Clinical Capacity Concerns
Clinical Capacity Concerns take several forms:
A workload issue occurs when a nurse, in her professional judgment, is concerned that due to insufficient staffing on a specific shift, or insufficient levels of training, equipment and so on, she is unable to complete or adequately perform all of her assigned tasks within the hours of the shift. The insufficient staffing could result in compromised patient/client/resident care (e.g. medications not given on time, treatments not done). For example, if a community care nurse is required to cover half the case load of another nurse who has called in sick, she is unlikely to be able to provide adequate care for all of her clients. Similarly, if the ER is above capacity and nurses are treating patients in hallways or other areas, it is very difficult to provide appropriate care.
A competency concern relates to the adequacy of the scope of practice or employment of health care workers to the care they are asked to provide. For example, an RN or LPN may be concerned if an employer hires an unregulated care provider to feed patients in the Intensive Care Unit (ICU). The nurse may believe that the unregulated care provider does not have adequate training or an adequate level of competency to determine whether a patient is swallowing properly. According to CRNNS and CLPNNS, the RN or LPN has a responsibility to provide either direct or indirect supervision of this care provider (CRNNS/CLPNNS, Assignment and Delegation Guidelines for Registered Nurses and Licensed Practical Nurses, 2012). The RN or LPN in this situation must intervene to ensure patient safety and inform the employer of this competency issue. Failure to report could be considered professional misconduct by the relevant licensing body.
A procedure or policy concern relates to the appropriateness of the employer’s procedures and policies with respect to safe patient care. For example, if an employer announced that within the next two months, the licensed nursing staff on the night shift in a large nursing home will be reduced to one, LPNs and RNs in the facility might be concerned that this change will compromise resident safety. The nurses might make recommendations concerning this policy, realizing that CLPNNS and CRNNS standards require them to provide feedback on policies and procedures that affect resident care. To take another example, if an employer decided that RNs in the ER will begin suturing, without providing the necessary education and training, the nurses would be rightly concerned with upholding their professional standards and the quality of patient care. In this case, there is a concern with both the employer’s policy and the competency of the nurses who have not received the appropriate training.