Clinical Concerns

Processes To Facilitate Student Success

Minimally, a Student Practice Education Support Plan (SPESP) will be implemented to facilitate student success. The SPESP is a written agreement between the student and program in which identified gaps are described and remediation processes are articulated. The SPESP includes objective measures that must be met for the student to be successful in the practice education experience.

Practice Education Concerns

Practice education concerns may be communicated to the RN(AAP) by preceptors, practice education site staff, patients, and others. Behaviour(s) that place the patient or staff in jeopardy are reviewed.

• Physical jeopardy is the risk of causing physical harm.
• Emotional jeopardy means that the student creates an environment of anxiety or distress which puts the client or family at risk for emotional or psychological harm.
• “Unsafe clinical practice is an occurrence or pattern of behaviour involving unacceptable risk” (Scanlan, Care, & Gessler 2001, para 17).

Killam, Luhanga, and Bakker (2011) reviewed the literature to identify characteristics of unsafe practice in the practice setting. The behaviours identified by the authors are provided below. It is important to note that these behaviours are not exhaustive but provide a reference and context to the concern or complaint received.

Lack of Accountability/Unprofessional Practice

• Does not accept responsibility for own actions, does not admit mistakes, covers up errors.
• Is dishonest.
• Does not recognize potential for doing harm, lack of insight.
• Is reluctant to assume a professional role.
• Doesn’t make the effort to learn, is not interested.
• Breaks confidentiality.
• Does not ask for help when unsure.
• Demonstrates inappropriate boundaries.

Patterns of Behaviour

• Demonstrates a pattern of unacceptable practice or significant performance issues in practice education settings.
• Disregards policy does not know policies.
• Is frequently late or absent.
• Does not change behaviour in response to feedback; repeats mistakes even after feedback.

Unmet Competencies

• Has a poor knowledge base.
• Is unable to apply concepts and theory in practice.
• Poor and/or inconsistent skills in assessment and client care.
• Is unable to apply concepts and theory in practice.
• Unable to set priorities; unable to care for clients at level of complexity expected for the course and year in the program.

Communication and Professionalism 

• Lack of respect for clients, family, staff, peers, or Clinical Faculty.
• Aggressive with clients.
• Ineffective communication with clients, staff, peers, or Clinical Faculty.

Issues with Judgement

• Poor clinical judgment.
• Practices beyond scope of practice.
• Evidence of impaired judgment due to drugs, alcohol, or lack of sleep.
• Demonstrates extreme anxiety that is disproportionate to the situation

A student who is practicing unsafely is responsible to recognize and be accountable for their own mistakes and participate in the remediation process.