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Vadim has worked as an LPN in the long term care facility for just over a year. It is the start of his shift and he goes to say hello to his clients. When he greets Rita, she appears pale and a bit disoriented. Vadim asks her how she’s feeling, and she says, “not my best this morning. I’m all sweaty and a bit nauseated. Maybe I shouldn’t have skipped dinner last night.”

Vadim knows that Rita is diabetic and has skipped meals before and become hypoglycemic as a result. He tells Rita to stay in her bed while he grabs a glucometer. Vadim tests her blood sugar and sees that it is low.  He does a quick focused assessment and vital signs. Based on his assessment, the low blood sugar reading and his clinical judgment, Vadim concludes that Rita is showing signs of hypoglycemia.

Can Vadim treat Rita’s condition within his autonomous scope of practice?

Yes. If Vadim has the competencies to treat hypoglycemia, follows his  organization’s/employer’s decision support tool, and treats Rita’s hypoglycemia with glucagon, he can treat Rita’s hypoglycemia within his autonomous scope of practice. 
In deciding to treat Rita, Vadim considers the risks, benefits and possible outcomes.

Before treating a condition, Vadim must first collect information using his assessment and critical thinking skills to make a nursing diagnosis of a condition. Vadim judges the outcome is reasonably predictable, and the benefits outweigh the risks. He knows he has the competencies to treat hypoglycemia and manage any intended or unintended outcomes. He follows his organization’s/employer’s decision support tool (DST) and knows his actions are within his organization’s/employer’s policy. Vadim knows he is responsible and accountable for his decision to treat Rita.

After Vadim administers glucagon to Rita, he monitors her response and follows the DST for next steps. Vadim reinforces with Rita the importance of eating regular meals. He documents the incident and his actions. He informs members of the health care team of this incident, including Rita’s nurse practitioner. 

No. If Vadim does not have the competencies to treat hypoglycemia or does not follow his organization’s/employer’s decision support tool for hypoglycemia, he does not meet the standard for acting within autonomous scope of practice. Nurses can only perform activities within their autonomous scope of practice if they have obtained the competence and meet the requirements set out in the Acting within Autonomous Scope of Practice standard. As Vadim does not meet the standard’s requirements to administer glucagon, he requires a client-specific order from a listed health professional to administer the glucagon (or alternate treatment).

Vadim asks a colleague to treat Rita’s hypoglycemia.  Vadim reinforces with Rita the importance of eating regular meals, documents the incident and notifies the physician and members of the health team.  He follows up with his manager to arrange the required training for treating hypoglycemia.

Treating conditions within autonomous scope of practice

Under the Nurses (Licensed Practical) Regulation LPNs are authorized to diagnose and treat a variety of conditions in their autonomous scope of practice that can be improved or resolved with nursing activities. The regulation sets out the type of diagnosis LPNs can make. Specifically, LPNs make a nursing diagnosis of a condition – not a disease or disorder – as the cause of a client’s signs and symptoms.

The Scope of Practice standard for LPNs sets the standards, limits and conditions under which LPNs treat hypoglycemia. Specifically, LPNs:

  • follow an organization/employer approved decision support tool (DST)
  • only administer glucagon to treat hypoglycemia

Note that individual organizations/employers may have further requirements that limit your scope of practice.

Acting Within Autonomous Scope of Practice

The standard, Acting Within​ Autonomous Scope of Practice, outlines the requirements for nurses when they carry out an activity within their autonomous scope of practice.
Nurses assumes accountability and responsibility for their decisions about client care activities they are educated, competent and authorized to make when acting within their autonomous scope of practice. 

A nurse’s autonomous scope of practice includes:

  • Carrying out restricted activities listed in section 6 of the regulation, and
  • Providing care or services that are considered non-restricted activities (i.e. general nursing activities)

Autonomous scope of practice does not include any activities, care or services excluded from autonomous scope of practice under BCCNM standards, limits, conditions and other controls on practice such as organizational/employer policies or legislation.


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