If your concerned about s situation impacting patient safety, it’s your obligation to intervene.  It can be hard to know what information to share with what person. This may be a good topic of conversation within your team or with your manager. Be sure to understand the organizational policy about how patient safety concerns are raised.

Something about my colleague’s behaviour concerned me

Raise concern informally: Do you feel comfortable raising the concern directly to your colleague? Is direct feedback appropriate?

For example, you have worked with colleague for a number of years and have never had concerns regarding their practice. On this occasion you overhear the colleague speaking in a tone to a patient that may be perceived as being harsh. In this situation, you can discuss your thoughts by focusing on the perception of your colleague’s behaviour, rather than on the colleague personally.

I have a concern about a pattern of behaviour that may impact patient safety

Raise concern formally: Escalate concern to a manager.

For example, over the past month you have worked three shifts with Elizabeth, an RN. Each shift you have had to remind Elizabeth to sign for medications she has administered. When you spoke directly to Elizabeth, she acknowledged her oversight and blamed the error on the unit’s busyness. You notice an unresolved pattern in nursing practice, despite direct feedback. In this situation, you can have a conversation with your manager to describe your observations on Elizabeth’s practice.

Nurse is not responding to employer remedial supports

Raise concern to CNO: Consider your professional accountability as a partner in ensuring public protection.

For example, you recognize your responsibility to ensure quality patient care by assisting nurses in addressing their remedial needs. For instance, you have been working with a nurse over the past several months and despite a variety of attempts to assist the nurse in addressing a competency gap, concerns remain about the nurses' practice.

Nurse has engaged in an activity that must legally be reported to CNO.

Legal obligation to report concern to CNO: There are certain situations legally required to be reported directly to CNO. For example, regulated health professions and facilities have an accountability to report suspected sexual abuse.

For example, You and your colleague Jin-Hee, an RN, are friends on social media. You happen to notice pictures Jin-Hee recently posted and recognize Jin-Hee’s companion, David, a recent patient. You are concerned as the pictures indicate a romantic relationship. When you speak to Jin-Hee about your concerns she dismisses them and states, “Don’t worry, David asked me out. I didn’t approach him. Besides, he was discharged three months ago.”