PRINCIPLES OF DUTY TO PROVIDE CARE

1.    Registered Psychiatric Nurses (RPNs) have a professional and legal obligation to provide their clients with safe, competent and ethical psychiatric nursing care.

2.    RPNs recognize that informed, capable clients have the right to make choices that may put their health at risk, to be independent, and to direct their own care.  Regardless of this right, RPNs do not comply with client wishes when doing so would require a nurse to act against the law or their CRPNA Standards of Practice or Code of Ethics.

3.    RPNS do not provide care that is outside their scope of practice except in situations involving imminent risk of death or serious harm that arises unexpectedly and requires immediate action.  In emergencies RPNs are ethically obligated to provide the best care they can given the circumstance and their own level of competence.

4.    RPNs do not allow their personal judgement about a client(s) or a client’s lifestyle to compromise the client’s care by withdrawing or refusing care.

5.     RPNs may withdraw from care provision or refuse to provide care if they believe that providing care would place them or their clients at an unacceptable level of risk. RPNs consider relevant factors, including:

a.    the specific circumstances of the situation;

b.    their legal and professional obligations; and

c.    their contractual obligations.

6.    RPNS who have a conscientious objection to a client’s request for a particular treatment or procedure:

a.  listens and, when possible, explore the client’s reason for the request or refusal and their understanding of options that could meet their needs.

b.  does not attempt to influence or change the client’s decision based on the nurse’s conscientious objection.

c.  does not allow their beliefs or values to alter or interfere with a client receiving safe, competent, and ethical care.

d.  ensures that the most appropriate person within the organization is informed of the conscientious objection well before a client is to receive the requested treatment or procedure.

e.  work with their organization/employer to ensure uninterrupted continuity of care including reporting the client’s request and, if needed, safe transfer of the client’s care to a replacement provider; and

f.   despite their conscientious objection, provide safe care to a client in a situation involving imminent risk of death or serious harm that arise unexpectedly and require urgent action for their client’s safety.

7.  RPNs do not abandon their clients.  Abandonment occurs when the RPN has engaged with the client or has accepted an assignment and then discontinues care without:

a.  negotiating a mutually acceptable withdrawal of service with the client; or

b.  arranging for suitable alternative or replacement service; or

c.  allowing the employer, a reasonable opportunity to provide for alternative or replacement service.

8.    RPNs may experience difficulties in meeting legal and professional obligations to provide care when:

a.    care delivery creates unreasonable danger to your client’s safety or your personal   safety

b.    providing care that conflicts with moral, ethical or religious beliefs or values.

9.    When faced with a situation that affects your ability to provide care you need to examine risks and ethical/moral dilemmas and determine the most appropriate course of action using a decision-making process that includes:

a.       determining the facts and identifying the issue or concern.
b.       clarifying the issue or concern.
c.       identifying your options and developing a plan
d.       implementing the plan, evaluating the outcomes of your decision, and amending         it if necessary.
e.       where appropriate, making your concerns known to your employer, your union,           or CRPNA.