Updated April 24, 2026
A nurse's scope of practice is shaped by more than what is legally permitted. The four controls on practice determine what a nurse may perform in any given role and setting:
- Legislation and regulation
- BCCNM bylaws and standards (including limits and conditions)
- Employer (organizational) policies and processes
- Individual nurse competence
Regulation may authorize an activity, but a nurse may perform it only when all four controls are met. Each control can narrow practice; none can expand practice beyond what is permitted by the level below.
Level 1: Legislation and regulation
This level sets the legal foundation for nursing practice in B.C. It establishes the profession's legislated scope of practice, and the restricted activities nurses may be authorized to perform.
Health Professions and Occupations Act (HPOA)
Nursing and Midwives Regulation (NMR), and the
Regulated Health Practitioners Regulation (RHPR)
The legislated scope applies to all nurses across practice settings (e.g., hospital, community, long-term care, or self-employment).
Example: An emergency department nurse and a school nurse work within the same legislated scope but apply it differently based on their roles and practice contexts.
Level 2: BCCNM bylaws, standards, limits, & conditions
BCCNM sets ethics and practice standards and may place limits or conditions on activities that are otherwise authorized in Regulation. Bylaws may also set additional requirements for practice.
Example: BCCNM may require additional education before a nurse is authorized to perform certain activities (e.g., venipuncture, depending on the class of licensure and requirements).
Level 3: Employer (Organizational) policies
Employers may set policies and procedures that specify how activities are performed and may restrict practice beyond Regulation or BCCNM standards. Job descriptions should clearly outline the responsibilities and expectations of a specific role. Employers may also require additional education, training, or supervision before a nurse performs certain activities.
If you are self-employed, you are also the employer. You are responsible for establishing appropriate policies, procedures, and supports to guide safe practice for yourself and any staff you employ.
Examples:
In some settings (e.g., ICU), nurses may be supported to assist with ventilator-related care, while this may not be supported in long-term care.
A nurse may be legally authorized to perform an activity, but an employer may prohibit it due to safety considerations, resource limitations, or organizational risk controls.
Level 4: Individual nurse competence
The first three controls define what a nurse may do. Competence determines what a nurse can safely do.
Competence is specific to the nurse and the context. It develops over time through education, experience, practice, and ongoing learning.
Example: A nurse with extensive practice experience and current competence in a skill may be able to perform it safely, while a newly graduated nurse may require additional education, supervision, or practice supports before performing the same activity.
Putting it together
The controls on practice help ensure every activity you perform is authorized, supported, and safe. A practical approach is to work through the levels in order:
Is it permitted by legislation/regulation?
Is it consistent with BCCNM standards, limits, and conditions?
Is it supported/allowed in this setting?
Am I competent to perform it safely for this client, today?
Finally, apply professional judgment: even when you can perform an activity, consider whether it is appropriate and, in the client's best interests.