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Introduction

Advanced procedures and activities encompass:

Standards

1.

Before incorporating an advanced procedure or activity into their practice, nurse practitioners consider:

 

a.

their foundational education in relation to the procedure or activity

 

b.

employer support that ensures the required organizational infrastructure is in place to support the nurse practitioner and the practice setting to incorporate the activity into practice

 

c.

inclusion and exclusion criteria for the client population

 

d.

risks to clients that are associated with performing the activity

 

e.

measures that would be taken to mitigate risks and make the activity as safe as possible

 

f.

how nurse practitioners will manage outcomes both intended and unintended

 

g.

how outcomes would be tracked and evaluated

 

h.

availability of best practice guidelines or other evidence-based tools

2.

Nurse practitioners perform advanced procedures and activities within their level of competence having acquired the knowledge and skill through additional education 6.

3.

Nurse practitioners perform advanced procedures and activities only when performance occurs with sufficient frequencyto maintain competence.

Limits and Conditions

Blood and blood products

1.

Nurse practitioners order immune globulin in accordance with BC Centre for Disease Control guidelines.

2.

Nurse practitioners order blood and blood products (with the exception of immune globulin) in accordance with the B.C. Provincial Blood Coordinating Office guidelines.

3.

Nurse practitioners who order blood and blood products (with the exception of immune globulin) must:

 

a.

successfully complete additional education6 (e.g. Bloody Easy Lite offered by the Ontario Regional Blood Coordinating Network); and

 

b.

review the following resources of the Ontario Regional Blood Coordinating Network and be knowledgeable with respect to their content:

 

 

i.

Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions. A Guide to Transfusion Medicine Fourth Edition

 

 

ii.

Bloody Easy Coagulation Simplified

Setting fractures and reducing dislocations

4.

Nurse practitioners:

 

a.

are limited to setting a closed, simple fracture of a bone

 

b.

are limited to reducing dislocations of the fingers and toes (digits of the upper and lower extremities)

 

c.

have authority to reduce anterior shoulder dislocations on the condition that the NP has the competence to interpret the x-ray if clinically indicated

Ordering or applying hazardous forms of energy

5.

Nurse practitioners:

 

a.

do not apply x-rays

 

b.

do not give an order or apply laser for the purpose of destroying tissue

Medical Aesthetics7 Limits and Conditions

1.

Nurse practitioners order medical aesthetic procedures only when:
a.

The individual acting on the order is a nurse holding practising registration with BCCNM; and,



​b.

​The ordering nurse practitioner, or another nurse practitioner or medical practitioner who has assumed responsibility for the care of the client, is or will be pre​sent within the facility when the procedure is being performed and immediately available for consultation.

​2.
Nurse practitioners complete additional education6 before providing or ordering medical aesthetic procedures.

​3.

​Nurse practitioners only provide medical aesthetic procedures or order them to be performed in an appropriate clinical setting that is suitable to safely perform the procedure and includes the equipment and supplies necessary to manage emergency situations.

​4.

​​Nurse practitioners only use Health Canada-approved drugs, substances and medical devices when providing or ordering medical aesthetic procedures.

​5.​

​Nurse practitioners only provide or order medical aesthetic procedures for clients under t​​he age of 19 for the treatment of acne or scarring.

​6.

​Nurse pract​​itioners do not provide or order any medical aesthetic procedures that require conscious/procedural sedation or general anesthesia​.

Footnotes

5

The British Columbia Medical Quality Initiative defines non-core procedures and activities as those which are outside of the core activities and that require further training or demonstration of skill. Core activities are defined as those procedures or activities that the majority of practitioners in the specialty perform and inherent activities/procedures requiring similar skill sets.

6

Additional education is structured education (e.g. workshop, course, program of study) designed so that nurse practitioners can attain the competencies required to carry out a specific activity as part of nurse practitioner practice. Additional education builds on the entry-level competencies of nurse practitioners, identifi​es the competencies expected of learners on completion of the education, includes both theory and application to practice, and includes an objective, external evaluation of learners’ competencies on completion of the education. The term does not refer to a course or program approved by BCCNM for BCCNM certified practice.

​7

​“Medical aesthetics” refers to elective non-surgical clinical procedures that include the performance of a restricted activity (activities listed in sections 6, 7 and 9 of the Nurses (Registe​​red) and Nurse Practitioners Regulation) and are primarily intended to alter or restore a person’s appearance​.

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With great respect, we acknowledge that BCCNM’s office is located on the unceded territories of the hən̓q̓əmin̓əm̓ speaking peoples – xʷməθkʷəy̓əm (Musqueam), and sel̓íl̓witulh (Tsleil-Waututh) Nations, and the Sḵwx̱wú7mesh-ulh Sníchim speaking peoples - Sḵwx̱wú7mesh Úxwumixw (Squamish Nation) whose historical relationships with the land continue to this day.​