How to write a nursing Competency Assessment Supplement (CAS) for Ontario RPNs

How to write a nursing Competency Assessment Supplement (CAS) for Ontario RPNs

Clinical practice is now based on evidence-based practices rather than unsystematic clinical experience. Evidence-based practice is an important tool for making informed decisions regarding patient care and improving the quality of healthcare (Chien, 2019). When I was working in the medical-surgical department, there was an issue with patient falls. The department recorded the highest number of falls that year which led to poor patient satisfaction. To improve on this practice, I was part of the team that educated staff on doing hourly rounding to identify patient needs and act promptly. Although the staffing during that period had challenges, the unit managed to reduce the risk of falls within six months of implementing the purposeful rounding protocol (Competency #11). Evidence-based practice was observed to improve quality by reducing the number of falls in the medical-surgical unit.

Continuous quality improvement (CQI) is recognized as a strategy for improving the effectiveness of services provided to patients and outputs in healthcare organizations (Hill et al., 2020). This process helps individuals and healthcare organizations to decide how better they can implement practices or adopt new measures to improve quality. For example, when I was working in the emergency department, there was a big challenge for staff and nursing students to deliver good care after critical events. Although deaths are inevitable and expected in the ERs, those occurring due to errors, understaffing, or negligence seemed to have a big impact on staff. To ensure such issues did not have a big impact on the subsequent delivery of care, I challenged the unit manager to include discussions of such events days before the beginning of shifts. Additionally, the use of debriefing sessions after critical events was another strategy for students and staff to use for readjusting after critical events (Competency #13).

In the realm of healthcare professionals, misconduct is a practice that is unacceptable because of its threat to patient safety and relationship with other employees. Misconduct can jeopardize the quality of relationships and have serious consequences on the practice of nurses. When I was working in the emergency department, there was an issue with staff receiving small tokens from patients following service delivery. At one time I observed a patient give some cash to a student nurse after wound dressing. To address this issue, I invited the student for lunch and used the chance to talk about professional misconduct. I explained to the student that receiving money from patients is a form of bribery with serious consequences later in their professional careers (Competency #17). The student was sorry and explained that he was not aware of monetary appreciation from patients and the link to professional misconduct. The student promised to change and never engage in receiving unacceptable gifts from patients.

Medical errors, near misses, and adverse events are serious causes of mortality and morbidity. A small error can activate a chain of events that can harm the quality of services offered to the patient and subsequent harm making their recognition an important step towards prevention. When I was working in the emergency department, I frequently managed patients requiring moderate sedation under the supervision of a RN and physician. During one busy afternoon, there was a patient admitted after sustaining a fall. The attending physician and RN coordinated care including manual manipulation and relocation of the hip after sedation. However, I noticed the patient started experiencing breathing difficulties during recovery. After going through his charts, I noticed that the patient was given a large dose of diazepam and the other staff did not have knowledge about his regular use of hydromorphone for back pain. The use of this drug made it difficult for the patient to achieve sedation and this made the RN and the physician give inappropriate doses of diazepam (Competency #18). Early recognition of this error led to close patient monitoring and taking of actions to prevent respiratory distress and other possible complications.

Understanding the indigenous populations in Canada is one of the key areas emphasized in schools. The promotion of cultural competency begins by knowing the origin of people and how their culture shapes healthcare delivery. One area that I can remember dealing with is the Truth and Reconciliation Commission (TRC) actions. The TRC requires all nursing students to be knowledgeable about the rights of aboriginals and treat them with respect to their values. There was a time in the ED when I had to consult one of the aboriginal healthcare professionals regarding the care of a young family that was deeply rooted in their culture. I did not know how to approach the family, but I understood that providing culturally competent care could improve their clinical experience (Competency #24). I was surprised by the amount of information that the healthcare professional obtained from the family because of their interaction and sharing of cultural values.

