The following scenarios are designed to provide guidance around circumstances in which employers are required to make a report to the College.
Brenda, a nurse on an ICU, is suspected by her manager of having a drug abuse problem and of diverting medication from the unit for her own use. Brenda frequently asks co-workers to co-sign for wastage they have not witnessed. Her clients are treated with higher dosages of prn pain medication than other nurses’ clients on the unit. She primarily works night shifts, takes lengthy breaks and has taken above-average sick time. Her manager has noticed that Brenda is loud and boisterous one moment, and withdrawn the next. In addition, Brenda’s partner has expressed concerns to the manager about Brenda’s health. When asked, Brenda denied that she has any health issues but then took a sick leave. Since she has been off work, there have been no reports of missing medication. Does the facility operator have an obligation to report the manager’s concerns to the College?
It is mandatory for a facility operator to report to the College when there are reasonable grounds to believe that a nurse is incapacitated. "Incapacitated" means that the member has a physical or mental condition, and the disorder affects the member’s ability to practise safely. In the preceding scenario, there are several indications that Brenda may have a health condition affecting her practice. The facility should determine if these indicators are enough to suggest that Brenda meets both requirements of the definition of incapacitated: first, that she has a condition or disorder and second, that her practice warrants some restrictions. Brenda does not need to admit that she is incapacitated. Nor does the facility operator have to “prove” the concerns are true before the obligation to report arises. After the report is filed, the College will assess the information and determine the appropriate regulatory action. If further inquiries regarding Brenda’s health are appropriate, the information will be reviewed by the Inquiries, Complaints and Reports Committee (ICRC).
Paul, a nurse at a retirement facility, is being treated for bipolar disorder. The owner of the facility has never had any concerns with Paul’s practice, conduct, or his relationships with his nursing colleagues or clients. Paul has had some short-term absences, which were supported by his physician, but he has always returned to work in good health. However, because of the new legislation, the facility operator wonders if he is required to report Paul’s condition even though there have been no issues.
There are two components to the definition of incapacity in the Regulated Health Professional Act, 1991:
- the member must have a physical or mental condition; and
- the condition must warrant restrictions (or a prohibition) on the member’s practice.
In this case, Paul’s health condition has not affected his nursing practice. Paul also removes himself from practice when necessary; therefore, the facility likely has no reason to believe that he is incapacitated as defined in the legislation and the College would not expect a report.
Clarice, the clinical manager of a neuroscience unit in a large acute care hospital, recently hired a new nurse, Danielle, who has extensive experience in long-term care settings. Danielle’s therapeutic skills are extremely strong, but she struggles with certain aspects of medication administration. Clarice meets with Danielle and together they develop a learning plan to address the areas of concern. Unfortunately, Danielle’s near-miss errors continue. Clarice decides that Danielle must be paired with a more senior nurse on the unit, and informs the facility operator of the steps she has taken to have Danielle supervised. The facility operator then reports Danielle’s situation to the College.
Facility operators are required to report to the College when there is reason to believe that a nurse who practises at the facility is incompetent. The definition of incompetence includes three key components:
- it must relate to the nurse’s professional care of a patient;
- the nurse must display a lack of knowledge, skill or judgment; and
- the deficiencies must be of a nature or to an extent that demonstrates that the nurse is unfit to continue to practise, or that her or his practice should be restricted.
In this case, Danielle’s deficiencies in the areas of medication administration are of a degree that her employer has placed limitations on her ability to practise independently. Further, it appears that, at this time, the remedial measures have not resulted in significant improvement.