The goal of the College of Registered Nurses of British Columbia is safe and appropriate nursing practice regulated by nurses in the public interest and achieved by promoting good practice, preventing poor practice, and intervening when practice is unacceptable.
(CRNBC Mission statement)

        Quality of care is achieved in a number of different ways.  Some are the responsibility of the individual nurse, others are the responsibility of the profession.
        As an individual, the nurse can ensure quality care for clients and their family by adhering to the Standards of Practice for the province of British Columbia.  The nurse can ensure that his/her knowledge is current by taking courses, reading professional journals and through certification.
       The CRNBC has set Standards for Practice for all nurses in the province of British Columbia. These Standards for Practice include:
 

     One of the characteristics of a professional is to competently apply knowledge. Inherent in this characteristic is the belief that nurses will continue to upgrade their knowledge and skills to ensure safe practice.
 

        It is becoming clear that a basic nursing education will not necessarily get you any nursing position - especially in acute care settings. Nursing is becoming more specialized and nurses working in certain areas require additional post graduate education to enable them to work in those areas. Currently, in many British Columbia hospitals it is highly recommended or a requirement for new graduates to have the BCIT Perinatal Nursing course before being considered for a position on a maternity nursing floor. This course, and others like it, provide the new graduate or nurses who want to move to a new area of clinical practice with the knowledge and skills required to work competently.

        The Canadian Nurses Association (CNA) offers nurses an opportunity to become certified in a number of areas yearly.  Over 1000 nurses annually take the examination through CNA.  Other nurses write certification examinations designed by special groups, e.g. Intravenous Nurses

    
        In addition to the increasing number of certification courses, nurses are able to avail themselves of continuing education courses. The College Registered Nurses of British Columbia offers a variety of continuing education courses. Nursing journals, especially American journals, offer continuing education courses to their subscribers.

        Technology has allowed continuing education courses to be offered through the Internet. The Nursing Centre is one site that has a great variety of courses available to nurses. 

 Evidenced Based Practice

       Nursing and health other health care professionals are looking at past practices to ensure that care is research based.  Quality assurance, continuous quality improvement, total quality management and evidence based practice are terms used to ensure that health care is not only of excellent quality and backed by research but also to ensure that health care is cost effective.

        Quality Assurance is a systematic way that nurses can use to monitor and evaluate the care given to clients using a predetermined set of criteria in an attempts to ensure that the care is exceptional.  Continuous quality improvement allows nurses to constantly improve the system in which they work to provide the highest level of quality care by providing them with the training, support and time required.  Total quality management is a philosophy of management that is committed to continuous improvement in quality.  Evidenced based practice is the conscientious use of current best practice evidence in the research to make decisions about nursing care.
 

        Based on the following the nursing profession must ensure that the care they give is not only of superior quality and supported by research but that the care is also cost effective.
 

        In the late 1970s the Registered Nurses Association of British Columbia implemented a Quality Assurance Program for nursing.  The focus of this program was to guarantee a degree of excellence in nursing care by establishing the highest standards of care that could be expected to be achieved by nurses in a given setting (CRNBC, Quality Assurance Manual).  The program was seen as being continuous if excellence was to be maintained or improved upon.

        Quality Assurance was slowly being replaced by Continuous Quality Improvement (CQI) in the late 1980s.  The roots of quality improvement go back to the work of W. Edwards Deming in Japan. He changed the management style of industry in Japan and improved the quality of the products produced.  Products that are now highly respected for quality in North America.

        In the United States, W. Edwards Deming's work was adapted by Dr. Donald M. Berwick to improve the quality of health care. Total Quality Improvement (TQM) is now being used in several health care facilities in North America. TQM has met with both success and failure. What worked well in industry was not as easily transferred to health care.

        In Canada TQM and CQI have been used in both major hospitals (St. Joseph's Health Centre, London) and on specific wards within a hospital (orthopedic surgery).  In London, St. Joseph's Health Care Centre adopted the following characteristics and principles:

1. Quality is consistent conformance to customers' expectations.
2. Measurements of quality are through indicators of customer satisfaction, rather that indicators of self gratification.
3. The objective is conformance to expectations 100 per cent of the time.
4. Quality is attained through prevention and specific improvement projects.
5. Management commitment leads the quality process.

Hassen, P. (1993). Rx for hospitals: New hope for medicare in the nineties. p. 23

    The Centre for Nursing Research in Montreal has developed a web site on Evidenced-based practice in nursing through the Sir Mortimer B. Davis Jewish General Hospital.

      In Australia, the Joanna Briggs Institute has a list of Best Practice Guidelines available on-line for nurses in Australia.

     In Canada, the Health Information Research Unit at McMaster University is actively involved in Evidence Based Practice.  They provide timely evidence based information on health care to professionals in Canada and abroad.  The Health Information Research Unit Web site (overview) will allow a health professional to access information from a variety of sources, including the Cochrane Library.  The Agency for Healthcare Research and Quality is an American site devoted to promoting quality care based on research.

When Practice Fall Below the Expected Standard

The profession, under the Health Professions Act, is empowered with the following responsibilities:

 

Duty and objects of a college 16 (1) It is the duty of a college at all times (a) to serve and protect the public, and (b) to exercise its powers and discharge its responsibilities under all enactments in the public interest. (2) A college has the following objects: (a) to superintend the practice of the profession; (b) to govern registrants according to this Act, the regulations and the bylaws of the college; (c) to establish standards of academic or technical achievement and the qualifications required for registration as a member of the college; (d) to establish, monitor and enforce standards of practice to enhance the quality of practice and reduce incompetent, impaired or unethical practice amongst registrants; (e) to establish and maintain a continuing competency program to promote high practice standards amongst registrants; (f) to establish, for a college designated under section 12 (2) (h), a patient relations program to seek to prevent professional misconduct of a sexual nature;

            Self-regulation is a privilege that we should not ignore or abuse.  Self-regulation is an integral part of the Health Professions Act.  As noted above self-regulation is one of the Standards for Practice for all nurses in British Columbia.

           When nurses fail to meet these standards, the College has been mandated  to promote good nursing practice by preventing poor practice and intervening when nursing practice is unacceptable.

            An integral  part of self regulation is the Continuing Competence Program.  This places the onus on each individual nurse to assess her own practice and professional development.

        The CRNBC, to 'prevent poor practice and intervene when nursing practice is unacceptable', may institute a Professional Conduct Review look under Complaints Tab). The review, initiated by a complaint, may be resolved informally or formally. The latter may involve a consensual complaint resolution or a formal investigation and inquiry.

        Nurses have an moral, and in some provinces a legal, duty to report a nurse who does not use proper skill, judgment and knowledge in the care of clients.