Registered Nurses' Association of Ontario

Practice Recommendations

Recommendation 1 The nurse must acquire the necessary
knowledge to participate effectively in
therapeutic relationships.
Recommendation 2 Establishment of a therapeutic relationship
requires reflective practice. This concept
includes the required capacities of: selfawareness,
self-knowledge, empathy, awareness
of boundaries and limits of the
professional role.
Recommendation 3 The nurse needs to understand the
process of a therapeutic relationship and
be able to recognize the current phase of
his/her relationship with the client.
Recommendation 4 All entry-level nursing programs must
include in-depth learning about the therapeutic
process, including both theoretical
content and supervised practice.
Recommendation 5 Organizations will consider the therapeutic
relationship as the basis of nursing practice
and, over time, will integrate a variety
of professional development opportunities
to support nurses in effectively developing
these relationships. Opportunities must
include nursing consultation, clinical
supervision and coaching.
Recommendation 6 Health care agencies will implement a
model of care that promotes consistency
of the nurse-client assignment, such as
primary nursing.
Recommendation 7 Agencies will ensure that at minimum, 70
per cent of their nurses are working on a
permanent, full-time basis.
Recommendation 8 Agencies will ensure that nurses’ workload
is maintained at levels conducive to
developing therapeutic relationships.
Recommendation 9 Staffing decisions must consider client
acuity, complexity level, complexity of work
environment, and the availability of expert
Recommendation 10 Organizations will consider the nurse’s
well-being as vital to the development of
therapeutic nurse-client relationships
and support the nurse as necessary.
Recommendation 11 Organizations will assist in advancing
knowledge about therapeutic relationships
by disseminating nursing research,
supporting the nurse in using these findings,
and supporting his/her participation
in the research process.
Recommendation 12 Agencies will have a highly visible nursing
leadership that establishes and maintains
mechanisms to promote open conversation
between nurses and all levels of management,
including senior management.
Recommendation 13 Resources must be allocated to support
clinical supervision and coaching
processes to ensure that all nurses have
clinical supervision and coaching on a
regular basis.
Recommendation 14 Organizations are encouraged to include
the development of nursing best practice
guidelines in their annual review of performance
indicators/quality improvement,
and accreditation bodies are also
encouraged to incorporate nursing best
practice guidelines into their standards.


Establishing Therapeutic Relationship
Practice Recommendations