Plar Self Assessment Form
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9PLAR
Self Assessment Form
____________________________________
_____________________________________
____________________________________
Name
Signature
Date
Please fill the form out accordingly in the space provided. Check off which box best applies to you, then please type your explanation/example in the space provided.
STANDARD I - PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY
The RN with additional authorized practice consistently demonstrates professional conduct and competence while practising in accordance with the SRNA
standards for registered nursing practice and CNA’s Code of Ethics for Registered Nurses. Further, the registered nurse demonstrates that the primary duty is to
the client to ensure safe, competent, ethical registered nursing care.
The RN with additional authorized practice:
Confident
Needs
No
Please describe a situation where this standard was met, if
Developing
Opportunity
applicable
1. Practises in accordance with common law, federal and
Examples:
Gunshot legislation
provincial legislation, professional and ethical standards, SRNA,
Narcotic policy
government and employer policies with particular relevance
Reviewing employer policy
for the RN with additional authorized practice.
2. Understands the scope of practice of the RN with additional
authorized practice and how it differs from that of a RN and
RN(NP).
3. Understands the scope and roles of other health care team
members as they relate to collaboration and consultation.
4. Collaborates with members of the health-care team using
Examples:
Consulting collaboratively with a physician using
appropriate communication, conflict resolution and
appropriate communication to ensure the patient care
negotiation skills, to provide and promote interprofessional
needs are met. For example; medi-vac an ill child who you
client and family-centered care at the individual, organizational
feel needs further assessment.
and systems levels.
5. Knows the appropriate circumstances, diseases, disorders or
conditions under which to consult, as determined by the
clinical decision tools.
6. Appropriately utilizes the clinical decision tools in addressing
the limited common medical disorders for the client.
7. Demonstrates accountability for client care decisions made
Example:
Patient is prescribed Septra for symptomatic UTI; C&S
within his/her practice.
comes back showing that this is resistant to Septra; patient
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