It’s likely that you’re already diagnosing and treating conditions in your practice. When you plan for and provide nursing care, you’re making clinical judgments about your client’s status and carrying out appropriate nursing activities.
Nurses (Licensed Practical) Regulation /Nurses (Registered) and Nurse Practitioner Regulation/
Nurses (Registered Psychiatric) Regulation, you can make a nursing diagnosis that identifies a
condition (not a disease or a disorder) as the cause of a client’s signs or symptoms. A nursing diagnosis is a clinical judgment about your client’s physical or mental condition. It involves drawing a conclusion about what’s causing the signs or symptoms you’ve assessed.
Conditions always have associated signs and symptoms. A condition may result from a known disease or disorder or its treatment. For example, a nurse may diagnose hypoglycemia in a client with diabetes, urinary retention in a post-operative client or angina in a client with a history of coronary artery disease.
In mental health there may be times when the signs and symptoms may not be as readily observable (i.e. internal suicidal ideation, thoughts of paranoia, anxiety).
Other conditions, such as hypoxia or pain, may result from a medical problem such as an undiagnosed disease or disorder. In these situations, a nurse may diagnose and stabilize the condition until a physician or nurse practitioner diagnoses the underlying disease or disorder.
The nursing regulations authorize you to carry out certain restricted activities without an order to assess or treat a condition that you’ve diagnosed. Additional education and/or following a DST may be required for some restricted activities.
Think about the clients in your clinical practice and consider the conditions you may diagnose and treat. Ask yourself:
This list is not exhaustive, and activities are subject to organization/employer policies. * indicates that there are limits and/or conditions in place with this activity.
Perform a bladder scan
Respiratory depression due to opioid overdose
Constipation related to medication
Apply electricity (AED) in cardiac emergencies
Paranoid ideation/disturbed thought process
Move client to a reduced stimulation secure room.
Client not responding to de-escalation interventions and immediate risk for physical violence
Apply physical restraints
The Acting Within Autonomous Scope of Practice Standard establishes the level of knowledge, skill and judgment you require when carrying out any activity autonomously. This includes having the competence to:
Depending on the activities you are carrying out, there may be BCCNM limits and/or conditions.
For example, nurses who provide wound care (not suturing of skin lacerations, performing a procedure on tissue below the dermis or below the surface of a mucous membrane) must meet certain limits and/or conditions.
LPNs provide wound care only if a wound care treatment plan is in place. Also, LPNs who probe, irrigate, pack or dress a tunneled wound must successfully complete additional education and follow decision support tools.
RNs may provide wound care without an order, including cleansing, irrigating, probing, debriding, packing, and dressing.
RPNs may provide wound care without an order, including cleansing, irrigating, probing, debriding, packing and dressing.
The British Columbia Provincial Nursing Skin and Wound Committee has produced a range of
decision support tools for skin and wound care.
Organization/employer policies may limit nurses’ scope of practice. Before carrying out an activity within autonomous scope of practice, you’ll need to make sure there are no restrictions set by your organization/employer. Your organization/employer may use decision support tools (DSTs) to outline expectations and support evidence informed nursing practice when diagnosing and treating conditions. These DSTs may be called:
Be aware that when you carry out any activity within autonomous scope of practice, even when following a DST, you are
responsible and accountable for your decisions and actions.
If there are no existing organizational/employer policies to support practice, nurses advocate or help develop policies based on current evidence-based information. Check with your clinical resource or practice leaders.
Nurses work with other members of the health care team to provide clients with safe and effective care. Consider how you communicate and consult with others on the team. You may seek advice from a colleague before arriving at a nursing diagnosis, finalizing a plan of care, or determining the most appropriate treatment for a client. You might consult with a physician or NP for assistance or orders.
We have several case studies that may help you understand the Acting Within Autonomous Scope of Practice Standard.
For further information on the Standards of Practice or professional practice matters, contact us:
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