks, and registration/licensing fee at the College, you will be entered in the Register and active-practising roster and a licence issued. There is information outlining the College's regulatory requirements for registration of nurses educated outside of Canada on the next page. Please note: the College is a regulatory body for registered nurses in Nova Scotia and cannot provide information about employment or immigration. For information about immigration and work visas contact




the Citizenship and Immigration Canada office closest to you. Thank you for your interest in nursing in Nova Scotia. If you have further inquiries please contact me as noted below.

Yours sincerely,

Sheri MacLellan Administrative Assistant IEN Registration




Information Sheet Please read the following information outlining registration requirements. All registration requirements must be met before applicants can register with the College. Applicants seeking registration and licensure with the College are required to: 1. have graduated from an approved school of nursing with preparation at the general nurse level.

Applicants of specialized programs such as midwifery, psychiatric nursing and paediatric nursing are not eligible for registration unless a program leading to general nurse preparation was also completed;

2. have completed a nursing program that is a minimum of two years in length, conducted by an approved school of nursing, with no less than 500 theory hours and 1000 clinical practice hours;

3. have identifiable theory and clinical experience in medical, surgical, obstetrical, and pediatric nursing if graduated prior to January 1966 and after that date it must also include psychiatric nursing. (Applicants not meeting the stated theoretical and clinical requirements are required to successfully complete an approved course in that subject);

4. have official documentation of their original and current registration status and confirmation of graduation from an approved school of nursing, with transcripts, sent to the College on the College’s forms;

5. applicants whose first language is NOT English are required to provide evidence of English language fluency (prior to meeting the requirements of # 6). The language tests accepted for demonstration of English fluency are listed at the end of this letter.

6. pass the Canadian Registered Nurse Examination (CRNE). The CRNE is a comprehensive examination covering medical, surgical, obstetrical, children’s, psychiatric, community and geriatric/long term care nursing. It is composed multiple choice questions, written over one-half day and is offered three times a year in Nova Scotia, in February, June and October.




Criteria for Entry to the Register and Active-Practising or Transitional Roster (International) Applicants seeking entry to the Register and active-practising or transitional1 roster maintained by the College of Registered Nurses of Nova Scotia (the College) must meet the regulatory requirements set out in the RN Act (2006) and Regulations (2009). To be registered and issued a licence to practise nursing, applicants must:

1. submit application for entry to the Register and active-practising or transitional roster; 2. pay the applicable fees; 3. have graduated from a nursing program equivalent to programs approved in Nova Scotia at the time of

the applicant’s graduation, and that prepared the applicant at the registered general nurse level; 4. have registered in the country where they qualified to become a registered nurse; 5. have written the approved registration examination(s), including the Canadian Registered Nurse

Examination (CRNE); 6. have no criminal or disciplinary finding, such as, conditions imposed on their licence(s), suspension or

revocation of licence, that would not allow the holder to practise nursing in Nova Scotia. This applies even if the licence has been reinstated. Applicants with a criminal conviction for which they have not received a pardon, are required to provide documentation relative to the conviction.

7. provide confirmation that they have the capacity, competence, capability and character to safely and ethically practise nursing;

8. have met at least one of the following requirements:a) graduated from a nursing education program approved by the College within the five years

immediately preceding their application for entry in the active-practising or transitional roster, or b) completed at least 1125 hours in the practice of nursing within the five years immediately preceding

their application for entry in the active-practising or transitional roster; or c) completed at least 450 hours in the practice of nursing within the year immediately preceding their

application for entry in the active-practising or transitional roster; or d) successfully completed a re-entry program or other such program approved by the council within the

five years immediately preceding their application for entry in the active-practising or transitional roster, or

e) is enrolled in and attending a nursing program approved by the Executive Director, and has met all other criteria for entry in the active-practising or transitional roster at the time they enrolled in the program; and

f) met the Continuing Competence Program (CCP) requirements by completion of the Building Your Profile (BYP) self-assessment tool or an equivalent tool.

9. provide criminal record check(s). Visit the College website at www.crnns.ca for details.

Eligibility for entry to the active-practising or transitional roster in each licensure year is assessed through the completion of the Application for Licence to Practise Nursing. Additionally members of the transitional roster must complete Appendix B: Annual Progress Report towards completion of a Baccalaureate Degree Program and ask their school of nursing to submit it to the College. Applicants entered in the active-practising or transitional roster are eligible to use the designation “Registered Nurse”, “Nurse”, or “nurse” or the abbreviation “RN”, “R.N.”, or “Reg.N”;

1 Transitional Licence: a licence given to members who meet all of the criteria for entry in the active-practising roster with the exception that they graduated after December 31, 2007 and do not hold a baccalaureate nursing degree. These members are enrolled in a baccalaureate nursing program approved by the Council, and have agreed to complete the requirements of the baccalaureate nursing program no later than five years after the date a transitional licence is first issued to the member.




English Language Proficiency Tests Accepted by the College Please note: Scores must be obtained in one sitting of the English language proficiency test. We do notaccept results that combine scores from more than one test or test date. Name of Test Passing Score Website Canadian English Language Benchmarks Assessment for Nurses (CELBAN)

Speaking – Level 8 Listening – Level 9 Reading – Level 8 Writing – Level 7

www.celban.org

Test of English for International Communication (TOEIC)

Listening & reading – 800 Writing & speaking - 170

www.toeic.com

International English Language Testing System (IELTS)

Overall band score no lower than 6.5 with a speaking band score of 7.0 on the academic test

www.ielts.orgNote: we may be able to download your test results directly from the company if you provide us with your Test Report Form Number

Michigan English Language Assessment Battery (MELAB)

Total score no lower than 83 on sections 1,2,3; no part score below 80. 3 on speaking

www.lsa.umich.edu/eli/testing/melab/

Canadian Academic English Language (CAEL)

Score no lower than 60 www.cael.ca

Test of English as a Foreign Language (TOEFL) iBT (The College’s TOEFL institution code is 9446)

Speaking – 20/30 Listening – 21/30 Reading – 21/30 Writing – 20/30 Overall score – 86

www.toefl.org

CanTEST

Overall score of 4.5 with no score lower than 4.5

www.cantest.uottawa.ca/

Test of spoken English (TSE) (no longer available in Canada)

Minimum score of 50 www.toefl.org

Revised 01/10

Mission Statements

The College of Registered Nurses of Nova Scotia is the regulatory body for the province's registered nurses. Its mission: Registered

nurses regulating their profession to promote excellence in nursing practice.

