​​​​Updated April 30, 2026​

​A nurse's scope of practice is shaped by more than what is legally permitted. The four controls on practice determine what a nurse may perform in any given role and setting:

1. Legislation and regulation
2. BCCNM bylaws and standards (including limits and conditions)
3. Employer (organizational) policies and processes
4. Individual nurse competence

Regulation may authorize an activity, but a nurse may perform it only when all four controls are met. Each control can narrow practice; none can expand practice beyond what is permitted by the level below.

Level 1: Legislation and regul​​ation

This level sets the legal foundation for nursing practice in B.C. It establishes the profession's legislated scop​​​e of practice, and the restricted activities nurses may be authorized to perform.

• Health Professions and Occupations Act (HPOA)

• Nursing and Midwives Regulation (NMR), and the

• Regulated Health Practitioners Regulation (RHPR)

​The legislated scope applies to all nurses across practice settings (e.g., hospital, community, long-term care, or self-em​ployment).

​Exampl​​e: An emergency department nurse and a school nurse work within the same legislated scope but apply it differently based on their roles and practice contexts.

​Leve​​l 2: BCCNM bylaws, standards, limits, & conditions

BCCNM sets ethics and practice standards and may place limits or conditions on activities that are otherwise autho​rized in Regulation. Bylaws may also set additional requirements for practice.

Example: BCCNM may require additional education before a nurse is authorized to perform certain activities (e.g., venipuncture, depending on the class of licensure and requirements).

​Lev​​​el 3: Employer (organizational) policies 

Employers may set policies and procedures that specify how activities are performed and may restrict practice beyond Regulation or BCCNM standards. Job description​​s should clearly outline the responsibilities and expectations of a specific role. Employers may also require additional education, training, or supervision before a nurse performs certain activities.

If you are self-employed, you are also the employer. You are responsible for establishing appropriate policies, procedures, and supports to guide safe practice for yourself and any staff you employ.

Examples:

• A hospital may allow IV insertion but require additional training before a nurse performs advanced IV therapy.

• In some settings (e.g., ICU), nurses may be supported to assist with ventilator-related care, while this may not be supported in long-term care.

• ​A nurse may be legally authorized to perform an activity, but an employer may prohibit it due to safety considerations, resource limitations, or organizational risk controls.

​Level 4: I​​ndividual nurse competence

The first three controls define wha​​t a nurse may do. Competence determines what a nurse can safely do.

Competence is specific to the nurse and the context. It develops over time through education, experience, practice, and ongoing learning.

​Example: A nurse with extensive practice experience and current competence in a skill may be able to perform it safely, while a newly graduated nurse may require additional education, supervision, or practice supports before performing the same activity.

​Putting it to​gether

The controls on practice help ensure every activity you perform is authorized, supported, and safe. A practical approach is to work through the levels in order:

• Is it permitted by legislation/regulation?
  

• Is it consistent with BCCNM standards, limits, and conditions?

• Is it supported/allowed in this setting?

• Am I competent to perform it safely for this client, today?

Finally, apply professional judgment: even when you can perform an activity, consider whether it is appropriate and, in the client's best interests.

​Controls on practice in action​​

Sce​nario​​

Naomi (RN) is working in a community health clinic. A client presents with dehydration after a gastrointestinal illness and needs IV fluids. The physician is not i​​mmediately available. Naomi considers whether she is authorized to start a peripheral IV and initiate IV therapy as part of the client's care plan.

​Is Naomi authorized?​

Lev​​e​​l 1 — Legislation and regulation

Naomi reviews the Nurses and Midwives Regulation (NMR) and the Regulated Health Practitioners Regulation (RHPR) and confirms that inserting an instrument beyond the epidermis (e.g., starting a peripheral IV) is a restricted activity that nurses may be a​​​uthorized to perform within the profession's legislated scope, depending on applicable requirements and authorization mechanisms.

​Level 2 — BCCNM​​

Naomi reviews BCCNM practice standards, limits, and co​​nditions related to IV therapy. She confirms that she has completed the required education and meets ​​any applicable BCCNM expectations for performing the activity safely (including competence, documentation, and seeking support as needed).

​Level​​ 3 — Employer policies​​

Naomi reviews her employer's p​​olicies for IV initiation in the clinic. The clinic requires:

• ​successful completion of an internal IV training program,
• annual skills validation, and

• clear documentation and escalatio​​n steps if complications occur.

Naomi has completed the require​​d training, her annual validation is current, and the clinic has the necessary supplies and support processes in place.

​Leve​l 4 — Individual competenc​​e

Naomi reflects on her knowledge, ski​​lls, ability, and judgment for IV insertion and IV therapy. She has performed peripheral IV starts regularly in this setting, is familiar with the clinic's escalation process, and determines she can carry out the procedure safely for this client.

​Naomi's deci​​sion​​

After working ​​through all four controls, Naomi determines she is authorized to start the IV and initiate IV therapy in this setting. She proceeds because she meets requirements at each level and the intervention is appropriate for the client's needs.