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quality-assurance-program

quality-assurance-program

College of Registered Nurses of Newfoundland and Labrador

Introduction
In fulfilling the mandate to protect the public, ARNNL is committed to promoting good nursing practice
and preventing poor nursing practice by focusing on early intervention through a proactive quality
assurance program (QAP). The program is designed to address practice concerns rather than wait until
they become more serious and require engagement in the disciplinary process. Therefore, the QAP, as
indicated in Figure 1, is an element of ARNNL’s quality assurance framework and not the professional
conduct review (PCR) process.
The intent of early intervention is to allow an opportunity for remediation to improve a registered nurses
practice and protect the public from unsafe nursing care while supporting the registered nurse to
continue to practice safely. The authority to do this, is derived from the Registered Nurses Act, 2008,
section 35.1(1).

Framework
ARNNL’s quality assurance framework identifies key elements that contribute to ensuring registered
nurses’ practice safely, competently, compassionately and ethically according to Standards of Practice
and Code of Ethics in the province of NL. The QAP is one of the key elements of ARNNL’s umbrella
Quality Assurance Framework.

Figure 1

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55 Military Road, St. John’s NL, A1C 2C5 | P: 709-753-6040 | TF: 800-563-3200 | F: 709-753-4940 | W:www.crnnl.ca

Quality Assurance Program

Quality Assurance Program
ARNNL’s focus on early intervention through a proactive QAP is based on the following principles:

Within the Mandate of ARNNL Regulating Authority:
QA processes shall fall within the mandate of ARNNL’s regulatory authority and support the mission to
advance nursing excellence for public protection and optimal health of the Newfoundland and
Labrador population.

Value-Add:
There should not be a process (external to ARNNL) that already address the issue; such as
Professional Practice Nursing in Regional Health Authorities (RHAs) and Employee and Family
Assistance Program services.

Preventative:
QA processes should be focused on public protection through prevention of conduct deserving of
sanction.

Evidence-Informed:
Implementation of QA processes should be guided by the best available research and information.

Agile:
QA processes will change based on new evidence, or emerging patterns in nursing practice and
regulations.

Potential Quality Assurance Concerns
The first line of early intervention and remediation when a registered nurse has a practice issue related to
competence, fitness, minor practice concerns etc., and is not conduct deserving of sanction, is the
employer. The employer may be able to appropriately address the practice issue (that is not conduct
deserving of sanction) and thus ARNNL may not need to be involved.
If remediation fails, or the employer does not have the resources to intervene and remediate, or the
registered nurse is self-employed, the employer/ public should notify ARNNL.

Practice issues, which are not conduct deserving of sanction, and can potentially benefit from early
intervention through the QAP, include, for example, issues where:




There is no foreseeable risk of harm to the public.
There are no previous allegations /QA issues against the registered nurse, except for possible
licensure allegations.
The action or behaviors does not appear to be reckless or intentional.
There is reception for remedial intervention.
The issues cannot be sufficiently managed within the employment setting or the registered nurse is
self – employed.

Human error, such as a single medication error, or a failure to implement a treatment due to oversight,
may not be a practice issue for referral to the QAP. However, if human error of the same type is repetitive,

55 Military Road, St. John’s NL, A1C 2C5 | P: 709-753-6040 | TF: 800-563-3200 | F: 709-753-4940 | W:www.crnnl.ca

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College of Registered Nurses of Newfoundland and Labrador
indicating a pattern of behavior and there is no activity (external to ARNNL) that already address the issue
such as Professional Practice Nursing in RHAs, it can be referred to the QAP.
At risk behavior, is when a registered nurse may knowingly deviate from a standard due to a lack of
understanding of the risk to the client, organization, self or others. For example, deviations from policy or
unprofessional communication. At risk behavior is a practice issue which can be referred to the QAP.

Quality Assurance Program Process
ARNNL is to be notified of the practice issue in writing which must be signed. Once received and
reviewed to be a practice issue which can benefit from a proactive approach, it may be addressed
through a quality assurance resolution or a quality assurance review. The person identifying the concern
will be notified that the practice issue will be addressed through the QAP and when concluded, the
outcome.

A quality assurance resolution involves a mutually agreed upon plan to address the practice issue
which includes intervention and evaluation. The resolution is prepared by ARNNL staff in
collaboration with the registered nurse.

A quality assurance review is required if a resolution cannot be achieved or deemed not to be
appropriate. A quality assurance review is a review of a registered nurse or a registered nurse’s
practice overseen by a quality assurance committee (QAC). This process can result in further
information gathering and more extensive intervention and evaluation. The QAC, has the authority
under legislation to make orders and requirements with respect to the registered nurse’s practice.

Conclusion
The QAP is a new program which ARNNL will continue to evolve and improve to strengthen its ability to
promote good nursing practice and prevent poor nursing practice in the interest of the public of
Newfoundland and Labrador.

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55 Military Road, St. John’s NL, A1C 2C5 | P: 709-753-6040 | TF: 800-563-3200 | F: 709-753-4940 | W:www.crnnl.ca

55 Military Road
St. John’s
NL | Canada
A1C 2C5
Tel (709) 753-6040
1 (800) 563-3200 (NL only)
Fax (709) 753-4940
crnnl.ca | @crnnlca

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