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Stress on staff when a colleague is unskilled or unprofessional in their practice was the third trend identified in a review conducted by the Practice Review Committee (PRC) of discipline decisions by the Professional Conduct Committee and Appeals Committee. In the May 2005 edition of Alberta RN, the first trend, a lack of professional responsibility and accountability, was discussed and the second trend, a lack of integrity and insight in a nurse's practice, was discussed in the July 2005 issue.

SCENARIO: Beatrice, a registered nurse (RN), is often five to ten minutes late for work. She arrives on the nursing unit out of breath and looking like she has just gotten out of bed. She often complains she is tired and just can't get a sound sleep like she used to when she first started out in her career.

Beatrice is always the first one to ask to go on a break and she is often the last one to return from break. On more than one occasion, her colleagues have observed that, when Beatrice comes back onto the nursing unit after her break, she seems very drowsy and inattentive to the nurse giving her report so the nurse usually has to repeat information several times. Staff members often answer call bells for Beatrice's patients as she either isn't around or doesn't seem to be aware that her patients are ringing their call bell.

The nursing staff is becoming increasingly concerned when they work with Beatrice that errors are just waiting to happen and they feel that they have a responsibility to check up on the care she provides. They are frustrated that she is always requesting to work extra shifts or to be on call when they know how tired she is when at work.

DISCUSSION: The Nursing Practice Standards provide guidance for RNs in addressing their concerns related to unsafe practice and support them in making sound decisions so that quality care can be provided.

STANDARD 1

Professional Responsibility

The registered nurse is personally responsible and accountable for ensuring that her/his nursing practice and conduct meet the standards of the profession and legislative requirements.

Indicators:

1.1 The RN is accountable at all times for his/her own actions.

1.6 The RN has a professional responsibility to practice competently.

1.7 The RN demonstrates competence by regularly evaluating his/her practice and taking necessary steps to improve personal competence.

1.8 The RN is responsible for ensuring her/his own fitness to practice.1

Beatrice has a responsibility to maintain her physical, psychological, emotional and spiritual well-being. Her behaviour suggests that she is experiencing a problem in one or more of these areas and that her thinking, decision-making, reaction time, judgment and ability to be flexible and handle stress may be negatively influenced. This problem can jeopardize client care.

When fatigue or other factors threaten an RN's fitness to practice safely, the RN has a right and a duty to withdraw from or refuse requests or requirements to work extra hours. In this scenario, Beatrice does not seem to be aware that her behaviour is placing her patients and co-workers at risk and she continues to request extra work hours. If staff members have concerns, they have a responsibility to address these concerns in a professional manner by first talking with Beatrice and then by bringing their concerns forward to their manager or clinical supervisor. RNs need to recognize the signs of stress that lead to self-exhaustion and identify strategies for dealing with stress for themselves and their colleagues.

RNs in direct care must balance a duty to care for patients with an equal duty to ensure that their fitness to practice competently does not threaten the safety of patients, co-workers or themselves. RNs in other roles (for example, clinical educators and managers) share this responsibility with RNs in direct care. Nurse managers are obliged to promote practice environments where fitness to practice and safe care can be maintained through ensuring appropriate staff mix, required resources and policies etc.

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