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 Quality Assurance 

Last modified Oct. 14, 2005  

Practice Review – Frequently Asked Questions

Contents:

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1. What is Practice Review?

Practice Review is a three-step process that yields an objective assessment of nurses' practice in relation to a set of competencies that have been identified as essential for safe, effective and ethical nursing care. These competencies are based on CNO's Standards of Practice and apply to all direct practice nurses regardless of their area of focus or practice.

Practice Review is part of CNO's Quality Assurance (QA) Program The QA program supports nurses in continuous practice improvement; facilitating practice development; and increasing the public's confidence in the nursing profession.

Your participation in Practice Review is a professional obligation as a member of a self-regulated profession and is confidential.

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2. Why is the College doing this?

The Registered Health Professions Act (1991) requires all Ontario's health regulatory colleges to develop, establish and maintain quality assurance programs. Practice Review is a key component of CNO's QA Program.

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3. What are the steps in Practice Review?

Step 1 - Practice Review Written Assessment (PRWA):

PRWA assesses a nurse's practice against established competencies from the College's Standards of Practice, using case-based scenarios and multiple-choice questions. Members can complete PRWA at a pre-selected site, or choose their own proctor and centre. Nurses have a maximum of six hours to complete the assessment, held over two sessions. Results and feedback are available four weeks after the overall completion of PRWA. Most nurses are expected to succeed and will exit Practice Review at this point.

Step 2 - Behaviour Based Interview (BBI):

If the results of Step 1 indicates that a more in-depth assessment is needed, nurses move on to Step 2, Practice Review Behaviour Based Interview (BBI). BBI is a 90-minute, face-to-face interview with a CNO Practice Consultant who will only assess those competencies that were identified as needing further assessment from Step 1. Members can complete the interview either at the College or by choosing their own location. Results and feedback will be available approximately four weeks following the completion of BBI.

Step 3 - Remediation

If the PRWA and BBI results reveal serious concerns about a members practice, the member will be referred to the QA Committee. The Committee has several options and, depending on the practice issue and identified needs, may recommend or direct specific learning activities or educational courses.

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4. What are the Competency Categories?

The five competency categories include:

  • Professional Behaviour/Ethics
  • Critical Thinking
  • Client and Nurse Safety (Illness and Injury Prevention)
  • Relationship (Nurse-Client and Inter-professional)
  • Clinical Skills

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5. How do I prepare for Practice Review and the Written Assessment?

The Competency Review Tool (#44028) will help you assess your skills against the competencies measured during Practice Review Written Assessment. It is available on our website, by FastFax 416-963-7502, or toll-free 1-877-963-7502.

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6. What happens if there are serious concerns about my practice?

If practice concerns surface, the QA Committee may recommend or direct remedial activities such as education. However, if serious practice concerns are raised, the Executive Director may impose a term, limit or condition on your registration, which must be recorded in the Public Register, as per the RHPA. Please note; the Committee cannot revoke a nurse's registration.

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7. Who will conduct the Step 2 Interview? Do I have to come to Toronto?

CNO Practice Consultants - experienced nurses with expert knowledge about practice standards - conduct the interview. The Practice Consultant can do the interview at the College or attend your location. If you choose the latter option, you may have to assist in arranging a suitable location. For confidentiality reasons, you may want to pick a location outside of your work.

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8. Will my travel expenses and time be reimbursed?

No. The College will not reimburse you for time or travel expenses.

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9. Do I have to let my employer know?

You are not obligated to tell your employer of your participation in the program. It is your decision. Participation is confidential, and will not be shared with anyone, including employers, outside of the College. Only you and the QA Committee will have access to the assessment results. The results are not used for any other College activity, such as complaints and investigations.

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10. Personal circumstances prevent me from participating at this time, what do I do?

Let us know. You may temporarily defer your participation in Practice Review if you have a valid, extenuating circumstance, including serious illness, disability, bereavement, or other significant factors. You will be required to provide documentation, such as medical certificates to demonstrate your exemption need.

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11. What is the role of the Proctor?

The role of proctor was designed to assist nurses who wish to complete Practice Review at a more convenient location and time. The proctor administers the written assessment and returns it to the College. They are also responsible for maintaining appropriate security measures in respect to the PWRA. Proctors receive $50 for administering the assessment.

A proctor must be a member of:

  • A regulated health profession (e.g. physician, nurse, midwife etc.), or
  • A profession such as a lawyer, engineer, teacher, social worker, librarian, accountant, judge etc.).

Relatives may NOT serve as proctor.

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12. What happens if I can't make it to the writing centre?

Notify the College immediately if you miss or are absent from your scheduled sitting.

 

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Competency Categories

Steps 1 and 2 of Practice Review are designed to assess the knowledge, skill and judgement required for safe, effective and ethical nursing care. The categories are:

Professional Behaviour/Ethics

You are accountable to the public and responsible for ensuring that your practice and conduct meet legislative requirements and the standards of the profession. This includes: promoting client well-being; providing and respecting clients’ choices in decision making; assuring privacy and maintaining confidentiality; respecting the sanctity and quality of life; decision making when working with unregulated care providers; and maintaining a commitment with the client, self, the profession, and employer.

Relationships

The nurse-client relationship is therapeutic and based on trust, respect, intimacy and requires the appropriate use of power. A professional therapeutic relationship includes establishing and maintaining appropriate boundaries and recognizing when the relationship crosses these boundaries. As with clients, your interaction with colleagues should also be professional.

Critical Thinking

Critical thinking involves asking, and considering the answers to, a number of questions. Integral to good decision making, critical thinking includes the activities of organizing and analysing information, recognizing patterns, and gathering evidence to support the conclusions drawn.

Client and Nurse Safety (Illness and Injury Prevention)

Enabling clients to avoid illness and injury involves taking measures to prevent injury, responding to safety risks to clients and health care team members, challenging questionable actions and orders, and intervening appropriately in situations of risk.

Clinical Skills

You are accountable for demonstrating competence in your area of practice. For nurses in direct practice, this requires having the knowledge and skills to perform client assessments, to administer medications safely, and to communicate and document according to CNO standards.

The Clinical Skills category is further broken down into the following subcategories:

  1. Assessment
  2. Communication
  3. Medications
  4. Documentation

While not all nurses administer medications as a part of their practice, all nurses are expected to have knowledge of medications as it relates to the care of their clients.

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Practice Review Written Assessment (PRWA): Development and Scoring

How was the PRWA developed?

Hundreds of nurses identified key competencies required for safe, effective and ethical nursing care. Questions based on practice standards were developed and tested in a written assessment trial. A scoring system was developed that effectively pinpoints the basic level of competence required to provide safe, effective and ethical care.

How was the score set for successful completion of the PRWA?

The scoring follows a similar method (Angoff) to the method used for national registration, certification, and the RN (EC) examinations. Each question is rated based on the knowledge and skill required by minimally competent nurses to answer the question correctly - difficult questions have a lower rating while easier questions are higher. As questions are developed, modified and/or removed, the overall required score would change, based on levels of difficulty. This is why pass marks do not appear on the Performance Profile.

How is the PRWA scored?

Answer sheets are electronically tabulated and compared to the established criteria. A nurse who scores higher than the standard score will exit Practice Review. A nurse whose score does not exceed the standard goes onto Step 2 Practice Review Behaviour-Based Interview (BBI).

The PRWA's validity relies on input from direct practice nurses at each step. To stay vital, the College will continue to involve nurses in the development of new questions, and will request feedback from Practice Review participants. We encourage you to participate in self-regulation whenever you can.

 

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