Immigrant Settlement and Integration Services (ISIS) is a leading community organization

that welcomes immigrants. Working in partnership, ISIS offers services and creates opportunities that enable immigrants to participate fully in Canadian life.

Metro Region Immigrant Language Services (MILS) is committed to encouraging integration and

settlement to newcomers by providing Canadian Language Benchmark assessments, English as a Second Language instruction and pre-employment related skill development programs to adult newcomers residing throughout the province of Nova Scotia.

The mission of the the Registered Nurses Professional Development Centre

is to deliver performance-based and continuing competency education for health professionals.

Contact Information

College of Registered Nurses of Nova Scotia4005-7071 Bayers RoadHalifax, Nova Scotia B3L 2C2 [email protected] 902.491.9744T 1.800.565.9744 (toll-free in NS)F 902.491.9510 www.crnns.cawww.nursingatlanticcanada.com

Immigrant Settlement & Integration Services2120-6960 Mumford Road Halifax, Nova Scotia B3L [email protected] 902.423.3607F 902.423.3154 www.isisns.ca

Metro Region Immigrant Language ServicesForsyth Adult Learning Centre136 Pinecrest DriveDartmouth, Nova Scotia B3A 2J9T 902.464.2868F 902.464.2828 www.milsns.info

Registered Nurses Professional Development CentreQueen Elizabeth II Health Sciences CentreVG Site, Room 231, Bethune Building 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9T 902.473.2175T 1.800.461.8766 (toll-free)Web: rnpdc.nshealth.ca

© July 2010

Immigrant Settlement and Integration

Services

Metro Region Immigrant

Language Services

Registered Nurses Professional

Development Centre

College of Registered Nurses

of Nova Scotia

Partnering forInternationally

Educated Nurses

Our Goal

To assist internationally educated nurses to navigate the

steps toward establishing community integration and nursing

employment in Nova Scotia.

Resources

Through our partnership, we have a number of resources available for internationally educated nurses, including:

English Assessment and Healthcare • Language Programs (ISIS)Mentorship/other support programs (ISIS)• Canadian Language Benchmark • assessments (MILS)English as a Second Language instruction • (MILS)Pre-employment related skill • development programs (MILS)Assessment of nursing credentials• (College of Registered Nurses) www.NursingAtlanticCanada.com • (multilingual website designed by the College of Registered Nurses) Website links to other professional • organizations and resources, including CNA LeaRN CRNE Readiness Test (College of Registered Nurses)Assistance in navigating the pathway to • licensure (College of Registered Nurses)Orientation to the Canadian healthcare • system (RNPDC)Competence assessments (RNPDC)• Professional support courses (RNPDC)• RN Bridging/Re-Entry Nursing Program • (RNPDC)Preparation for Canadian Registered • Nurse Exam (RNPDC)

Transition Program (RNPDC)•

Welcome

Together, the College of Registered Nurses of Nova Scotia (the College), Immigrant Settlement and Integration Services (ISIS), Metro Region Immigrant Language Service (MILS), and Registered Nurses Professional Development Centre (RNPDC) are pleased to welcome you, as an internationally educated nurse, to Nova Scotia.

We are committed to providing you with information and resources that we hope will help you settle in Nova Scotia and move you forward with your nursing career, specifi cally to determine what you must do to qualify for a licence to practise as a registered nurse in this province.

website: rnpdc.nshealth.ca

Programs for Internationally Educated Health Care Professionals

Registered Nurses Professional Development Centre

07.2010

Entrance to courses requires

Canadian Language Benchmark Level 6–7

• 30hoursofstudytime

• 10sectionsoffaculty-supportedlessons

Programfeesvary;approximately$75.

Orientation to the Canadian Health Care System for Internationally Educated Health Care Professionals

Entering into a new community can be

overwhelming. The RN‑PDC recognizes this.

That’s why we’ve created a program that is

sensitive to the concerns of health care providers

educated outside of Canada.

The Orientation to the Canadian Health Care

System for Internationally Educated Health Care

Professionals Program offers a path to pursuing

licensure.

This program is presented twice a year

and consists of a 3‑hour weekly session

over 10 weeks. Participants will become

familiar with Nova Scotia health care and

professional practice through a range of

classroom activities such as lectures, role‑

playing, case studies, and guest speakers.

Registered Nurses Professional Development Centre

Room 231, Bethune Building1276 South Park StreetHalifax, Nova ScotiaCanada B3H 2Y9

Toll-free 1-800-461-8766 Fax (902) 473-7590

Email [email protected] rnpdc.nshealth.ca

RN Bridging and Re-Entry Program for Internationally Educated Nurses

Nurses who were educated in countries

other than Canada and want to practice here

will benefit greatly from this well‑designed

program. The courses will help you to identify

the differences between your previous nursing

experience and Canadian nursing practice.

We will help you meet any educational and

practice “gaps” by focusing on the knowledge,

skills, and abilities that are expected of registered

nurses in Canada. This program is based on

entry‑level competencies as defined by the

registered nursing regulatory body.

You can participate in just one course, a

series of courses, or take the entire program. If

you have not worked as an RN for more than

5 years, this program can help you to re‑enter

practice. Clinical courses offer the internationally

educated nurse (IEN) the opportunity to use

knowledge and skills in a Canadian

practice setting.

