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.
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.
client-specific order must:
include a written/electronic signature.
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 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':
listed health 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
Regulation2 that allow the licensed practical nurse to perform that activity.
Listed health professionals are physicians, nurse 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
Regulation2. However, depending 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 treatment in British Columbia. 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 Columbia.
To the extent the activity is not within the activities or related limits and conditions listed in section 6 of the Regulation.