Working Extra Hours: Fitness to Practice / Duty of Care

RNs are increasingly concerned about the likelihood of being asked to work extra hours. RNs recognize that critical appraisal of the factors in any situation is the foundation of clinical decision-making and professional judgment. As is true with most ethical dilemmas, very often there is no one answer to clearly resolve the issue.

Duty of Care

  • The CRNPEI Standards for Nursing Practice (2018) requires that each nurse demonstrates responsibility and accountability to the public by providing competent, safe and ethical nursing practice (Standard IV).
  • The CNA Code of Ethics for Registered Nurses (2017) requires that nurses provide safe, compassionate, competent and ethical care (Part I A).
  • The safety and well being of the client are of primary importance in any decision related to duty of care.
  • RNs must balance a duty of care with a duty to ensure that their own physical, mental and emotional fitness to practice does not compromise the safety of clients, co-workers or themselves.
  • RNs are their own best judge concerning their level of fatigue and fitness to practice.
  • RNs have an obligation to identify possible alternatives or solutions other than refusing to stay or discontinuing the service.

Factors to consider in decision-making

  • Assess your level of fatigue and fitness to practice for the period of extra hours that you are being asked to work.
  • Identify any risks and benefits for clients associated with your decision. · Assess how the care of the clients will be affected if you leave.
  • Assess if you can stay for a short time beyond the end of your shift or if someone can come in early for the next shift.
  • If you are able to practice competently and safely, the decision to continue working is professionally responsible and fulfils the duty of care.
  • Let your employer know how long you can safely and competently continue to practice and under what conditions and circumstances.

When the situation has resolved

  • Review the effectiveness of the decision and analyze decisions based on the impact on client care and safety.
  • Identify the extent of the problem, possible contributing factors and solutions.
  • Identify ways to prevent and manage similar situations in the future.
  • Documentation, following the appropriate workplace form(s), must be filled out as followup to ensure these situations are avoided in future.