Our experienced, skilled,

and dedicated faculty

will provide you with

quality education

and support.


Canadian Language Benchmark Level 8

Courses

• ProfessionalNursinginCanada

• ProfessionalCommunicationforNurses

• PharmacologyforNurses

• MedicationAdministrationforNurses

• HealthAssessment

• ChangesinHealthandTherapeuticInterventions

• ClinicalNursingSkills

• ClinicalCourse:Medical–Surgical

NursingSpecialtyCourses

• MaternalInfantHealth(Obstetrics)–TheoryandClinical

• ChildHealth(Pediatrics)–TheoryandClinical

• PsychiatricMentalHealth–TheoryandClinical

Location:BethuneBuilding,1276SouthParkSt,Halifax

Programfeesvary;approximately$200–$1,000.

Supports for the Internationally Educated Nurse (IEN)

The RN‑PDC wants the path to liscensure for

IENs to be smooth and straightforward. The

following support can help you in making your

transition to Canadian nursing practice.

Canadian Registered Nurse Examination

(CRNE) Preparation Workshop ($75)

This one‑day workshop takes place in March,

July, and November. It provides you with study

resources and a review of exam competencies.

You will also get helpful tips on answering

multiple‑choice questions and developing an

individual study plan.

Professional Support Courses ($150)

If you are an internationally educated nurse (IEN)

or an internationally educated health professional

(IEHP) whose first language is not English, these

could be the courses for you. Each one focuses on

improving the communication skills needed to

work as a health care provider in Canada.

Transition Program

for Internationally

Educated Nurses

This program is designed

for IENs who have met the

eligibility criteria to write the

national Canadian Registered Nurse

Examination.

You must also be employed as a nurse working

with a temporary or full license in a health care

facility in Nova Scotia.

The Transition Program for Internationally

Educated Nurses provides participants with a

clear understanding of the Canadian health care

system and the role and responsibilities of the

RN and RN entry‑level competencies.

We understand that people learn differently.

We also know that people have different needs

based on their schedules. With our guidance

and support, IENs will work with employers to

develop their own individualized learning plans.

website: rnpdc.nshealth.ca


Canadian Language Benchmark Level 7

Courses

• ProfessionalTerminology

• CommunicationSkills

Location:BethuneBuilding,1276SouthParkSt,Halifax

Programfeesvary;approximately$150.

IEN Resource Room

• Providesnursingtextbooks,videos,

and computer access to all IENs who

wishtopracticeinNovaScotia

• Nofees

Standardsfor

Nursing Practice

NursingStandardsBROCHURE 09 - Updated Address:NursingStandardsBROCHURE 7/8/09 8:21 AM Page 1

Standards for Nursing Practice (effective January 1, 2004)©2003, College of Registered Nurses of Nova Scotia4005 - 7071 Bayers Road, Halifax, NS B3L 2C2All rights reserved. Copies of the Standards for Nursing Practice can be obtained bycontacting the College of Registered Nurses of Nova Scotia at 491-9744, ext. 230 ortoll-free in NS at 1-800-565-9744. This document can also be downloaded from theCollege website at www.crnns.ca.


Table of Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Nursing Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Self-Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Context of Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Assumptions related to the Standards for Nursing Practice . . . . . . . . . . . . . . . . . . . . .8

Assumptions related to the indicators of the Standards . . . . . . . . . . . . . . . . . . . . . . . .9

Standards for Nursing Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Standard 1: Accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Standard 2: Continuing Competence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Standard 3: Application of Knowledge, Skills and Judgment . . . . . . . . . . . . . . . . . .12

Standard 4: Professional Relationships and Advocacy . . . . . . . . . . . . . . . . . . . . . . . .13

Standard 5: Professional Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Standard 6: Self-Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Standards for Nursing Practice 1


Introduction

The professional practice of nursing is defined in the Registered Nurses Act (2001) and Regulations(2001), and reflected in the Standards for Nursing Practice (the Standards) and Code of Ethics forRegistered Nurses (the Code; Code of Ethics). Through the Registered Nurses Act (the Act; RN Act), thenursing profession is granted the authority to set standards for the practice and education of its members,with an obligation to protect the public and serve the public interest.

The College of Registered Nurses of Nova Scotia (the College; CRNNS), working with registered nursesand the public, regulates the nursing profession to promote excellence in nursing practice. This mission isrealized through a number of ways, one of which is the development of the Standards for NursingPractice; the minimal professional practice expectations for any registered nurse in any setting or role.The Standards for Nursing Practice provide an overall framework for the practice of nursing, and linkwith other standards and competencies developed by the College, as well as with the Code of Ethics forRegistered Nurses (developed by the Canadian Nurses Association and adopted by the College).

Standards for nursing practice were first developed in Nova Scotia in 1983 and extensively revised in1996, with the input of registered nurses from all areas of the province and a variety of practice settings.However, to ensure that the Standards for Nursing Practice continuously reflect the changing practice ofnursing they must be reviewed and revised on an ongoing basis. These new Standards have evolved,again with the input of nurses province-wide, in response to emerging trends in both nursing and healthcare (e.g., increasing complexity of patient care, new roles and expectations for nurses, multidisciplinaryteamwork and collaboration, evidence-based practice, and primary health care), and changes to theRegistered Nurses Act (2001).

In addition to the Standards for Nursing Practice and Code of Ethics, which apply to both novice andexperienced registered nurses, the College has established competencies that entry-level registered nursesin Nova Scotia are expected to demonstrate upon graduation from an approved nursing educationprogram. Entry-level registered nurses are prepared to practise in accordance with the Standards andCode, and will strengthen their efficiency and ability to prioritize, organize and make decisions based ontheir foundational level of knowledge and practical experience.

