We have created three case study vignettes to encourage you to consider the competence needed, knowledge and skill, and help you decide about courses/certifications.
Barbara is on maternity leave and is planning to return to work on her medical unit next month. Her CPR certification expired while she was off, so she now has to complete a full CPR course rather than a recertification course. Barbara works in a rural hospital where CPR courses are only offered at certain times of the year. The next full course offered by her employer isn’t occurring for six months. This poses a problem for Barbara as she is unable to return to work until she obtains her certification. Barbara recalls overhearing past conversations among her RN colleagues that only certain CPR certifications are acceptable. As she has been off, she hasn’t clarified with the other nurses about the acceptable courses. So Barbara decides to contact CARNA to “get the list” of acceptable courses so she can register herself into a full CPR course soon.
Barbara calls a policy and practice consultant at CARNA to inquire about the CPR courses that are acceptable for registration. During the discussion, she is surprised to learn that the Health Professions Act does not have CPR as a requirement for a practice permit and the Registered Nurses Profession Regulation does not indicate that CPR is a requirement for registration as a RN. The policy and practice consultant informs Barbara that CPR certification may be a component of an employment contract or job/role description and covered under the employer’s policies. If required to hold CPR certification this is because the employer requires this as part of their job description for that particular role. If having certification in CPR is required in their job description then the RN that completes this certification is adhering to CARNA Practice Standard Indicator 1.2: The nurse follows current legislation, standards and policies relevant to their practice setting.
The policy and practice consultant discusses with Barbara that competency in CPR requires both knowledge and skill, so an appropriate course should contain both components.
Mykala has been an RN for almost three years and is working in long-term care. She has been approached on several occasions by the health care aides to provide foot care for their residents who have diabetes. Mykala is competent in cutting toenails with nail clippers, but after her assessment of some of the residents’ feet, she decides that the care they require is beyond her level of knowledge and competence.
Mykala is frequently the only RN working on her shift so she isn’t able to ask for assistance from an RN colleague. When Mykala reviews her organization’s policies regarding foot care it states that an RN with a certificate in foot care is able to provide nursing assessment and foot care for residents with complex foot care needs or those with diabetes or other lower limb circulatory issues. Mykala reviews the Nursing Intervention Classification (NIC) resource on the CARNA website to view the suggested activities listed for the nursing intervention of foot care as well as activities for the intervention of “teaching: Foot Care” for guidance. Finding no clear direction on which course to take, Mykala contacts CARNA to speak with a policy and practice consultant.
Often patients requiring foot care have complex health issues or comorbidities and the intervention is considered higher risk for negative outcomes. Foot care for this population is a specialized area of practice and would benefit from post entry to practice education.
Mykala speaks to a policy and practice consultant at CARNA who informs her that CARNA does not have a policy or a specific requirement for a foot care course. In response to these questions, the policy and practice consultant emphasizes the importance of RNs applying the Practice Standards for Regulated Members in their practice and understanding their responsibility to practice competently and to continually acquire and apply knowledge and skills in the provision of evidence-informed nursing care.
Evidence-informed practice is based on successful strategies that improve client outcomes and is derived from a combination of various sources of evidence including client perspectives, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data. This means that CARNA expects that an RN practises based on the best possible evidence and recognized best practices. The policy and practice consultant suggested that Mykala review all the foot care courses available and consider the content and review her own knowledge, skill and competency to determine her needs and to choose a course that is current, evidence-informed and would best meet her needs.
The policy and practice consultant also discussed with Mykala the importance of having a strong understanding of IP&C practices and following employer IP&C policies that would be relevant when performing foot care.
The policy and practice consultant encouraged Mykala to follow up with the clinical nurse educator as a resource for best practice information related to the provision of foot care.
Dale is moving to Alberta to begin his career as a new occupational health nurse (OHN). He calls CARNA to inquire if CPR is a component of registration as an RN and which course he should be taking in order to facilitate him in receiving a practice permit. He tells the policy and practice consultant that he is starting as a new OHN in the oil and gas industry in Alberta in the next six weeks.
The policy and practice consultant responds that Dale doesn’t require CPR as a component of holding a practice permit in Alberta; those requirements come from the employer either through policy and/or job descriptions. The policy and practice consultant is familiar with the Occupational Health and Safety (OHS) Code in Alberta and knows that under that Code, “a Nurse is a RN who is a member of CARNA …who is an advanced first aider.” The OHS Code also defines advanced first aider as, “a nurse or other person who holds a certificate in advanced first aid from an approved training facility.”
The policy and practice consultant tells Dale that even though CARNA does not have a specific requirement for CPR certification, his employer and/or the Alberta OHS Code requirements may be relevant in his situation so she encourages him to speak to his new employer and inquire about the job description and employer policies. The policy and practice consultant also suggests that Dale look up the requirements under the Alberta OHS Code and review the approved training facilities list.
This is a component of Dale meeting Practice Standard Indicator 5.2: the nurse follows all current and relevant legislation and regulations and 5.4: the nurse practices within the legislated scope of practice of the profession.