​Updated May 28, 2026​​

The situation

Vadim, an LPN in a long-term care facility, notices Rita is pale, sweaty, and disoriented. She admits to skipping dinner the night before. Vadim checks her blood sugar, confirms it is low, and diagnoses hypoglycemia.

Read the full case

Vadim has been working as an LPN in a long-term care facility for just over a year. At the beginning of his morning shift, he walks through the unit to greet his clients. When he reaches Rita's room, he immediately notices that she looks pale and slightly disoriented.

Concerned, Vadim asks how she is feeling. Rita replies, “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 recalls that she has experienced hypoglycemia in the past when she skipped meals. He advises her to remain in bed for safety while he retrieves a glucometer. Vadim performs a quick focused assessment, including vital signs, and checks her blood glucose level. The reading confirms what he suspects: Rita's blood sugar is low.

Drawing on his assessment, the glucometer result, and his clinical judgment, Vadim makes a nursing diagnosis of hypoglycemia. He administers glucagon according to the organization's decision support tool (DST) and monitors Rita's response closely, checking her blood glucose, vital signs, and level of consciousness. As she begins to recover, he reassures her and reinforces the importance of eating regular meals to prevent future hypoglycemic episodes. Vadim documents his assessment, nursing diagnosis, treatment, and Rita's response in her chart. He also communicates the incident and his actions to the nurse practitioner and the rest of the health-care team to ensure continuity of care.

If Vadim had not obtained the competencies to administer glucagon, he would not meet the practice standard Licensed Practical Nurses: Acting Within Autonomous Scope of Practice. He would still recognize and diagnose hypoglycemia, keep Rita safe, and request treatment from a competent colleague or prescriber. He would continue monitoring and reassuring her, document his actions, notify the health-care team, and follow up with his manager to arrange training to provide this care autonomously in the future. 

Vadim's actions​​

​​Step 1: Assessment 

Vadim conducts a focused assessment of Rita, noting pallor, diaphoresis, and mild disorientation. Rita reports nausea and a history of skipping meals. Vadim checks her vital signs and performs a capillary blood glucose test.

Step 2: Diagnosi​s

Based on assessment findings and his clinical judgment, Vadim makes a nursing diagnosis of Rita's conditions as hypoglycemia.

Step 3: Decision and action​​ 

If competent​​:  If Vadim has completed the required education and follows an employer-approved DST, he may administer glucagon to treat hypoglycemia within his autonomous scope.

If not compet​​ent​:​ If Vadim has not obtained the competencies, he cannot administer glucagon autonomously. He must seek a client-specific order or ask a competent colleague to provide treatment.

Step 4: Follow-​up 

Vadim monitors Rita's response, reinforces the importance of eating regular meals, documents the incident and care provided, and informs the physician or nurse practitioner and the health care team. If he was not competent, Vadim follows up with his manager to arrange the required training.

​​​Apply the standard

Which action is within Vadim's autonomous scope of practice as an LPN when caring for Rita's hypoglycemia?

Option A: Monitor Rita and provide reassurance only until a physician assesses her.

Not correct. While monitoring and reassurance are important, delaying treatment could place the client at risk.

Option B: Administer glucagon for hypoglycemia if competent and following an approved DST.

Correct. Administering glucagon is a restricted activity that LPNs may perform autonomously if they have the competencies, follow BCCNM standards and limits, and act according to employer policy.

Option C: Document Rita's symptoms and wait for another nurse to initiate treatment.

Not correct. Documentation alone does not address the immediate emergency. LPNs must act within their scope when competent to do so.

Option D: Encourage Rita to eat or drink without following the DST.

Not correct. Interventions must follow an employer-approved DST. Skipping this step is unsafe and outside BCCNM standards.

​​​How Vadim meets the standards

Vadim demonstrates that he is meeting all expectations in the practice standard Licensed Practical Nurses: Acting Within Autonomous Scope of Practice. This includes:

• Conducting a focused assessment and making a nursing diagnosis of hypoglycemia.
• Considering risks, benefits, and the predictable outcomes of administering glucagon.
• Acting safely within his competence, using an employer-approved DST.
• Reinforcing health teaching about the importance of regular meals.

• Co​mmunicating with the health-care team and documenting his assessment, treatment, and outcomes.

​If Vadim does not have the competencies to administer glucagon, he recognizes he does not meet the standard for acting within autonomous scope. In that case, he seeks assistance from a competent colleague, ensures Rita is safe until emergency help arrives, documents the incident, notifies the health team, and arranges with his manager to obtain the necessary training.

​​​Acting within autonomous scope of practice – Recap

Within their autonomous scope of practice, LPNs can make independent decisions about client care activities they are educated, competent, and authorized to perform, provided they meet any limits and conditions set by BCCNM and employer policy. This includes:

Non-restricted activities:

• Monitoring vital signs and reporting changes
• Supporting daily living needs (feeding, mobility, hygiene)
• Health teaching and counselling

Restricted activities that do not require an order (within competence and BCCNM limits/conditions):

• Administering oxygen to a hypoxic client using an approved DST
• Giving immunizations under approved DSTs
  
• Administering glucagon for hypoglycemia (if competent and following an approved DST)

• Performing urinary catheterization when permitted and competent​ 

Outside LPN autonomous scope: Activities that require an order (e.g., prescribing medications, initiating IV therapies without authorization, referring directly to medical specialists), or activities restricted by BCCNM standards, employer policy, or legislation.

Key point: Even when an activity falls within autonomous scope, LPNs must always apply the four controls on practice—legislation/regulation, BCCNM standards, employer policy, and individual competence—before acting.

​​Resources

• Acting within autonomous scope thinking tool
• Nursing in a team approach: Stable or predictable 
  
• Risk assessment tool
  
• Nurses: Medication practice standard​
• Nurses: Documentation practice standard​​