According to the Act, nursing practice is defined as the performance of professional services requiringsubstantial specialized knowledge of nursing theory and the biological, physical, behavioral,psychological and sociological sciences as the basis for:

(i) assessment, planning, intervention and evaluation ina) the promotion and maintenance of health,b) the facilitation of the management of illness, injury or infirmity,c) the restoration of optimal function, ord) palliative care, or

(ii) research, education, management or administration incidental to the objectives identifiedin subclause (i),

and includes the practice of a nurse practitioner (RN Act, 2001, c.10, s.1).

2 Standards for Nursing Practice



Definitions

Accountability: an obligation to accept responsibility or to account for one’s actions to achieve desiredoutcomes. Accountability resides in a role and can never be delegated away. Accountability is alwaysabout outcomes, not processes, which are simply the means through which outcomes are achieved(Porter-O’Grady & Wilson, 1995).

Advocacy: the supporting, protecting and safeguarding of clients’ rights and interests. Advocacy isundertaken in the best interests of clients. Advocacy is an integral part of nursing and forms thefoundation of trust inherent in the nurse-client relationship (RNABC, 2000). Within the boundaries oftheir roles, nurses ensure that clients have the necessary information to make decisions and choices, andto act according to their own wishes.

Boundary: a dynamic line of separation in the nurse-client relationship between professional andtherapeutic and non-professional and personal (RNABC, Position Statement, 2000). Professionalboundaries are the defining lines which separate the therapeutic behaviour of a registered nurse fromany behaviour which, well intentioned or not, could reduce the benefit of nursing care to patients,clients, families and communities (Guidelines for Nurse-Client Relationships, CRNNS, 2002).

Client(s): the recipient(s) of nursing services: e.g., individuals (family member/guardian/substitutecaregiver), families, groups, populations or entire communities (adapted from NNCP, 1997, p. 42).

Communication: an interpersonal activity involving the transmission of messages by a sender to areceiver (Arnold and Boggs, 1999). Communication involves the giving or exchanging of informationthrough a complex composite of verbal, nonverbal and/or technological messages/signals.

Competent: the ability to integrate and apply the knowledge, skills and judgment required to practisesafely and ethically in a designated role and practice setting (Registered Nurses Regulations, 2001).

Continuing competence: the ongoing ability of a registered nurse to integrate and apply theknowledge, skills and judgment required to practise safely in a designated role and setting.

Delegation: the transfer of a task or function to a healthcare provider who does not have the authorityto perform that task or function (Phillips, Canadian Nurses Protective Society, 1997). Delegationinvolves the transferring of responsibility for the performance of a task or activity, but not theaccountability for the outcome of the task or activity.

While specific tasks or procedures may be appropriately delegated, a registered nurse cannot delegatenursing activities that include the core of the nursing process and require the specialized knowledge,judgment, and/or skill of a registered nurse.

Delegation occurs in specified or limited situations when a task is within the scope of practice of adelegating registered nurse and outside the scope of practice and/or employment of another healthcareteam member. The registered nurse is responsible for the decision to delegate, with five requirements:

1. Delegate task based on sound nursing judgment and rationale.

2. Delegate to the appropriate healthcare provider.

3. Delegate the appropriate task and confirm that the team member hasthe knowledge and ability to perform it.

4. Communicate the task (or part thereof) to the healthcare team member,and his/her accountability to complete it safely and ethically.

5. Communicate to the healthcare team member the requirement forfeedback and appropriate documentation of the task.


Evidence-based practice: best practice that is ideally based on science derived from systematicobservation, study, qualitative, and quantitative research (RNABC, 2000). When there is insufficientevidence from science, expert opinion or a combination of science and expert opinion is used.Evidence-based nursing is the combination of the best scientific evidence from nursing and otherresearch with the special clinical perspective of nurses in performing patient care activities pertinent tothe nursing profession (McPheeters, 1999).

Healthcare team: clients, families, health professionals, nursing students, volunteers and any otherswho may be involved in the planning and delivery of care.

Incapacity: the status whereby a respondent (registered nurse), at the time of the subject-matter of acomplaint, suffered from a physical, mental or emotional condition, disorder or addiction that renderedthe respondent unable to practise nursing with reasonable skill or judgment or that may haveendangered the health or safety of clients (Registered Nurses Act, 2001).

Incompetence: the display of lack of knowledge, skill or judgment in a respondent’s (registered nurse)care of a client or delivery of nursing services that, having regard in all the circumstances, rendered therespondent unsafe to practise nursing at the time of such care of the client or delivery of nursingservices or that renders the respondent unsafe to continue in the practice of nursing without remedialassistance (Registered Nurses Act, 2001).

Leadership: being involved, being open to new ideas, having confidence in your own capabilities and awillingness to make an effort to guide and motivate others. Leadership is action, not a position and notlimited to formal leadership roles. Leadership development is ultimately personal and inner self-development, which moves outward to influence, guide, support and lead others (Clemmer, 1999).Leaders have influence through their position, behaviour, experience, knowledge and development.Nursing leadership at all levels in an organization and in all areas of practice is essential to theprovision of safe, effective and ethical nursing practice and the maintenance of public trust.

Mentoring: experienced nurses (mentors) helping both novice and other experienced nurse learners(mentees) adjust to new environments, new roles and/or responsibilities. Successful mentoring usuallyoccurs over time and involves a personal commitment from both mentors and mentees.

Nursing assignment: designating nursing activities to be performed by an individual, which are inher/his licensed scope of practice (National Council of State Boards of Nursing, 1997).

