CRNA Practice Standards!
You are a newly graduated nurse, and during one of your shifts, you make a medication error. You recognize the error immediately and tell your coworker what happened. Your coworker tells you, “Just don’t do it again." According to the CRNA practice standards, what should you do?
Take responsibility for the error and follow workplace policies and procedures, including the appropriate reporting process.
CRNA Standard 1: Indicators 1.1 and 1.4 - Professional accountability and responsibility.
A newly graduated nurse notices that the client she is caring for has been left out of care planning. The nurse respectfully communicates the client’s wishes to the health-care team and advocates for the client's choices.
What CNA value and guiding principles are being demonstrated here?
Value 1 - Honouring dignity and autonomy of all people
1.2 - Promoting autonomy and self-determination
1.3 - Respecting people's preferences and choices
You are a new graduate nurse working with an experienced nurse who makes a dismissive comment about a patient being drug-seeking who frequently asks for help to relieve their pain. You notice that the patient's complaints are not being taken seriously. What should you do to support the patient and demonstrate effective followership?
Listen to the patient, take their concerns seriously, and respectfully advocate for their needs with the health-care team.
ICN Code provisions:
1.1 - Primary responsibility to patients
1.3 - Accurate information
2.7 - Patient advocacy
You are a newly graduated nurse and are asked to perform an intervention that you have never performed independently. Your coworker says, “You're not a student anymore; just do it.”
What should you do?
Recognize your limitations, do not perform the intervention independently without the necessary competence, and seek appropriate guidance or support.
CRNA Standard 1: Indicators 1.6, 1.7 and 1.8 - Scope of practice, competence, and professional development.
You are a newly graduated nurse working your first independent shift on the unit. You notice that a client is visibly frustrated because their concerns are not being addressed.
You realize that you have been focused mainly on completing your tasks and may not have taken enough time to understand what matters to the client.
You reflect on your approach, take time to listen to the client’s concerns, and bring those concerns to the health care team.
Which CNA value and guiding principles are being demonstrated here?
Value 2 - Valuing relationships and humanizing care
2.1 - Centring people's well-being and interests
2.2 - Self-reflection and self-awareness
You are on shift one day and notice that one of the unit fire extinguishers is missing. Your coworkers have also noticed, but tell you it is fine because matinence is responsible for those things. What should you do?
Raise the concern through appropriate channels, communicate the potential risk, and contribute to efforts to improve patient safety.
ICN Code provisions:
1.9 - Culture of safety
2.10 - Safeguarding patients
2.11 - Patient safety
You are a newly graduated nurse. During your shift, you notice a unit procedure that conflicts with current safe practice standards and may compromise patient safety. You stay quiet and think, “I am just a new grad. It’s not my place to say anything. They seem to know what they are doing."
According to CRNA Practice standards, what should you do?
Speak up and respectfully question the unsafe practice rather than remaining silent. Raise your concerns to protect patient safety.
CRNA Standard 1, Indicator 1.5: Nurses must question policies and practices that are inconsistent with best practices and safety standards.
You are a newly graduated nurse caring for a client who asks to add you on social media after discharge. The client says, “We get along really well, and I would like to keep in touch.”
You appreciate the connection you have built with the client. You recognize the importance of maintaining professional boundaries and respond respectfully, ensuring that the relationship remains therapeutic and in the client’s best interest.
Which CNA value and guiding principles are being demonstrated here?
Value 3 - Maintaining integrity and autonomy in nursing practice
3.1 - Integrity, honesty, responsibility, and accountability
3.2 - Professional boundaries and conduct
You witness a colleague being repeatedly spoken to disrespectfully by another nurse. Your colleague looks uncomfortable but does not speak up because they are worried that they will be treated even worse for bringing it up. What should you do?
Check in with your colleague, support them in raising the concern, and report or escalate the behavior through appropriate workplace channels when necessary.
ICN Code provisions
2.4 - Positive practice environments
3.4 - Collective professional action
4.3 - Health policy
You are a newly graduated nurse, and one of your patients' conditions suddenly begins to deteriorate.
You communicate your concerns to your coworker and charge nurse, advocate for your patient, and collaborate with the interdisciplinary team to determine the next steps.
What CRNA professional responsibilities are you demonstrating?
Effective communication, patient advocacy, and collaboration with the healthcare team.
CRNA Standards 3 and 4:
3.7 - Effective communication
3.8 - Advocacy for safe, competent, and ethical care
4.2 - Collaboration with the healthcare team
This is your first independent shift. You are asked to perform an intervention that you have never performed before, and you do not feel competent to perform it independently. Instead of pretending to know how to do it, you recognize your limitations and ask for help before providing care.
Which CNA value and guiding principle are being demonstrated here?
Value 6 - Providing competent professional nursing practice
6.2 - Working within one's scope of practice and seeking guidance when lacking competence
You are a new graduate nurse caring for a patient whose medication order says to administer 5 mg. While preparing the medication, you notice that your experienced coworker has prepared 10 mg and tells you, “That’s what we usually give because it works better.” The medication has not been administered yet. What should you do?
Pause the administration, verify the order and medication dose, and respectfully raise the discrepancy with your coworker. Follow the appropriate escalation process if the concern is not resolved.
ICN Code provisions:
2.10 - Safeguarding patients
2.11 - Patient safety
You are a newly graduated nurse. During your shift, you notice a change in one of your patients' conditions.
You use critical thinking to interpret your assessment findings and prioritize your concerns. You effectively communicate these concerns to your health care team and advocate for the patient’s safety.
You recognize that you do not have the expertise to manage the patient's care independently, so you seek assistance from the team.
Later, the charge nurse brings the team together to discuss how similar situations could be identified earlier.
Which CRNA practice standards are being demonstrated here?
CRNA practice standards:
2.3 - Critical thinking
2.4 - Judgment and prioritization
1.7 - Practising within one's competence
3.7 - Effective communication
3.8 - Patient advocacy
4.2 - Collaboration
4.7 - Quality improvement
You are a newly graduated nurse working with an experienced nurse who asks you to document that a patient’s assessment was completed, even though it was not. The nurse says, “I’ve been doing this for the past 15 years. The patient is fine, and we are too busy to check everything.”
- Refuse to document an assessment that was not completed and ensure the patient is assessed appropriately.
- Respectfully explain that documentation must be accurate and escalate the concern if needed.
- Demonstrate effective followership through respectful communication while maintaining independent professional judgment.
CNA Value 3: Maintaining integrity and autonomy in nursing practice (3.1 — honesty and accountability).
During several shifts, you notice that nurses on your unit regularly skip required repositioning for dependent patients because the unit is short-staffed. One patient develops a stage 1 pressure ulcer. When you raise the issue, your charge nurse says, “We don't have time to do everything, so this is just how the unit works.” what do you do?
Address the immediate patient's needs, assess and report the skin concern according to policy, document care accurately, and bring the recurring missed-care and staffing concerns to the appropriate supervisor. Support a broader quality-improvement effort to improve repositioning practices and patient safety.
ICN Code provisions:
2.4 - Safe work environment: Nurses need proper resources and support to provide safe care.
3.5 - Speak up: Nurses should challenge unsafe or unethical practices.
4.3 - Improve healthcare policies: Nurses help develop policies that improve patient care.