Equitable distribution of healthcare resources is among the essential components of primary healthcare and a key challenge for providers and policymakers (Figueroa et al., 2019). In research, issues dealing with resource distribution are the most difficult because they are feasible and long-term solutions. Healthcare providers must strive to push for equity during service delivery for patients and other vulnerable communities. For example, when I was working in the medical-surgical department, there were a significant number of admissions involving the homeless. I observed that these individuals faced challenges with accessing basic care like going for x-ray, billing, and timely discharge. Most workers ignored the urgency of their needs and they were not given priority during treatment. To address this challenge, I proposed to the management to have a distinct section for the homeless in the unit and a daily allocation of staff to deal with key issues like billing and diagnostic testing. This system was adopted across other departments and areas like X-ray had distinct points for the vulnerable to access necessary services (Competency #26).

Advocacy is among the major roles that nurses assume in their profession. Patient advocacy involves taking bold actions to fight for their well-being by giving them a platform to air their challenges and ensuring their safety (Nsiah et al., 2019). Actions like patient education, double-checking errors, and protecting their rights demonstrate the nurses’ adherence to the advocacy role. When I was working in the medical-surgical unit, I observed how the issue of understaffing affected the quality of care delivered to patients. Many patients, especially those that required routine wound dressing experienced problems in receiving the right care. I involved the unit manager to draft a report demonstrating how patients were being affected by the issue and how an additional staff member could make a huge impact on the patients’ lives. Although it took time to approve, an additional staff member was provided to aid nurses in doing their duties (Competency #27). For those with serious health issues, health education was routinely offered to ensure they had some control over their health outcomes.

Nursing practice is guided by the professional code of ethics that stipulates the actions and activities nurses should perform. Sometimes the action of nurses or other healthcare professionals can be questionable and reporting it to the relevant authority is required. The nurse is responsible for ensuring their practice and conduct and that of their colleagues are in alignment with the standards of the profession. For example, I once worked with a colleague who drank alcohol at work. I several occasions, I noticed changes in behavior that were consistent with alcohol use and my attempts to advise against drinking did not yield positive results. One afternoon, the staff member was aggressive toward patients and I decided to report him to the unit manager. I wrote a report about his behavior and how it threatened patient safety. The individual was summoned and warned about his behavior and how it could ruin his career (Competency #30).

All healthcare professionals are mandated to report sentinel events after discovery to managers and other relevant authorities. Reporting is regularly used to pass information about certain key events and calls for action. For example, working in the medical-surgical unit made me appreciate the importance of writing incident reports. There was a patient who sustained a fall in the medical-surgical ward because of mental health issues. The patient’s family had been advised about restraining the patient to avoid serious injuries until she was stable but they refused. After falling from the bed and sustaining a hip injury, I wrote an incident report and submitted it to the nurse manager. The patient’s family wanted to sue the hospital for negligence claiming that the nurses failed to monitor their patient. The incident report and other previous reports turned out to be helpful tools to show the family that they contributed to the adverse event. Eventually, reporting helped save the institution costs of treatment and fines that could have occurred (Competency #32).

A comprehensive health assessment is used to give nurses insight into the patient’s health status and guide treatment approaches. In most cases, healthcare providers take the patient’s vitals and self-reported symptoms alongside a few tests to use for treatment. A comprehensive assessment involves taking a medical history, a general survey, and a complete physical examination to identify other health concerns that patients may have. For example, when I was working in the medical-surgical unit, every patient admission involved taking a full history and presenting symptoms. A physical examination was done on all patients to identify other health problems and the findings were documented in the HER system. Collecting this information helped in identifying further symptoms related to illness and other health problems that could otherwise go undetected (Competency #37).


Chien L. Y. (2019). Evidence-Based Practice and Nursing Research. The Journal of Nursing Research : JNR27(4), e29.

Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: A rapid review. BMC Health Services Research19(1), 1-11.

Nsiah, C., Siakwa, M., & Ninnoni, J. (2019). Registered Nurses’ description of patient advocacy in the clinical setting. Nursing Open6(3), 1124–1132.

Hill, J. E., Stephani, A. M., Sapple, P., & Clegg, A. J. (2020). The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: A systematic review. Implementation Science15(1), 1-14.

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