Fitness to practice (FTP)
Fitness to practise (FTP) is "all the qualities and capabilities of an individual relevant to their capacity to practise as a registered nurse, including but not limited to, freedom from any cognitive, physical, psychological or emotional condition and dependence on alcohol or drugs that impairs his or her ability to practise nursing" (The Canadian Nurses Association (CNA), 2017).
When you experience health concerns that affect your skills, abilities and judgement you may not be able to provide safe, competent and ethical nursing care in the best interest of the public and patient safety. There may be times when you are unable to recognize you are not fit to practise. Your health condition may be chronic and your health status declining. Physical and mental health, substance abuse and addiction disorders can cloud your judgment regarding your own FTP.
How to meet this requirement
- You must do one of the following on initial application, when renewing your registration, and
when returning to practice:
- Declare your FTP.
- Let CARNA know if you are:
- Unable to practise due to a physical or mental health condition, substance abuse and addiction or if you are on medical leave.
- On a leave of absence due to a mental, physical or substance abuse issue at renewal time.
- As an RN, you are responsible for maintaining your own FTP throughout the year. Here are some helpful tips:
- If your colleagues raise concerns about your practice, take care to assess your practice.
- You can withdraw from practice or request modification(s) if you are experiencing a short or longer term illness.
- You are not required to inform CARNA of your FTP status during the practice year.
- If physical or mental health conditions are affecting your FTP, you may require medical advice, treatment and monitoring.
- If stressors in your life are affecting your FTP you can seek assistance through counselling. You may want to review your employer resources/benefits for coverage.
- If you have concerns about your FTP you should consult your health-care provider to determine if you can practise safely.
- If you are self-employed, you may need to arrange for another appropriate health-care professional to provide care for your client.
- You may wish to access your employer's Occupational Health Nurse (OHN). They can/will collaborate with you, your primary care provider and your workplace to develop a plan which may involve modified hours or duties. Only information about your ability to return to work and any workplace modifications and/or accommodations can be shared with your manager. OHNs are required to ensure that your personal health information remains confidential and no medical information be disclosed to your manager.
You may be disciplined if you work while unfit to practise.
You can be investigated and disciplined for unprofessional workplace behaviours even if those behaviours are related to an underlying health problem. The unprofessional workplace behaviours are disciplined, not the underlying health problem. However, the underlying health problem is taken into consideration at the time of a hearing.
The Health Professions Act gives the Complaints Director the authority to act on matters related to incapacity. If the Complaints Director has grounds to believe a regulated member may be incapacitated, an Order to cease practising will be made along with requirements to undergo appropriate health assessments and treatment. Once the Complaints Director receives medical clearance from all of the health-care providers, the Order will be lifted and the member will be able to return to work.
What physical and mental conditions affects FTP?
Incapacity is defined in the HPA as "suffering from a physical, mental, or emotional condition or disorder or an addiction to alcohol or drugs as defined in the Pharmacy and Drug Act, or other chemical that impairs the ability to provide professional services in a safe and competent manner". If you are incapacitated then you are not fit to practise.
When fatigue interferes with FTP, it can impair your judgment and can create significant risk for you and your clients. Fatigue can be either physical, mental/psychological or both and it can be short or long term. Many factors in the workplace environment and in your personal life can contribute to fatigue. Factors such as sleep deprivation and fatigue from long hours of work can affect your ability to observe, to collect data, to analyze information, to solve problems, and/or to respond rapidly.
When you are too fatigued, you should inform your employer you cannot take on extra shifts. It is recommended that you manage your non-work activities so that they do not affect your FTP. For more information about the provision of safe, competent, ethical nursing care when you work extra hours read the CARNA guidelines on working extra hours.
Here are suggestions on how you can manage fatigue:
- Get adequate rest and recreation.
- Make sleep, breaks and naps a priority.
- Create a work-life balance.
- Eat a healthy, balanced diet and exercise regularly.
- Decrease caffeine consumption.
- Recognize when you are fatigued.
- Use a buddy system to check for fatigue.
- Know organizational policies.
- Engage in appropriate self-care (CNA, 2012).
Substance use becomes problematic when it interferes with your ability to practise in a safe, competent and ethical manner. If you or others close to you question if your drug or alcohol use is problematic, seek assistance and consider removing yourself from the practice setting.
If you are worried about a colleague, discuss your concerns with them privately. If you remain concerned, indicate that you will need to follow-up with the most appropriate person. If you do not wish to talk directly with your colleague, you should discuss concerns directly with the most appropriate person. Please see Problematic Substance Use: Guidelines for Regulated Members for more information.
You need to be able to provide safe, competent and ethical care in your practice setting. It is recommended that you discuss the possibilities for workplace accommodation with your employer.