Professional misconduct: includes such conduct or acts relevant to the practice of nursing that, havingregard to all the circumstances, would reasonably be regarded as disgraceful, dishonorable orunprofessional which, without limiting the generality of the foregoing, may include:

(i) failing to maintain the College of Registered Nurses of Nova Scotia Standards for NursingPractice,

(ii) failing to uphold the code of ethics adopted by the College,(iii) abusing a person verbally, physically, emotionally or sexually,(iv) misappropriating personal property, drugs or other property belonging to a client or a

registrant’s employer,(v) inappropriately influencing a client to change a will,(vi) wrongfully abandoning a client,(vii) failing to exercise discretion in respect of the disclosure of confidential information,(viii) falsifying records,(ix) inappropriately using professional nursing status for personal gain,(x) promoting for personal gain any drug, device, treatment, procedure, product or service that

is unnecessary, ineffective or unsafe,(xi) publishing, or causing to be published, any advertisement that is false, fraudulent, deceptive

or misleading,(xii) engaging or assisting in fraud, misrepresentation, deception or concealment of a material

fact when applying for or securing registration or a licence to practise nursing or taking anexamination provided for in this Act, including using fraudulently procured credentials(Registered Nurses Act, 2001).



Professional practice issue: any issue or situation that either compromises client care or service byplacing a client at risk or affecting a nurse’s ability to provide care/service consistent with the Standardsfor Nursing Practice, other standards and guidelines, or agency policies (Resolving ProfessionalPractice Issues Framework, CRNNS, 2001).

Quality improvement: organizational philosophy that seeks to meet client needs by utilizing astructured process that identifies and improves all aspects of care and service on an ongoing basis(CCHSA, 1995).

Reasonable: nursing practice compared to registered nurses with similar education and experience.

Reflective thought/practice: a deliberate attempt to analyze and evaluate areas of nursing practice,through conscious thought and examination of one’s past or present actions. Reflection can be practisedin various ways including inward thought, use of diaries, journaling, sharing experiences and clinicaldebriefing (Sheard, 2002). Sharing of experiences can be a valuable method of experiential learning.

Research mindedness: an awareness of and openness to nursing research (Ross-Kerr & MacPhail,1996).

Research utilization: reading and critically evaluating nursing research and best practice knowledge,using relevant findings in practice, and evaluating results and communicating findings to others, toultimately enhance client care in the clinical setting.

Scope of practice: the roles, functions and accountabilities which members of a profession areeducated and authorized to perform.

Self-regulation: the relative autonomy by which a profession is practised within the context of publicaccountability to serve and protect the public interest. The rationale for self-regulation is the recognitionthat the profession is best able to determine what can be practised, how it is to be practised and who canpractise, as long as the public is well served.

Therapeutic relationship: a purposeful, goal directed relationship between nurse and clients that isdirected at advancing the best interest and outcome of the client. The therapeutic relationship is centralto all nursing practice and is grounded in an interpersonal process that occurs between the nurse andclient(s) (RNAO, 2002).



Nursing Standards

A standard is an authoritative statement that sets out the legal and professional basis for nursing practice(CNO, 2002). Nursing standards can further be defined as statements that describe the desirable andachievable level of performance expected of registered nurses in their practice, against which actualperformance can be measured, and serve as a guide to the professional knowledge, skills, and judgmentneeded to practise nursing safely. The primary reason for having standards is to promote, guide, directand regulate professional nursing practice.

The nursing standards established by the College are the benchmark for assessing the professionalconduct of all registered nurses in Nova Scotia, regardless of specialty or practice setting. Nursepractitioners are required to meet the Standards for Nursing Practice, as well as additional standards setspecifically for their expanded practice (Standards of Practice for Nurse Practitioners, CRNNS, 2002).

Standards range from the unwritten but inherent requirements of a profession to the broad, profession-specific standards established by the College, and progress on the continuum to detailed care standardsestablished by specific agencies. As standards progress from profession-wide expectations to specificlevels of nursing care, the focus changes accordingly: from describing the minimum standards thepublic can expect from a registered nurse, to standards developed by specialty nursing groups, and on toidentifying specific client care standards that relate to nursing actions and interventions needed toachieve desired client outcomes. Figure 1 (below) illustrates the complementary relationship betweenthe nursing standards established by the College and those set at other levels within the healthcaresystem: a range of standards that represents congruent expectations in relation to the practice ofregistered nurses in the delivery of quality care. As depicted in Figure 1, the College Standards form thebasis for all other standards of care.

Practice standards developed by and for aspecialized area of nursing practice areadditional standards that guide individualpractice. These standards, which must reflectthe Standards for Nursing Practice, may beadopted by agencies and/or specific nursingunits.

Indicators corresponding to each of theStandards statements illustrate how eachstandard is to be applied and met in the fourareas of nursing practice — clinical practice,education, administration, and research. Theseindicators provide more specific criteriaagainst which the actual performance of anindividual registered nurse is to be measuredby her/himself and others. However, theindicators are not intended to be a completelist and should be interpreted in the context ofthe specific practice setting of individualnurses. In addition to the Standards, othermethods of assessing the performance of registered nurses include job descriptions, performanceappraisals, quality assurance processes, peer review processes, and comparisons to the "reasonable andprudent" practice of other nurses.

While factors unique to practice environments may impact a registered nurse’s practice, the Standardsfor Nursing Practice, ultimately, reflect the expected level of performance. The College is committed todeveloping collaborative initiatives that support and promote the delivery of safe, competent, andethical nursing practice.


Figure 1: Pyramid of Nursing Standards

Client

Unit

Agency

Specialty

Standards for Nursing Practice(regulatory)


Self-Regulation

Registered nurses are accountable for their own practice, including being accountable to understand theStandards for Nursing Practice and to apply them in their work regardless of their area of practice, roleor setting. The College is accountable for ensuring that the nursing profession, as a whole, carries outits commitment to the public (i.e., ensuring that its members act in the public interest and provide theunique service that has been designated to them by society).

The College is accountable for establishing and monitoring the standards of practice of its members,and has the statutory responsibility to take action when a registered nurse’s ability to provide safe andappropriate care is questioned.

