I’m a nurse on an in-patient mental health unit. We often receive orders from physicians asking us to perform checks on patients every 15 minutes due to a high risk of self-harm. These 15-minute checks are difficult for the nurses to perform because of our high workload and nurse-to-client ratios. What are our accountabilities for frequent assessment and monitoring?

Assessing patients is part of a nurse’s professional practice to keep patients safe and improve a patient’s health outcomes.

The Nursing Act, 1991 includes the accountability of assessing patients in the nursing scope of practice statement.

Nursing Scope of Practice Statement

The practice of nursing is the promotion of health and the assessment of, the provision of care for and the treatment of health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function.

All nurses are expected to regularly assess clients, although certain clients may require more frequent assessments, such as monitoring every 15 minutes. For example, if you work with clients who have acute mental illnesses, frequent checks may be ordered because there are unique safety issues. These include an increased risk of violence, self-harm and suicide. Many of these clients may be isolated, require restraints or have limited capacity for advocating for themselves. Therefore, frequent monitoring is essential in supporting client safety.

The Code of Conduct states that nurses participate and advocate for improving the quality of their practice setting to support safe client care. Nurses must also take action if client safety and well-being are compromised. Therefore, if nurses have concerns about their ability to perform ongoing assessments as ordered and part of the client’s care plan, nurses are accountable for sharing those concerns with their team and clinical manager.

All members of the health care team have a shared accountability to advocate for quality practice environments and support systems that promote safe care. Nurses are also accountable for providing a complete record of client care including documenting assessment data such as when client assessments are completed. For more information about these accountabilities, see the Documentation, Revised 2008 practice standard.

If you have any practice-related questions, visit Practice Support.

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