The College is seeing an increase in the number of nurses who are not performing ongoing client assessments at the frequency needed to ensure client safety. This pattern emerges when we review cases in which clients are exposed to risk.
Ongoing client assessments are critical to providing safe client care. Assessment is a professional accountability and an essential part of your nursing practice, as outlined in Professional Standards, Revised 2002.
All nurses are expected to regularly assess clients. However, certain clients may require more frequent assessment. For example, if you work with clients who have acute mental illnesses, frequent checks are essential because there are unique safety issues for these clients, which may include an increased risk of violence, self-harm and suicide. Some of these clients may be isolated, require restraints or have a limited capacity to advocate for themselves. Frequent monitoring supports client safety. Clients who are classified as being high risk may require monitoring as frequently as every 15 minutes.
Communication is key
Another source of risk to clients is the potential loss or miscommunication of client information during the transfer of care or handover. Care transitions happen often, such as when a client experiences a change in health care providers or location, when a shift ends or you take a break. Each time, you must communicate client-specific information to a colleague that is clear, focused and comprehensive.
Work with your health care team to establish and maintain effective communication. Be sure to consider:
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What are the potential risks to my clients?
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How can I clearly and effectively communicate client information between health care providers in our practice setting?
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Is this communication sufficient to minimize risk for my clients?
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Is this communication sufficient to facilitate the continuity of care?
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How does our current practice contrast with best practice evidence?
Using effective communication strategies to meet the therapeutic needs of your client is one of your accountabilities, as outlined in Therapeutic Nurse-Client Relationship, Revised 2006. This also applies during care transitions.
Shared accountability
The Professional Standards practice standard states that you must facilitate, advocate and promote the best possible care for clients. You must also take action if client safety and well-being are compromised. Therefore, if you have concerns about your ability to perform ongoing assessments appropriate for your practice, speak to your clinical manager and ask your team for support.
If you are a nurse in an administrator role, work with your team to develop policies for a safe work environment in the best interest of clients and professional practice. All members of the health care team have a shared accountability to advocate for a quality practice environment that supports nurses’ ability to provide safe and effective care.
Understand the standards
Practice standards outline the expectations for nurses that contribute to client safety. Practice guidelines, which often address specific practice-related issues, help nurses understand their responsibilities and how to make safe and ethical decisions in their practice.
Would you like to better understand the standards and how to apply them to your practice? We can help! Check out our tools and resources page, as well as Ask Practice, which answers your most frequently asked practice questions. You can also contact our Practice Support team with any practice question by filling out our Practice Support form.