The three principles of self-regulation reflect a continuing commitment to enable the nursing professionto practise effectively in an ever-changing healthcare industry and to sustain public confidence andtrust. All College programs and services reflect and are grounded in the three principles of self-regulation.

The three principles are:1. Promoting good nursing practice.2. Preventing poor nursing practice.3. Intervening when practice is unacceptable.

The College promotes good nursing practice by:• setting standards for nursing education.• setting licensure requirements.• promoting evidence-based nursing and health care.• promoting professional quality workplace environments.• establishing and promoting professional practice standards, competencies and an ethical code.

The College prevents poor practice by:• providing nurses with tools and resources to maintain and enhance their competencies(e.g., Mentor Match Program™, Building Your Profile™).

• providing nurses with guidelines for resolving professional practice problems(e.g., practice consultation services; Professional Practice Issues Resolution Framework).

The College intervenes in unacceptable practice through:• the professional conduct review process.




Context of Practice

The context of practice is defined as conditions or factors within a practice setting or healthcareenvironment affecting the practice of nursing, including client/patient population, type of care,complexity of interventions, frequency of interventions, service delivery models, and staffing(Guidelines for Shared Competencies and Delegated Medical Functions, RNANS, 1999).

The Standards statements are broad in nature, capturing the diverse practice settings and roles in whichnurses practise. Although corresponding indicators illustrate how each standard is to be met, they maybe further developed to address specific contexts of practice and required competencies.

Assumptions related to the Standards for Nursing Practice

Registered nurses practise within a complex and continually evolving healthcare system and are anintegral part of the sustainability of that system. The four major roles within the practice of nursing arepractitioner, administrator, educator, and researcher/scientist. Depending on the practice setting andexpertise of a registered nurse, one or more of these roles will be the main focus of a nurse’s practice.Nurses may assume aspects of more than one role within the context of their practice. For example, anurse in a practice setting provides direct client care but also assumes an educator role when mentoringa student in clinical practice.

The Standards:

• support registered nurses by outlining practice expectations of the profession.

• are used as a legal reference for reasonable and prudent practice.

• inform the public and others about what they can expect from practising registered nurses.

• form the basis for the development of standards specific to various contexts of practice.

• apply at all times to all registered nurses in all practice roles (e.g., direct practice, education,administration, research), including nurse practitioners.

• provide guidelines to assist registered nurses in decision making and self-assessment as partof reflective practice.

• may be used in conjunction with other resources to guide nursing practice (e.g., agency missionstatements, nursing models).

• may be used to develop position descriptions, and performance appraisal and qualityimprovement tools.



Assumptions related to the indicators of the Standards

The indicators:

• illustrate how the Standards are met, but are not intended to be all-inclusive or exhaustive lists ofcriteria for each standard.

• may be further refined or developed to address specific roles and contexts of practice, andcorresponding required competencies.

• may be expanded to describe the practice expectations of nurses of varying levels of competence,ranging from entry-level to advanced-level practitioners.

• used to illustrate one standard may also demonstrate the application of other standards.

Standards for Nursing Practice

The Standards for Nursing Practice are interrelated and all equally important.

Standard 1: Accountability – the registered nurse is accountable to the public for competent, safeand ethical nursing practice.

Standard 2: Continuing Competence – the registered nurse attains and maintains competenciesrelevant to own scope of nursing practice.

Standard 3: Application of Knowledge, Skills and Judgment – the registered nurse demonstratescompetencies relevant to own scope of nursing practice.

Standard 4: Professional Relationships and Advocacy – the registered nurse establishesprofessional therapeutic relationships with clients and advocates for clients in theirrelationships with the health system.

Standard 5: Professional Leadership – the registered nurse demonstrates professional leadership inthe delivery of quality nursing and healthcare services to the public.

Standard 6: Self-Regulation – the registered nurse assumes personal accountability to practisenursing competently and ethically.


Standard 1: Accountability

The registered nurse is accountable to the public for competent, safe, andethical nursing practice.

INDICATORS

Each registered nurse:1.1 Practises in accordance with:

1.1.1 the Registered Nurses Act, Regulations and By-Laws;1.1.2 the CRNNS Standards for Nursing Practice;1.1.3 the CNA Code of Ethics for Registered Nurses;1.1.4 other relevant acts and legislation;1.1.5 relevant College position statements, guidelines, and other documents;1.1.6 individual competence; and1.1.7 indicators 1.1.1. through 1.1.6, to evaluate own practice.

1.2 is accountable and responsible for own actions and decisions at all times.

1.3 recognizes and reports errors and takes all necessary action to prevent or minimize harm arisingfrom an adverse event.

1.4 takes action in situations where client safety and well-being is potentially or actuallycompromised.

1.5 exercises reasonable judgment in practice.

1.6 seeks assistance appropriately and in a timely manner.

1.7 supports policies and practices consistent with the College’s Standards for Nursing Practice, andquestions those in conflict with the Standards.

1.8 understands, promotes and complies with the values and beliefs in the Code of Ethics forRegistered Nurses (CNA, 2002) (adopted by the College’s governing Council in 2002).

1.9 contributes to a safe, supportive and professional practice environment.

In addition, the nurse administrator:1.10 promotes a practice environment that supports professional accountability.

1.11 promotes a quality practice environment that supports nurses’ ability to provide safe, effective andethical nursing practice.

In addition, the nurse educator:1.12 promotes a learning environment that supports professional accountability.

1.13 provides appropriate supervision of learners that supports their ability to provide safe, effectiveand ethical nursing practice.

In addition, the nurse researcher/scientist:1.14 promotes a research environment that supports professional accountability.



Standard 2: Continuing Competence

The registered nurse attains and maintains competencies relevant to ownscope of nursing practice.

INDICATORS

Each registered nurse:2.1 has appropriate1 theoretical knowledge, skills and judgment as needed in own practice.

