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Duty to Report

Nurses have legal and ethical duties to report incompetent or impaired practice or unethical conduct of regulated health professionals.

Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the College of Registered Nurses of British Columbia and all legislation relevant to nursing practice.

Nurses1 have legal and ethical duties to report incompetent or impaired practice or unethical conduct2 of regulated health professionals. It is important for nurses to understand when to report, what to report and how to report, and to know what is required of them both legally and ethically.

In B.C., the Health Professions Act establishes a legal duty for nurses to report situations in which there is a good reason to believe that a health professional's3 practice is impaired or incompetent and may pose a significant risk to the public. The Act also requires nurses to report any sexual misconduct of a health professional.

The ethical duty to report arises from nurses' primary responsibility, which is to provide competent and ethical care to clients. This includes understanding how to respond in a situation in which another health professional is not providing competent or ethical care.

The obligation to take action is shared by nurses, employers, regulatory bodies and others.

Principles

The following principles set out the legal and ethical requirements for practice.

Legal Duty

1.

Nurses must report in writing to the appropriate regulatory body when they have good reason to believe that the public might be in danger because a health professional continues to practise when he or she is:

  • suffering from a mental or physical ailment, an emotional disturbance or an addiction to drugs or alcohol that impairs his or her ability to practise; or
  • not competent to practise.

2.

Nurses must report in writing to the appropriate regulatory body if they have good reason to believe that a health professional has engaged in sexual misconduct. However, if concerns about sexual misconduct are based on information from a client, nurses must first obtain the client's consent before making a report. If the client does not have the capacity to consent to health care treatment, nurses must obtain the consent of the client's parent, guardian or substitute decision-maker.

3.

In employment situations, nurses may report to their supervisor or employer, who will then report to the appropriate regulatory body. However, if it comes to the nurse's attention that no report has been made by the supervisor or employer, the nurse must make a direct report to the regulatory body.

Note: The Health Professions Act protects a nurse who makes a report in good faith from legal liability in circumstances where the nurse has a legal duty to report under the Act.

Ethical Duty4

4.

Nurses are attentive to signs that a colleague is unable, for whatever reason, to perform his or her duties, and they are ethically obligated to take the necessary steps to protect client safety. Consequently, nurses may have an ethical duty to report to a health professional's regulatory body in the following situations:

  •  When a health professional has a pattern of incompetent practice (e.g., failing to assess clients; documenting incomplete or inaccurate information or not documenting at all).
  •  When a health professional has a pattern of impaired practice (e.g., from fatigue that interferes with physical or cognitive ability to function; from an addiction to drugs).
  • When there are allegations that a health professional has behaved unethically (e.g., has committed theft, fraud, or breach of trust; has had, or is having, an inappropriate relationship with a client or former client; has abused or abandoned a client).
  • When a health professional has been charged or convicted of a crime that may result in that health professional's integrity being questioned or in the public losing confidence in the profession or the health care system (e.g., impaired driving, assault).
  • When an employer has not reported that a health professional's employment has been terminated or a health professional has resigned when there are unresolved concerns about his or her practice.

Applying the principles to practice

Taking action

When applying the principles of duty to report to your practice, be sure to follow a fair and thoughtful process. The process outlined below is intended to help you decide the best action to take in cases of incompetent or impaired practice or unethical conduct.

1. Define the behaviour

Ask yourself:

  • Is the health professional failing to provide competent care?
  • Does the behaviour involve a breach of accepted ethical standards?
  • Has there been a pattern of questionable behaviour, and is it likely to continue?
  • Is the health professional unable or unwilling to recognize and correct the behaviour?
  • Have clients been harmed by this behaviour or are they likely to be harmed in future?

Take action if you answer yes to any of these questions.

2. Decide on the most appropriate course of action

Consider whether the most appropriate action is for you to discuss your concerns directly with the health professional, or to report to your manager, or to contact the regulatory body directly.

If a discussion with the health professional resolves the matter, you may not need to take any further action.

If you decide it is not wise to discuss your concerns directly with the health professional or you continue to have concerns that are based on reliable information, you are obligated to take action. The usual course of action would be to talk to your manager or the person to whom you normally report in your workplace about your concerns. (Make sure the concerns are documented.) If it later comes to your attention that no report has been made by the person you report to and the situation is still unresolved, you should then report directly to the regulatory body.

If you are worried that client safety might be jeopardized by a reporting delay, contact the regulatory body directly. The person at the regulatory body who deals with complaints will counsel you on the best course of action and next steps to take.

