Updated June 24, 2026
The situation
Mike, a nurse in a group home, assesses Simon, a 22-year-old who was stung by a wasp. Simon reports feeling unwell, and Mike observes signs of anaphylaxis.
- Read the full case
Mike is a nurse working at a community mental health group home. One afternoon, Simon, a 22-year-old client, comes to the nurses’ station after being stung by a wasp. He shows Mike his red, swollen shoulder and tells him he does not feel well. Simon explains that he has never been stung before, does not know if he is allergic, and has no other known allergies.
Mike sits Simon down and conducts a focused assessment. Based on Simon’s symptoms and clinical presentation, Mike suspects anaphylaxis. Recognizing this as a potentially life-threatening emergency, he asks a colleague to call 9-1-1.
Mike knows that under regulation, nurses may autonomously diagnose and treat certain emergency conditions, including anaphylaxis. He also knows that BCCNM sets limits and conditions.
Confident in his competence and supported by employer policy and the DST, Mike determines that administering epinephrine is the most appropriate treatment. He explains to Simon that he is likely experiencing a reaction and that an injection is needed to help his breathing. Mike administers the epinephrine and continues to monitor Simon closely while waiting for the ambulance.
When paramedics arrive, Mike provides a clear and thorough handover, sharing Simon’s presenting symptoms, his nursing assessment, the epinephrine administration, and Simon’s response. He then documents the incident and his decision-making in Simon’s record.
Mike understands that he is responsible and accountable for the care he provided. By assessing, diagnosing, treating, evaluating, and documenting within his autonomous scope of practice, he ensured Simon received timely and appropriate emergency care.
Mike's actions
Apply the standard
Simon is showing signs of anaphylaxis. What is within Mike's autonomous scope of practice?
- Option A: Wait for paramedics before taking action
Not correct. Waiting without treatment could put the client at serious risk. Nurses have the authority and if competent and authorized to act within their autonomous scope when anaphylaxis is suspected.
- Option B: Administer epinephrine using DST
Correct. Administering epinephrine for suspected anaphylaxis is a restricted activity nurses may perform autonomously, provided they are competent, follow employer policy, and use a decision support tool (DST). This aligns with the
Acting Within Autonomous Scope of Practice standards.
- Option C: Prescribe antihistamines
Not correct. Prescribing is outside the autonomous scope of practice for LPNs, RNs, and RPNs.
- Option D: Call 9-1-1 but give no treatment
Not correct. While calling 9-1-1 is essential, nurses must also act immediately to treat anaphylaxis if competent and authorized. Relying solely on emergency responders could delay life-saving care.
How Mike meets the standards
Mike demonstrates that he is meeting all expectations in the
Acting Within Autonomous Scope of Practice standard. This includes:
- Conducting a focused assessment and making a nursing diagnosis of a condition - anaphylaxis.
- Considering risks, benefits, and the predictable outcome of treatment.
- Following the organization's DST and policies.
- Administering epinephrine safely, within his competence.
- Documenting care and remaining accountable.
Mike may diagnose and treat anaphylaxis autonomously, provided he:
- Meets BCCNM standards, limits, and conditions
- Follows employer policies and DSTs
- Acts within their individual competence
Acting within autonomous scope of practice – Recap
Within their autonomous scope of practice, nurses can make independent decisions about activities they are educated, competent, and authorized to perform― provided they have the necessary competence (knowledge, skills, judgment, and attitudes) and meet any limits and conditions set by BCCNM and employer policy. This may include:
Non-restricted activities
- Monitoring vital signs
- Supporting daily living needs (feeding, mobility, hygiene)
- Health teaching
Restricted activities that do not require an order (within competence and BCCNM limits/conditions)
- Administering oxygen to a hypoxic client
- Giving immunizations following required competencies and DSTs
- Administering epinephrine for suspected anaphylaxis
- Inserting a urinary catheter (when permitted by designation and conditions)
Outside autonomous scope: Restricted activities that require an order, or those limited by BCCNM standards, employer policy, or legislation.
Key point
Even when an activity falls under autonomous scope, nurses must apply all four controls on practice—legislation/regulation, BCCNM standards/limits/conditions, employer policy, and individual competence—before acting.