2.2 applies problem-solving processes in decision making, and evaluates these processes.

2.3 continually assesses practice to identify learning needs and opportunities for growthand improvement.

2.4 demonstrates continuing competence improvement activities in own practice.

2.5 role models continuing professional development, including continuous learning andreflective practice.

2.6 uses reflective thought and feedback from others in assessing own practice, and provides feedbackto others to support their professional development.

2.7 shares knowledge with clients, other nurses, healthcare providers, and the public.

2.8 demonstrates awareness of changing trends in nursing, health, and society that impactown practice.

In addition, the nurse administrator:2.9 promotes a practice environment that supports continuous professional development for competent

nursing practice.

2.10 encourages and supports nurses to engage in continuous learning.

In addition, the nurse educator:2.11 promotes a learning environment that supports continuous professional development for competent

nursing practice.

2.12 encourages and supports learners to engage in continuous learning and reflective practice.

In addition, the nurse researcher/scientist:2.13 promotes a practice environment that supports the conduct of research and the identification and

integration of current research findings in order to promote continuous professional developmentfor competent nursing practice.

2.14 communicates best practice and research findings to others.

Explanatory Notes1. Descriptors such as “appropriate”, “effective”, “efficient”, and “relevant” should be interpretedaccording to the context of practice — that is, the conditions or factors within a practice setting orhealthcare environment affecting the practice of nursing, including client/patient population, type ofcare, complexity of interventions, frequency of interventions, service delivery models, and staffing(Guidelines for Shared Competencies & Delegated Medical Functions, RNANS, 1999).




Standard 3: Application of Knowledge, Skills and Judgment

The registered nurse demonstrates competencies relevant to own scope ofnursing practice.

INDICATORS

Each registered nurse:3.1 applies a theoretical and/or evidence-based rationale for nursing decisions.

3.2 applies appropriate1 knowledge, skills and judgment to assess, plan, intervene and evaluateservices, and revises plan as needed.2

3.3 records and maintains documentation that is clear, timely, accurate, reflective of observations,permanent, legible and chronological.

3.4 uses communication skills effectively and efficiently.

3.5 coordinates human resources and manages physical resources, to promote quality services.

3.6 participates in activities that promote quality nursing and healthcare services.

3.7 adapts positively to changes within the healthcare system that impact own practice.

In addition, the nurse administrator:3.8 promotes a practice environment that contributes to ongoing demonstration and evaluation

of competencies.

3.9 promotes a practice environment that encourages learning and evidence-based practice.

In addition, the nurse educator:3.10 promotes a learning environment that contributes to ongoing demonstration and evaluation of

competencies.

3.11 integrates evidence-based theory and best practices into educational activities.

In addition, the nurse researcher/scientist:3.12 promotes a research environment that supports and facilitates research mindedness and research

utilization.

3.13 supports and evaluates practice through research activities and application of evidence–basedknowledge.


2. This indicator is consistent with the definition of nursing as recorded in the Registered Nurses Act(2001). When the element of diagnosis is applicable to practice it may be incorporated. This indicatorrefers to the generic process of data collection, analysis, synthesis, integration and evaluation. Thisprocess is known by several names according to the discipline in which it is applied. For example, innursing practice this protocol is commonly known as the nursing process; in education, it is oftenreferred to as the planning process.



Standard 4: Professional Relationships and Advocacy

The registered nurse establishes professional therapeutic relationships withclients and advocates for clients in their relationships with the healthsystem.

INDICATORS

Each registered nurse:4.1 initiates, maintains and concludes professional therapeutic relationships with clients.

4.2 maintains appropriate boundaries between professional therapeutic relationships andnon-professional, personal relationships.

4.3 demonstrates a professional presence with clients.

4.4 assists clients in the expression of individual diversity regarding health (e.g., needs, values, wishes,cultural beliefs, sexual orientation, age, and gender), and ensures that their perspectives areconsidered.

4.5 shares relevant1 information with clients regarding their health.

4.6 protects confidentiality of all information gained in the context of a professional relationshipand exercises discretion in respect to disclosure of confidential information.

4.7 supports clients’ rights to make informed decisions2 regarding their health.

4.8 assists clients to identify appropriate resources and services within the healthcare system.

4.9 promotes advocacy through the development of collaborative partnerships with clients, nursingcolleagues, other healthcare team members and the public.

4.10 participates in and supports the development and implementation of policies that ensure thatclients’ rights are respected.

4.11 advocates for clients, professional practice environments, and the nursing profession.

In addition, the nurse administrator:4.12 advocates for systems of care and services that assist nurses to develop and maintain professional

therapeutic relationships with clients.

4.13 promotes a practice environment that supports client advocacy and enables nurses to fulfill theiradvocacy role.

In addition, the nurse educator:4.14 implements educational activities that support the establishment of professional therapeutic

relationships.

4.15 maintains appropriate professional boundaries with learners, recognizing potential authorityimbalances between learner and educator.

4.16 promotes a learning environment that supports client advocacy.



In addition, the nurse researcher/scientist:4.17 communicates evidence-based and best practice knowledge related to professional and therapeutic

relationships.

4.18 promotes a research environment that supports client advocacy.


2. An informed decision is one that is voluntarily made by a client after information about actions,available alternatives, and potential consequences have been explained. An informed decision assumesthat a client is competent and possesses the capacity to make a decision related to an issue.



Standard 5: Professional Leadership

The registered nurse demonstrates professional leadership in the delivery ofquality nursing and healthcare services to the public.

INDICATORS

Each registered nurse:5.1 coordinates client care and collaborates with other members of the healthcare team.

5.2 demonstrates respect for the knowledge, expertise and contributions of other healthcare teammembers.

5.3 demonstrates professional judgment and accountability when delegating or assigning tasks orfunctions to other members of the healthcare team.

5.4 demonstrates professional judgment and accountability when assuming tasks from other membersof the healthcare team.

