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Acting with client-specific orders

Part 2: Scope of practice standards

For public safety, licensed practical nurses need to know which activities they are allowed to perform within their autonomous scope of practice and which activities require a client-specific order ​​before they are allowed to perform them. Licensed practice nurses also need to know which health professionals are authorized to give a client-specific order that they are allowed to act with.

A client-specific order is an instruction or authorization given by a regulated health professional for a nurse to provide care for a specific client, whether or not the care or service includes a restricted activity or a non-restricted activity.  A consultation, referral or professional recommendation is not an order.

The client-specific order must:

  • be documented in the client's permanent record by the regulated health professional giving the client-specific order,
  • include all the information needed for the ordered activity to be carried out safely (e.g., time, frequency, dosage), and
  • ​​include a written/electronic signature.

The Nurses (Licensed Practical) Regulation lists restricted activities that are allowed to be performed by licensed practical nurses.  Restricted activities are clinical activities that pose a significant risk of harm to the public. These include restricted activities that 'do not require an order' (Section 6 of the Regulation) and restricted activities that 'require an order' (Section 7 of the Regulation). Some restricted activities are listed under section 6 and also under section 7 of the Regulation. The BCCNM Scope of Practice for Licensed Practical Nurses – Standards Limits Conditions provides additional details about Section 6 and Section 7 restricted activities.

Licensed practical nurses need to consider all four controls on practice to determine whether they require a client-specific order before performing an activity:

  • ​The Nurses (Licensed Practical) Regulation
  • BCCNM standards of practice
  • Organizational/employer policies, processes, and restrictions
  • ​The nurse's individual competence

A licensed practical nurse may act with a client-specific order given by a 'listed health professional' or a 'non-listed health professional':

  • ​A listed healt​h professional1 is a health professional listed in the Nurses (Licensed Practical) Regulation as authorized to give an order for a restricted activity to be performed by a licensed practical nurse. Only these health professionals are authorized to give orders for activities listed in section 7 ('restricted activities that require an order') of the Regula​​tion2 that allow the licensed prac​​tical nurse to perform that activity. Listed health professionals are physicians, nu​rse practitioners, registered nurses (with or without certified practice), registered psychiatric nurses, dentists, midwives, naturopaths, podiatrists, and pharmacists.

  • A non-listed health professional is a health professional who is NOT listed in the Nurses (Licensed Practical) Regulation. A non-listed health professional is not authorized to give orders for restricted activities in section 7 of the Regula​​tion2. However, d​epending on organizational/employer policies and processes, they may give orders for activities that are within the licensed practical nurse's autonomous scope of practice. Non-listed health professionals have specialized competence within their profession's scope of practice and individual competence that allows them to assess a client and to design or recommend care to meet the client's needs. An example of a non-listed health professional is a dietitian.

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A listed health professional must be registered to practise in British Columbia, except where the client has been transferred from Alberta, Yukon or the Northwest Territories for emergency treatmen​t in British Columbi​a. In​ addition, an order for a licensed practical nurse to cast a fracture of a bone may only ever be given by a physician or nurse practitioner who registered in British Columb​ia.


To the extent the activity is not within the activities or related limits and conditions listed in section 6 of the Regulation.​​