Introduction
Nursing practice includes a wide range of activities that nurses perform without authorization from other health-care professionals.
Autonomous scope of practice means nurses act independently to make decisions and carry out activities that fall within their education, competence, and legal authority—without needing a client-specific order from another regulated health professional. Acting autonomously requires balancing regulation, BCCNM standards, employer policies, and your own competence.
Activities you may perform autonomously
Nurses are authorized to perform specific activities as outlined by the Nurses and Midwives Regulation (NMR) and the Regulated Health Practitioners Regulation (RHPR) (together referred to as “Regulation"), allowing them to act autonomously without the need for a client-specific order. These activities include:
Non-restricted activities are activities that fall within the broad scope of nursing practice and are not identified as restricted activities in Regulation. These activities are not ones that the Regulation specifically limits or restricts, but nurses still apply professional judgment and meet all regulatory, ethical, and employer requirements before performing them.
Examples of non-restricted activities: hygiene care, client teaching, repositioning, and documentation.
Note: Just because an activity is not restricted does not mean it is risk-free. There are some non-restricted activities that are higher risk (e.g., applying restraints, enteral feeds). As a result, BCCNM requires an order for some higher-risk non-restricted activities. Employers may also require an order before a nurse performs the activity.
Restricted activities that do not require an order are activities that nurses are permitted to carry out without an order from another health professional (i.e., within autonomous scope) when the nurse meets the limits, purposes, and conditions set out in Regulation. Restricted activities must be performed in accordance with BCCNM standards, limits, and conditions, employer policies, and the nurse's competence.
Examples of restricted activities: administering oxygen in some forms, treating anaphylaxis, and performing nursing assessments.
Your responsibilities when acting autonomously
- Regulatory requirements
Nurses are responsible and accountable to multiple layers of control when acting autonomously. Before acting, be certain that what you're about to do is legally authorized in Regulation and meets the:
The four controls on practice are a decision-making framework that guides nurses in determining their legal and professional authorization to perform activities. This structured process ensures that your actions align with legislation and regulation, BCCNM standards, employer policies, and your own competence. Read more about controls on practice: LPN, RN, RPN.
- Accountability and professional judgment
- Nurses remain professionally accountable when acting within their autonomous scope of practice. Autonomy does not remove accountability — nurses are responsible for determining if the activity is within the nursing scope of practice, their autonomous scope, and their competence.
Nurses cannot perform activities that are unsafe, inappropriate, or inconsistent with Regulation, BCCNM standards, limits, and conditions, and employer policies. - Nurses are expected to communicate and collaborate with other health professionals when client care requires consultation or coordination.
- Informed client consent must always be obtained before carrying out any activity, including those within autonomous scope of practice.
- Competence and client-centred care
- Nurses ensure they have the knowledge, skill, ability, and judgment to carry out the activity safely.
- Competence is dynamic — it requires reflection, ongoing learning, and seeking feedback. Nurses recognize when an activity is beyond their competence and consult, collaborate, or escalate to another health professional.
- Autonomous decisions always keep the client's goals, values, cultural safety, and preferences at the centre of care.
- Risk management and safety
- Nurses ensure that the environment, staffing, equipment, and supports are in place to manage the activity safely.
- If resources to ensure client safety are not available, the nurse does not proceed autonomously and should escalate or consult as needed.
- Documentation and accountability
Nurses document in keeping with BCCNM's
Documentation practice standard and employer policies. Clear, accurate, and timely documentation is essential for accountability, continuity of care, and legal protection.
FAQs
- Can a nurse pronounce death?
Yes. Pronouncing death means determining, through physical assessment, that life has ceased. In B.C., there are no laws restricting who may pronounce death; however, BCCNM has limits and conditions on this activity, and employer/organizational policies may also apply. Always review the BCCNM practice standards and your employer's procedures.
- LPNs, RNs, and RPNs: may pronounce death, but not in cases related to Medical Assistance in Dying (MAiD).
- NPs: may pronounce death related to MAiD.
- RPNs: must follow a decision support tool when pronouncing unexpected deaths.
- Can a nurse autonomously make a nursing diagnosis and treat a suspected opioid overdose?
Yes. Administering naloxone without an order is within the autonomous scope of practice for LPNs, RNs, and RPNs if the nurse is competent to do so and the activity is not restricted by employer policy.
The
Acting Within Autonomous Scope of Practice standard outlines the requirements when performing such activities and set the specific standards, limits, and conditions under which nurses may administer naloxone to treat opioid overdose.