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Professional Practice

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The College of Nurses of Ontario (CNO) and other regulatory bodies have Standards of Practice that registrants are expected to meet in order to provide safe, ethical and quality patient/client/resident care within their scope of practice.

ONA has developed the Professional Responsibility and Workload (PRW) process to resolve professional practice and workload issues.

By engaging in the PRW process, you are playing a pivotal role in meeting your Accountability Standard for your regulatory college, while advocating for patient safety and quality patient care.

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The Professional Practice Process

The professional responsibility clause:

  • Gives you say in the quality of care you provide.
  • Provides a problem-solving approach that helps you meet professional standards.
  • Provides documented evidence.
  • Provides you with union representation for practice concerns.
  • Provides for resolution of disputes.

It is your professional responsibility to report unsafe patient care/practice concerns to your employer. Examples of such concerns include lack of adequate staff and/or inappropriate skill mix for acuity, delay in assessment, non-nursing duties, lack of supplies, and inadequate orientation/mentorship.

The tool available to assist is the ONA Professional Responsibility Workload Report Form (PRWRF). Failure to comply with your professional obligation of reporting is considered professional misconduct (see College of Nurses of Ontario (CNO) Reference Document, Legislation and Regulation: Professional Misconduct, p.12). You may choose to report to both the employer and the CNO.

Nurses who use the professional responsibility process are taking steps to correct excessive workload situations and meet their professional responsibility requirements as patient advocates, ensuring the provision of safe quality patient care.
 
This process has led to:

  • Increased staffing levels;
  • Practice setting improvements;
  • Safer work places;
  • Improved communication processes with employers;
  • Enhanced nursing practice/quality of care; and
  • The provision of necessary equipment and supplies.

 What to do?
  • Obtain a Professional Responsibility Workload Report Form from your Unit/Floor Union Rep which should be available on your floor, or call the Union office 613-546-0906 to request forms.
  • Fill out the form every time the employer creates an unsafe and/or unprofessional practice or setting.
Remember the Professional Responsibility Workload Report Form (PRWRF) in itself is not a Professional Responsibility Complaint (PRC), but the start of a paper trail to identify and demonstrate ongoing concerns requiring a response by your employer. It provides evidence of your identification of nursing practice, nursing/client care, workload and patient safety issues, and provides you with the documentation should you or another member find yourself in the unfortunate position of responding to the Complaints and Disciplines committee at the College of Nurses of Ontario (CNO.)
 
Fill out a form when you encounter the following Professional Responsibility Concerns/Indicators in your unit:
  • Inadequate/inappropriate staff and/or skill mix for acuity.
  • Delay in assessment, treatment or medication.
  • Non-nursing duties and/or lack of support staff.
  • Any workload, employer practice, policy or situation that is detrimental to patient/client/resident care and/or safety.
  • New patients admitted to unit with inadequate staff.
  • Staff not given adequate orientation and/or mentorship in area assigned.
  • Lack of adequate equipment and/or supplies.
  • Click to view examples. 

How do I complete the form?

  • Focus on your practice – How was your practice affected? Identify professional/CNO standards you feel you had trouble meeting.
  • Focus on patient care factors – For example, change in acuity, total care, restraints, altered mental status, receiving blood products/TPN/infusions, less than four hours post-op, etc.
  • Include the number of patients with each factor, if possible.

The Process:

  1. When a workload issue occurs, the first step is to try and resolve the issue within the program/area/unit. If necessary, ask assistance from a team leader, supervisor, coordinator or charge nurse.
  2. If the concern is not resolved, notify your manager/designate (as soon as possible) by voice, e-mail or in person by the next working day. (if in the off hours)
  3. Encourage and support your colleagues to practice in the process. This may include signing the form, discussing the situation and writing possible solutions or recommendations to the problem on the form.
  4. Discuss your practice and/or workload concern with your manager, if you prefer, your Bargaining Unit President or designate, who will present for/with you to the manager. Make sure that section seven (7) of the form, management comments, is completed. Give the white “Manager/Chief Nursing Officer (or designate) Copy” to your manager.
  5. Keep the green “Member Copy” for your records or when using electronic versions, print a copy for yourself.
  6. Submit the white “LRO Copy” and the pink “Local Copy” to your Bargaining Unit President, Nursing Office Armstrong 0

On occasion some managers may take the filing of workload forms personally and can be perceived that they discourage staff from filing by retaliation, threats and suggestions that “well, perhaps it’s your lack of organization; perhaps we should review your performance.” It is important to remind your managers that it is your professional responsibility to report and address issues in order to provide safe, quality patient care. If your manager is a nurse or other regulated health professional, it is their professional responsibility to respond and address issues in order to provide safe, quality patient care.

What happens once your form is submitted: 

  • You should expect a follow up from your manager/designate during your next few shifts that they are in the building, after which you will receive a written response of this discussion.
  • Also the union will receive a copy of the written manager’s response, which will be reviewed and attached to your complaint.
  • The Union will receive their copy, which will be carefully read, coded and relevant details input into a data base for the hospital unit affected. At this time you will be sent a letter from the union informing you that your complaint has been received and processed for presentation at the next upcoming monthly Hospital Association Committee (HAC) meeting. (Please note: this letter now provides you with a union contact if you have additional information you wish to add to your complaint.) 
  • When unsatisfactory responses or no resolution to the PRC is achieved during HAC and a number of similar concerns have compiled in a given time period for a particular unit the Union will move forward using the Formal PRC process, with the aid of a Professional Practice Officer from ONA Central.
  • This process can escalate to the point of an Independent Assessment Committee (IAC), which has been negotiated under your collective agreement to resolve PRC’s.

PRC Coding

  • Overcapacity/Increased volume
  • Incorrect staffing mix
  • Critical incident
  • Lack of equipment
  • Working short (any type of staff)
  • Lack of supplies
  • Critical patient
  • Visitor/family issues
  • Moving beds/patients/equipment
  • Student Supervision
  • Acuity
  • Housekeeping/Maintenance issues
  • Inappropriate assignment of patient
  • Orientation
  • Calling in staff
  • Meds unavailable/given late
  • Triage over-load
  • Non Nursing duties
  • Constant care issue
  • Hallway Nursing
  • Health & Safety issues
  • Missed breaks/rest periods
  • Infection control practices

Resources

Looking for sector-specific resources?

Find Professional Responsibility Workload Report Forms (PRWRFs) and other resources specific to your sector, on the ONA Professional Practice webpage.

Professional Responsibility and Workload Process: A Guide for ONA Members
College of Nurses of Ontario Professional Standards
Ask-a-Specialist Sessions

Have a question?

If you need assistance with the Workload Report Forms or have any questions regarding professional practice, please contact your Bargaining Unit President and/or your Professional Practice rep.

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