Nursing Matters

Professional Practice Success Story

December 20, 2023

The Professional Practice Process is an advocacy tool designed to help frontline registered nurses address workload and quality of care concerns. The process provides a way to bring the employer to the table and work collaboratively with RNs to improve the quality of care for patients and working conditions for staff.

The professional practice process isn’t perfect. It takes time. It can take patience and persistence to see the process through. But the process can and does work. A recent success from Branch 5 is proof. The following success story was submitted by Karen Noseworthy, President of Branch 5.

Winter/ Spring 2022

In early 2022, the bed availability at my site, like most facilities in the province, was dire. The hospital was operating on mandated overtime and double over-capacity protocol, with patients in the emergency room awaiting admission to beds that didn’t exist. This spilled over into the Post Anesthesia Care Unit (PACU), with patients requiring extended stays and occasionally being housed overnight. All the while, surgeries proceeded as scheduled, in blind hope there would be beds available at the end of the day.

As time went on, patients overnighting in the PACU became the new norm. Meanwhile, our staff had many concerns which we documented using professional practice forms. We had many discussions with our manager, who was very willing to listen to us, but the direction remained to proceed with surgeries.

August 2022

Surgeries continued as scheduled and patients that could not be placed on the floors would be held in PACU overnight. As a result, on most days evening staff were notified prior to arriving for their 8 hour shift that they would be working 16 hours.

With our many professional practice forms in hand, we requested a meeting with our manager, human resource business partner, professional practice consultant, and our RNU labour relations officer.

In the meeting we outlined our concerns, discussed the main issues, and identified possible solutions. A briefing note was prepared by our manager and our staff added a document containing the compromised standards of nursing practice, potential risks to patient safety, national care standards that we could not meet, as well as violations of our collective agreement.

Concerns and Solutions

It took some time, patience, and persistence but I am happy to report that we have had some success in our attempt to better the situation in PACU for both patients and staff.



One of our primary issues was safety for staff who were being left in PACU after hours and on weekends with no means of notifying security in an emergency in case they could not get to the phone.


We now have a PANIC button installed in one of our bays (the most frequently used bay after hours). If we are in trouble, the button will activate a response from security.

Medication Availability


Admission prescriptions for patients held in PACU overnight were not filled as the pharmacy was closed. Leaving the PACU to go to the night cupboard and get medications compromised a standard that the RN should never be left alone in PACU with a post-operative patient, an enormous patient safety risk. Also, there was policy around pharmacy not filling scripts until a bed was assigned.


The pharmacy policy was amended and medication orders can now be filled for patients admitted in PACU. A big win was that we will now be getting our own PYXSIS system installed.



A major concern for us was the utilization of the evening shift, along with on-call staff, to take care of admitted elective post-op patients overnighting in PACU. We would sometimes have two RNs on the evening shift (who are on call for emergencies that arise during the night) to care for two to three admitted patients, with the additional possibility of caring for an acutely ill post-op patient who may require an ICU bed, with no ICU bed available. Overtime, mostly mandatory, was escalating.


Management agreed to track overtime and overnights stays. While waiting for a response from senior management, our manager agreed that if the evening staff needed a third person on stand-by, they would be compensated at the on-call rate and appropriate OT rate (if called in).

I am happy to report that we now have a third RN scheduled on evening shift. This added RN is an increase to our core staff by 1 FTE. It’s worth noting that while it doesn’t fix the problem of housing patients in PACU all night, it certainly does help with the workload of getting admitted patients recovered and to their beds in the evening, as patients most often cannot be transferred to their floor until after change of shift (1930 hrs). The additional RN has also helped cut down on OT incurred by day staff, who previously stayed past the end of their shift due to the high patient count when admissions were delayed.

Final Thoughts

The path to success in this particular situation was a culmination of advocacy, support and guidance provided by our RNU labour relations officer, as well as a manager and HR business partner who were open to listening and working with us. Without a doubt, our professional practice forms and the document staff created highlighting the risks to patient safety and compromised standards of practice played a huge part in our win.

I know that the professional practice process is time consuming and frustrating. It takes time and patience and doesn’t always result in tangible change. I’m happy to say that in this case we did have success, and the result is a win for patients, management, and staff.

In Solidarity,



For more information on the professional practice process visit myRNU or contact