5.5 participates in and supports quality improvement initiatives and programs.

5.6 acts as a role model, resource and mentor to clients, learners, nursing peers and colleagues.

5.7 articulates the contributions of nursing within the healthcare delivery system.

In addition, the nurse administrator:5.8 provides opportunities for nurses to develop leadership abilities.

5.9 seeks to ensure that available resources and competencies of nursing personnel are used efficientlyand effectively.

5.10 facilitates a work environment of trust and respect among all healthcare professionals consistentwith the mission, vision and values of the organization.

In addition, the nurse educator:5.11 facilitates a learning environment that encourages nurses to further develop expertise and

leadership skills.

5.12 role models the development of expertise, leadership, professional qualities and effectiveinterpersonal skills.

In addition, the nurse researcher/scientist:5.13 advances nursing leadership through the communication of research and best practice findings.



Standard 6: Self-Regulation

The registered nurse assumes personal accountability to practise nursingcompetently and ethically.

INDICATORS

Each registered nurse:6.1 practises within nursing scope of practice and own level of competence.

6.2 maintains a current licence to practise.

6.3 recognizes and avoids violation of any professional, ethical or legal boundaries withinown practice.

6.4 responds to and reports situations which may be adverse for clients and/or healthcare providers,including incompetence, misconduct, and/or incapacity of registered nurses and/or other healthcareproviders.

6.5 participates in the resolution of professional practice issues or conflicts.

6.6 strives to maintain own physical, mental and emotional well-being and safety.

6.7 complies with employer and/or agency policies in the best interest of the public (e.g., policiesregarding Internet use in the workplace).

In addition, the nurse administrator:6.8 supports nurses to work within their professional, ethical and legal boundaries of practice.

6.9 promotes practice environments that support nurses’ physical, mental and emotional well-beingand safety.

In addition, the nurse educator:6.10 educates learners regarding professional, ethical and legal boundaries of practice.

6.11 encourages learners to develop skills to address unethical, unprofessional or unsafepractices or behaviours of peers or colleagues.

In addition, the nurse researcher/scientist:6.12 communicates research and best practice knowledge related to self-regulation to

other nurses and health team members.



References

Arnold, E., & Boggs, K. (1999). Interpersonalrelationships: professional communication skillsfor nurses (3rd ed.).Philadelphia: WB Saunders.

Canadian Council on Health ServicesAccreditation. (1995). Quality Improvement andthe Client Centered Accreditation Program.Ottawa: Author.

Canadian Nurses Association. (1997). NationalNursing Competency Project. Ottawa: Author.

Canadian Nurses Association. (1998). Policystatement: Evidence-based decision making andnursing practice. Ottawa: Author.

Clemmer, J. (1999). Growing the distance: timelessprinciples for personal, career and family success.Canada: TCG Press.

College of Registered Nurses of Nova Scotia.(2002). Guidelines for Nurse-Client Relationships.Halifax: Author.

College of Registered Nurses of Nova Scotia.(2002). Position statement: Quality care, evidence-based practice and nursing leadership. Halifax:Author.

College of Registered Nurses of Nova Scotia.(2002). Standards of Practice for NursePractitioners. Halifax: Author.

College of Nurses of Ontario. (2002). ProfessionalStandards for Registered Nurses and RegisteredPractical Nurses in Ontario. Toronto: Author.

Dozier, A.M. (1998). Professional Standards:linking care, competence and quality. Journal ofNursing Care Quality, 12(4), 22-29.

Government of Nova Scotia. (2001). RegisteredNurses Act. Statutes of Nova Scotia, c. 10. s.1.

Government of Nova Scotia. (2001). RegisteredNurses Regulations, made under Section 8 of theRegistered Nurses Act, c. 10. Halifax: Registry ofRegulations.

McPheeters, M. Lohr. (1999). Evidence-basedpractice and nursing: commentary. OutcomesManagement for Nursing Practice, 3(3), 99-101.

National Council of State Boards of Nursing.(1997). Glossary.

National Working Group on ContinuingCompetency for Registered Nurses. (1999).Canadian Nurses Association. Ottawa.

Phillips, E. (1997). Delegation and Liability. TheCanadian Nurse, 93 (6), 47-48.

Porter-O’Grady, T., & Krueger Wilson, C. (1995).The leadership revolution in health care: alteringsystems, changing behaviors. MD: AspenPublishing.

Registered Nurses Association of BritishColumbia. (2000). Standards for Nursing Practice.Vancouver: Author.

Registered Nurses Association of BritishColumbia. (2000). Position statement: Advocacyand the Registered Nurse. Vancouver: Author.

Registered Nurses Association of BritishColumbia. (2000). Position statement: Nurse-ClientRelationships: Establishing ProfessionalRelationships and Maintaining AppropriateBoundaries. Vancouver: Author.

Registered Nurses’Association of Nova Scotia.(1998). Entry-Level Competencies for RegisteredNurses in the Year 2001. Halifax: Author.

Registered Nurses’Association of Nova Scotia.(1999). Guidelines for Shared Competencies &Delegated Medical Functions. Halifax: Author.

Registered Nurses Association of Ontario. (2002).Establishing therapeutic relationships. NursingBest Practice Guidelines. Toronto: Author

Ross-Kerr, J.C., & MacPhail, J. (1996). CanadianNursing: Issues and Perspectives. Toronto: Mosby.

Sheard, A. (2002) Reflective practice: A literaturereview. Beginning Journeys Vol 6. Available athttp://www.cpit.ac.nz/nursing/journey6/sheard.asp


Standards for Nursing PracticeCollege of Registered Nursesof Nova Scotia4005 - 7071 Bayers RoadHalifax, NS B3L 2C2

Tel 491-9744Toll-free (NS) 1-800-565-9744Fax 491-9510E-mail [email protected] www.crnns.ca


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