Practice Standards set out requirements related to specific aspects of nurses' practice. They link with other standards, policies and bylaws of the British Columbia College of Nurses and Midwives and all legislation relevant to nursing practice.
Nurses1 have a professional responsibility to delegate activities appropriately to other members of the healthcare team. This includes unregulated care providers (UCPs), who have no legally defined scope of practice or practice standards, and work under a variety of different job titles and job descriptions.
Under certain circumstances, a nurse may delegate to a UCP the performance of an activity that is primarily performed by nurses. The delegated activity is client-specific and may be either an aspect of
practice2 or a restricted
activity3 that is within the nurse's scope of practice.
Nurses are accountable and responsible for their delegation decisions.
The responsibility for the practice of nursing cannot be delegated. The nurse must continue to be responsible for the overall assessment, determination of client status, care planning, interventions and care evaluation when delegating the performance of an activity to an unregulated care provider.
The decision to delegate the performance of an activity to meet the care needs of a client must be the decision of that client's nurse.
When delegating to an unregulated care provider, nurses consider all of the following:
client factors such as health status and ability to direct and consent to care;
The activity to be delegated, including the risk of harm to the client, complexity of the activity, and predictability of the outcome;
care environment factors, including organizational/employer policies, processes, and supports;
unregulated care provider factors, including knowledge, skills, ability, and judgement, to be satisfied that the unregulated care provider is able to perform the delegated aspect of practice or restricted activity safely without causing harm to the client;
the level of supervision the unregulated care provider needs for the activity to be safely delegated.
Before delegating the performance of an activity to an unregulated care provider, nurses ensure the unregulated care provider has sufficient training, supervision and support to perform the delegated activity safely.
Nurses delegate to an unregulated care provider only when organizational/employer policies and procedures clearly outline the responsibility and accountability for all those involved in the act of delegation, including the nurse's responsibility and accountability for evaluating and re-evaluating the decision to delegate.
Nurses communicate and collaborate with the client (or their substitute decision-maker), with the unregulated care provider receiving the delegation, and with the nursing/healthcare team about the delegation decision, the delegation process, and continuity of care related to the delegated activity including:
the plan of care for the client including delegation of the activity;
the level of supervision needed for the delegated activity to be performed safely;
the plan for reporting and managing unexpected changes in the client's health status, and intended and unintended outcomes of the delegated activity;
the plan for reassessment/follow-up with respect to the delegated activity;
when the delegation decision would benefit from the expertise of other healthcare professionals;
documenting the plan of care and the delegation decision.
“Nurses" refers to the following BCCNM nursing registrants: registered nurses, registered psychiatric nurses, nurse practitioners, licensed graduate nurses.
An 'aspect of practice' means an activity, other than a restricted activity, that is part of providing a health service that is within the scope of nursing or psychiatric nursing practice and requires professional knowledge, skills, ability and judgment.
A 'restricted activity' is a higher risk clinical activity that must not ordinarily be performed by any person in the course of providing health services, except members of a regulated profession who have been granted specific legislative authority to do so, based on their education and competencies. The restricted activities for nurses are prescribed in the Nurses (Registered) and Nurse Practitioners Regulation and the Nurses (Registered Psychiatric) Regulation. When a nurse delegates the performance of a restricted activity to a UCP in accordance with this Practice Standard, this is an exception to the usual restriction against performance of restricted activities by unregulated persons, and the nurse remains responsible for the performance of the activity.