What's your responsibility and accountability?
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.
For example:
- You diagnose and treat hypoglycemia in your client following your organization's hypoglycemic decision support tool (DST).
- Your post-op client is drowsy and their oxygen saturation is 82%. Based on your assessment you make a nursing diagnosis of hypoxia caused by post anesthetic drowsiness and shallow respirations.
- You diagnose acute confusion in your client, and decide to withhold antipsychotic medication, check vital signs, perform a glucometer to assess blood sugar level, and perform a mini-mental status examination.
Nursing Diagnosis
Under the
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
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.
Treating conditions within autonomous scope of practice
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.
What’s my responsibility and accountability?
When you diagnose and decide to treat a condition, you are responsible and accountable for the diagnosis, appropriate treatment, and your client’s outcomes. Deciding to carry out an activity within autonomous scope of practice (non-restricted and restricted activities in Section 6 of the regulations requires a greater level of knowledge, skill and judgment than carrying out the same activity with a client-specific order from another health professional. The Acting Within Autonomous Scope of Practice standard sets out expectations for nurses carrying out activities autonomously.
Diagnosing and treating conditions in my practice
Think about the clients in your clinical practice and consider the conditions you may diagnose and treat. Ask yourself:
- What's the clinical decision-making process I use when I plan and provide care?
- How does diagnosing conditions fit into my nursing process?
- Do I have the knowledge, skill and judgment required to make this nursing diagnosis?
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.
- Examples of acting within autonomous scope of practice
-
|
Possible Condition
|
Possible Treatment
|
Designation
|
|
RN
|
LPN
|
RPN
|
|
Hypoglycemia
|
Administer glucagon
|
 *
|
*
|
*
|
|
Anaphylaxis
|
Administer epinephrine
|
*
|
*
|
*
|
|
Hypoxia
|
Administer oxygen
|
|
*
|
|
|
Urinary retention
|
Perform a bladder scan
|
|
|
|
|
Respiratory depression due to opioid overdose
|
Administer naloxone
|
|
|
|
|
Constipation related to medication
|
Administer laxatives
|
|
|
|
|
Cardiac arrest
|
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
|
|
|
*
|
Things to consider when acting within autonomous scope of practice
- BCCNM standards, limits and conditions
-
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:
- diagnose the condition, based on your assessment of your client’s signs or symptoms
- determine that the condition requires treatment and that the planned treatment is appropriate for this client at this time
- carry out the treatment safely and ethically
- manage any intended and unintended outcomes
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.
Ask yourself:
- How do I apply the Acting Within Autonomous Scope of Practice Standards in my practice?
- Are there any limits and conditions on the activities I carry out?
- Organization or employer policies and resources
-
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:
- nurse initiated activities (NIAs)
- clinical practice standards and procedures
- protocols
- algorithms
- clinical decision support tools (CDSTs)
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.
Ask yourself:
- What organizational resources guide and support me to diagnose and treat conditions?
- Communication, documentation and collaboration
-
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.
Ask yourself:
- How do I communicate my nursing diagnosis, plan, treatment and client outcomes to other team members?
- How does my documentation reflect this process?
Putting it all together
We have several case studies that may help you understand the Acting Within Autonomous Scope of Practice Standard.
Need help or support?
For further guidance on understanding and applying the standards of practice, contact our team by completing the Standards Support intake form.
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