3. Report to the regulatory body

Before you submit a formal report to the health professional's regulatory body, contact the person at that regulatory body who is responsible for dealing with complaints to discuss your next steps.

In cases where you are required to file a formal report, submit the report in writing to the registrar of the regulatory body in which the health professional is a registrant. The report should be as complete as possible, without unnecessarily invading the privacy of anyone else who may be involved (e.g., another health professional or a client). If concerns about sexual misconduct are based on information from a client, you must also obtain consent from the client before making a report. If the client does not have the capacity to consent to health care treatment, you must obtain the consent of the client's parent, guardian or substitute decision-maker.5 Remember, it is the regulatory body's job, not yours, to investigate your concern.

The report should generally include:

  • Your name and the name of the health professional who is the subject of the report. A detailed description of the behaviour with examples of specific incidents. For each incident, provide the date, time, place, who was involved, names of health professionals and others who have direct knowledge of the behaviour, what happened and how it affected client care.
  • Copies of any supporting documents, after obtaining appropriate releases, e.g., copies of incident reports, chart pages, narcotic records, performance appraisals or other performance reports, written statements from co-workers, other staff, clients or clients' relatives.
  • An outline of any actions taken to deal with the behaviour and a description of how the health professional responded to those actions.
  • The names of affected clients, if you have received consent from the client or their substitute decision-maker.
  •  If applicable, the date the health professional started working for the employer and the date employment was terminated.

Understanding the obligations of others under the Health Professions Act

Employers, health care facilities and other people associated with a health professional have a duty to report under the Health Professions Act in certain circumstances:

  • When they terminate a health professional's employment based on the belief that the public might be in danger if the health professional continues to practise because he or she is:
  • suffering from a mental or physical ailment, an emotional disturbance or an addiction to drugs or alcohol that impairs his or her ability to practise; or
  • not competent to practise.
  • When they revoke, suspend or impose restrictions on the privileges of the health professional, based on the belief that the public might be in danger (as above).
  • When they dissolve a partnership or association with the health professional based on a belief that the public might be in danger (as above).

Note: A report must be made in these cases even when a health professional takes steps to end the situation. For example, if a health professional resigns his or her employment before being terminated, or gives up privileges before the employer relinquishes them, the employer must still report.

A report must also be made when a health professional is hospitalized for psychiatric care or treatment for drug or alcohol addiction and is therefore unable to practice. In this case, the chief administrative officer of the hospital and the attending physician must report to the registrar of the appropriate regulatory body.

Glossary

Client abandonment: Discontinuing the provision of care after engaging with the client or accepting the client assignment without first:

  • negotiating a mutually acceptable withdrawal of service with the client; or
    allowing the employer a reasonable opportunity for alternative or replacement services to be provided.

Competence: The integration and application of knowledge, skills and judgment required to perform safely, ethically and appropriately within an individual's practice or in a designated role or setting.

Inappropriate relationship: Relationship between a health care professional and a client that has a negative effect on meeting the client's therapeutic needs or encroaches on the client's right to receive safe, ethical and competent care.

Sexual misconduct: Professional misconduct involving one or more of the following: Sexual intercourse or other forms of physical relations between the health professional and the client

  • Touching of a sexual nature of the client by the health professional
  • Behaviour or remarks of a sexual nature by the health professional toward the client

Note that any touching, behaviour or remarks towards a client that are of a clinical nature appropriate to the service being provided is not sexual misconduct.

Unethical conduct: Behaving in a way that contravenes established ethical standards. Examples of unethical conduct include:

  • Committing theft, fraud or breach of trust
  • Having an inappropriate relationship with a client or former client
  • Abusing or abandoning a client

F​or more information

St​andards of Practice

CRNBC's Standards of Practice (Professional Standards, Practice Standards, and Scope of Practice Standards) set out requirements for practice that nurses must meet. They are available from the Nursing Standards section of the CRNBC website.

Other CRNBC ​resources

Other r​esources

Footnotes

1

"Nurse" refers to all CRNBC registrants.

2

Terms defined in the Glossary are highlighted in bold type the first time they appear.

3

In reference to the legal duty to report, "health professional" refers to a registrant of any health profession college under the Health Professions Act.

4

The same concern may invoke both a legal and an ethical duty to report.

5

A nurse has a separate legal duty to make a report to a child welfare worker under the Child, Family and Community Service Act where a client is under the age of 19 and is in need of protection. There are circumstances where a nurse should not seek or wait to obtain the consent of a parent or guardian before making a report under this legislation. For more information, see The B.C. Handbook for Action on Child Abuse and Neglect.

 

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