CPNRE Collaborative Practice and Teamwork 2 — Questions and Answers
Question 1: A practical nurse disagrees with the physician's care plan. What is the most appropriate first action?
- Change the plan without discussion
- Discuss the concern directly with the physician in a respectful and professional manner (Correct answer)
- Refuse to follow the plan until changed
- Document disagreement and follow the plan without communication
Correct answer: Discuss the concern directly with the physician in a respectful and professional manner
Professional advocacy involves respectfully communicating concerns to the physician using evidence and clinical assessment.
When a practical nurse has concerns about a care plan: review the concern carefully; communicate directly with the physician using SBAR; present objective clinical data; document the discussion; if legitimate safety concern is dismissed, escalate through the chain of command (charge nurse, nursing supervisor). Practical nurses have a professional obligation to advocate for client safety per provincial regulatory college standards (CNO, CRNBC, CARNA). Unilateral plan changes or silent non-compliance are inappropriate.
Question 2: During rounds, the physiotherapist plans twice-daily ambulation. The nurse knows the client has severe pain with movement. What should the nurse do?
- Follow the physiotherapy plan without modification
- Share pain assessment findings with the team so the plan can be appropriately modified (Correct answer)
- Decline to participate in ambulation until pain resolves
- Ambulate the client regardless of pain
Correct answer: Share pain assessment findings with the team so the plan can be appropriately modified
Sharing relevant clinical information during rounds ensures the team has a complete picture to develop a safe and effective plan.
The practical nurse's role in interdisciplinary rounds: contribute nursing assessment data others may not have. Sharing pain findings allows the team to premedicate before therapy, modify the plan, or coordinate timing with analgesic peak. This is collaborative practice per the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework. Each discipline contributes expertise to optimize client outcomes.
Question 3: After receiving a telephone order, repeating it back and receiving confirmation, what is the next required step?
- Implement immediately without documentation
- Document immediately and have the physician co-sign within the required timeframe (Correct answer)
- Wait for written order before implementing
- Ask another nurse to verify first
Correct answer: Document immediately and have the physician co-sign within the required timeframe
Verbal orders must be documented immediately and require physician co-signature within the facility's required timeframe for accountability.
Safe verbal/telephone order process: HEAR clearly; WRITE immediately (date, time, order, physician name, nurse name); READ BACK verbatim; CONFIRM (physician verifies correct); IMPLEMENT; physician co-signs within 24-48 hours per provincial standards. Many facilities document: 'V.O. Dr. Smith / read back confirmed / [nurse initials]'. Practical nurses must follow their facility's policy and provincial standards (CNO/CRNBC guidelines).
Question 4: Which behavior demonstrates effective collaboration within an interprofessional healthcare team?
- Completing all tasks independently without consulting others
- Actively participating in team huddles and communicating client status changes to relevant team members (Correct answer)
- Informing only the charge nurse and allowing them to relay to other disciplines
- Waiting for other team members to initiate communication
Correct answer: Actively participating in team huddles and communicating client status changes to relevant team members
Active participation and proactive communication of relevant client information demonstrates collaborative practice skills.
Effective interprofessional collaboration: participate actively in huddles and rounds; proactively communicate status changes to relevant team members; use structured communication tools (SBAR, I-PASS); respect and value each team member's expertise; share assessment findings clearly; follow up on communicated concerns. The CIHC Interprofessional Competency Framework identifies collaboration as core for all healthcare providers including practical nurses. Siloed practice that withholds information compromises client safety.
Question 5: Which client situation is appropriate for delegating urinary catheter care to an unregulated care provider (UCP)?
- A client with a new catheter placed yesterday and cloudy urine
- A clinically stable client with a long-term catheter and clear urine output (Correct answer)
- A client who just returned from surgery 2 hours ago
- A client with a new fever and decreased urine output
Correct answer: A clinically stable client with a long-term catheter and clear urine output
Routine catheter care for a stable client with an established catheter and normal output is appropriate for delegation to a UCP under supervision.
Delegation to UCPs must consider: client stability (stable, predictable = appropriate); task complexity (routine catheter care for established catheter with normal output is appropriate); UCP competence; practical nurse ability to supervise. New catheters, post-surgical, and clients with abnormal findings (cloudy urine, fever, decreased output) require nursing assessment. Delegation principles are governed by provincial regulatory college standards (CNO, CRNBC, etc.) in Canada.
Question 6: A family member demands to know why a client was transferred to a different unit related to a safety incident under investigation. What is the most appropriate response?
- Explain the full details to satisfy the family
- Acknowledge concern, protect client privacy, and direct to the appropriate person (Correct answer)
- Tell the family there was an error and apologize
- Avoid the conversation
Correct answer: Acknowledge concern, protect client privacy, and direct to the appropriate person
The nurse should acknowledge concerns and direct to the appropriate person while maintaining client confidentiality.
Response to family asking about a safety incident: acknowledge concern with empathy; protect client privacy (do not disclose investigation details without authorization); direct to the appropriate person (charge nurse, patient relations, attending physician); document the interaction. Premature disclosure can compromise the investigation and legal proceedings. Provincial privacy legislation (PHIPA in Ontario, FOIPPA in BC) governs disclosure. Canadian Disclosure Guidelines govern formal disclosure processes.
CPNRE Collaborative Practice and Teamwork 2
A practical nurse disagrees with the physician's care plan.
What is the most appropriate first action?