2.2 Ethical and Professional Foundations

CNA Code of Ethics for Nurses

The Canadian Nurses Association (CNA)^[1] is a professional organization that represents the national and global interests of Canadian nurses. They represent registered nurses, nurse practitioners, licensed and registered practical nurses, registered psychiatric nurses, and retired nurses across all 13 provinces and territories. ^[2] The CNA developed the Code of Ethics for Registered Nurses as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.^[3]

CNA Registered Nurse Practice Framework

The CNA publishes The Framework for the Practice of Registered Nurses in Canada. This framework promotes a common understanding of RN practice among nurses, students and stakeholders (including other health professionals, employers, educators, policy-makers and the public). Given the large number of regulated and unregulated care providers in Canada, it is essential for policy-makers, decision-makers and employers to clearly understand RN competencies and contributions as well as to know when RN care is the most appropriate. ^[4] Each province and territory also has a regional governing body for nurses. These regional bodies are responsible for further outlining the scope of practice, practice standards, and professional standards for their registrants. The regulatory body in British Columbia is the British Columbia College of Nurses and Midwives^[5]

The CNA defines nursing as “the application of professional nursing knowledge, skills, and judgment for the purpose of: (a) promoting, maintaining, and restoring health; (b) preventing illness, injury, or disability; (c) caring for persons who are sick, injured, disabled, or dying; (d) assisting in pre-natal care, childbirth, and postnatal care; (e) health teaching and health counselling; (f) coordinating health care; or (g) engaging in administration, teaching, or research. ^[6] A registered nurse is an individual who is educationally prepared and licensed by a province or territory to practice as a registered nurse. 

CNA Entry-level Competencies

CNA entry-level competencies describe a competent level of behaviour in the professional role.^[7] A total of 101 competencies are grouped thematically under nine roles. Integration of all nine roles enables the entry-level registered nurse to provide safe, competent, ethical, compassionate, and evidence-informed nursing care in any practice setting. Some concepts are relevant to multiple roles. The roles include:

1. Clinician: provide safe, competent, ethical, compassionate, and evidence-informed care across the lifespan in response to client needs; integrate knowledge, skills, judgment and professional values from nursing and other diverse sources into their practice.
2. Professional: commit to the health and well-being of clients; uphold the profession’s practice standards and ethics and be accountable to the public and the profession; demonstrate accountability, accept responsibility, and seek assistance as necessary for decisions and actions within the legislated scope of practice.
3. Communicator: use a variety of strategies and relevant technologies to create and maintain professional relationships, share information, and foster therapeutic environments.
4. Collaborator: play an integral role in the health-care team partnership.
5. Coordinator: coordinate point-of-care health service delivery with clients, the health-care team, and other sectors to ensure continuous, safe care.
6. Leader: influence and inspire others to achieve optimal health outcomes for all.
7. Advocate: support clients to voice their needs to achieve optimal health outcomes and support clients who cannot advocate for themselves.
8. Educator: identify learning needs with clients and apply a broad range of educational strategies towards achieving optimal health outcomes.
9. Scholar: demonstrate a lifelong commitment to excellence in practice through critical inquiry, continuous learning, application of evidence to practice, and support of research activities.

CNA Practice Standards

Compared to the other designations of regulated nurses, the standards of practice for registered nurses vary across Canada with no national framework identified. The next section will focus on the professional and practice standards in British Columbia as set out by BCCNM.

BCCNM Professional Standards and Practice Standards

Professional Standards are “one set of standards under the umbrella of BCCNM Standards of Practice, are statements about levels of performance that nurses are required to achieve in their practice”.^[8]

• Standard 1: Professional Responsibility and Accountability
• Standard 2: Knowledge-Based Practice
• Standard 3: Client-Focused Provision of Service
• Standard 4: Ethical Practice

Nurses are guided by professional standards in all aspects of their roles, including medication administration.

Practice standards guide and direct nurses’ practice. ​They set out levels of performance that BCCNM nurse registrants are required to achieve in their practice. ^[9] There is a specific practice standard related to medication administration for nurses.

BCCNM Practice Standard for Medication

In British Columbia, the BCCNM has developed a practice standard for medication administration for all nurses. This practice standard outlines nurses’ accountabilities for providing safe nursing care to clients when performing activities involving medication.^[10]

Controls on Practice

Controls on practice explains the bases for nurses’ scope of practice. There are four levels of controls on registered nurses’ practice. All these components are required to provide quality, safe client care that is evidence-based.

1. Nurses (Registered) and Nurse Practitioners Regulation, which sets out the scope of practice in fairly broad strokes.
2. BCCNM standards, limits and conditions, which complement and further define and limit the scope of practice set out in the Regulation.
3. Employer/organizational policies, which may restrict registered nurses’ practice in a particular agency or unit.
4. An individual registered nurse’s competence to carry out a particular activity.

Media Attributions

• Figure 2.2: “Controls on Nursing Practice” is copyrighted by British Columbia College of Nurses and Midwives. All rights reserved. Reprinted with permission.