​​Key sta​​ndards

• Boundaries in the Nurse-client Relationship practice standard
• Duty to Provide Care practice standard
• Privacy and Confidentiality practice standard
• Professional Standards​
• Use of Title practice standard 

Introduction

Nurse practitioners (NPs) can work in RN roles. When they do, they practise within the RN scope and use the title RN (not NP), and they actively manage professional, legal, and employer boundaries to ensure safe and accountable care. An NP licence/registration authorizes working in an RN role, but it does not change regulatory status—under BCCNM bylaws, they remain NPs.

This means NPs may still be accountable to NP standards in some circumstances—for example, in an emergency with an imminent risk of death or serious harm, an NP may be expected to act to the extent they are competent and it is within their competence.

Key considerations

• Employer policy: Some employers may not allow NPs to take RN shifts.
• Certified practice: To work as a Certified Practice RN (RN(C)), you must apply separately to BCCNM for certification.
• Practice hours: RN or RN(C) hours do not count toward your NP practice hour requirement for NP registration renewal.
• Privileges: NP privileges granted by a health authority do not apply when you are working in an RN role.
• Legal issues: There may be legal implications for an NP working as an RN—contact CNPS for advice.
• Bylaw obligations: Even when working as an RN, you remain an NP under BCCNM bylaws. This means you have a duty to provide care in some emergency situations (e.g., imminent risk of death or serious harm) within your NP competence.

Questions to ask yourself

• How will I manage potential role confusion or conflict with clients, families, and colleagues?
• How will I set clear expectations and boundaries when moving between RN and NP roles?
• How will I protect client privacy and maintain confidentiality?
• What documentation and client record access issues do I need to consider?
• How will I maintain my fitness to practise while holding two roles?
• If I am a new NP, how will I ensure I consolidate my NP practice and not lose focus on my transition to the RN role?

Practice scenarios

The following scenarios show how working in both NP and RN roles can create challenges. Each one asks you to think about scope of practice, role boundaries, workplace policies, and your professional responsibilities.

Independent contractor NP and hospital RN shift

You are an NP working in a primary care network (PCN) without hospital privileges. On weekends, you pick up RN shifts on a surgical unit. On your first RN shift, you see one of your PCN clients is about to be discharged. You consider reviewing their records.

Considerations​

• To avoid role conflict, advise the manager of the potential conflict and request not to be assigned to your PCN client.
• If you are not assigned to this client, you are not authorized to access their medical record. Doing so would breach BCCNM's Privacy and Confidentiality practice standard and likely hospital policy.

• If you are assigned, or if the client approaches you as their NP, clarify that your role on the unit is as an RN, not as their NP.​
  

App​​ly y​our learning

You are working as an RN on​​ the surgical unit. One of your NP PCN clients is being discharged from the unit. You consider accessing their chart in the electronic health record to “stay inform​ed" ab​out their care in your NP role.

A. Yes, because they are your NP client.

Incorrect. While they are your NP client elsewhere, you are currently working in the RN role. You may only access the records of clients you are assigned to as their RN.

B. Yes, but only if the manager gives permission.

Incorrect. Even with manager approval, you cannot access the record of an NP client. Doing so breaches the Privacy and Confidentiality practice standard and likely employer policy.

C. No, because you are not providing care in your NP role.

Correct. When working as an RN, you cannot use your NP authority to access records. Doing so would breach confidentiality requirements and employer policy.

D. No, unless my client asks me directly.

Incorrect. A client's request does not authorize you to access their record when you are not assigned to provide their care in the RN role.

Re​flection ​questions

• What boundaries are being tested in this scenario?

• How does the Privacy and Confidentiality practice standard guide your actions?​
  

RN shift in Emergency Department, client overlap

You a​re working an RN shift in the Emergency Department (ED). A client from your NP practice recognizes you in the waiting room and asks you to renew a prescription you previously wrote.

Cons​​​iderations

• As an RN, you can only carry out medication-related activities for clients under your care on that shift.
• You cannot write or renew prescriptions in the RN role, especially not for Schedule IA medications.

• Clearly​ explain to the client that you are working as an RN during this shift and cannot provide NP services, including prescribing.

​Apply your le​​arning

While you are working as an RN in the ED, a client from your NP practice asks you for a prescription renewal. Which standards guide your response? Select all that apply.

A. Medication practice standard

Incorrect. While important, the issue here is not medication administration but your role boundaries.

B. Duty to Provide Care practice standard

Incorrect. You are not abandoning care; the issue is scope of practice in the RN role.

C. Registered Nurse: Acting Within Autonomous Scope of Practice standard

 Correct. This standard applies when acting autonomously as an NP, which you are not doing in the RN role.

D. Use of Title practice standard

Correct. You communicate that you are working as an RN, not as their NP. Maintaining role clarity protects client confidentiality and trust.

E. Duty to Report practice standard

Incorrect. This standard applies when you need to report impaired practice or unethical conduct and is not relevant here.

Reflec​tion questions

• What professional and legal limits apply in this situation?

• How might you explain your role clearly to the client while maintaining trust?​​
  

​RN​​ shift in a remote community nursing station

You are working in a remote community nursing station in the RN role when a client asks you for a prescription for birth control.

Considerations​

• The RN scope of practice does not authorize RNs to prescribe Schedule I medications (only certain certified practice RNs may prescribe within their limits).
• Because you are working as an RN, you cannot write the prescription.

• You m​ust refer the client to an authorized prescriber. 

Apply y​our learning

What is the safest and most professional way to respond when a client asks for services outside the RN scope of practice?

A. Clearly explain your role boundaries and refer the client to an authorized prescriber.

Correct. You must maintain scope of practice and ensure the client is connected to appropriate care.

B. Tell the client to return another day when you are working as an NP.

Incorrect. Delaying care unnecessarily may put the client at risk and reduce trust.

C. Provide the service because you are also an NP.

Incorrect. You cannot practise as an NP while working in the RN role.

D. Document the request but take no action.

Incorrect. Documentation alone is not enough; you have a duty to facilitate access to care.

Reflect​​ion questions

• How can you set clear boundaries when clients expect NP services while you are in an RN role?

• What referral options would ensure the client receives timely care?
  

Casua​​l RN and part-time NP in the same clinic

You work casually as an RN in a specialty clinic and recently started a part-time NP role in the same clinic. During an RN shift, the other NP on duty becomes ill and leaves. The manager asks you to cover the NP role for the rest of the day. 

Considerations​

• Clarify with the manager which role you will be working in for the remainder of your shift.
• If you move into the NP role, your RN assignment must be reassigned to another nurse.
• Ensure the change in your role is clearly communicated to the team.

• Wh​​en accessing client records, your documentation must reflect the role and title you are practising under (RN vs. NP). 

Apply your learning​​

If you switch from the RN role to the NP role partway through a shift, what is the most important step for maintaining accountability?

A. Document clearly in client records under the correct role/title.

Correct. Documentation must reflect whether you are acting as an RN or NP, to avoid confusion and ensure accountability.

B. Provide care under both titles at the same time to cover gaps.

Incorrect. Blending roles creates risk and accountability problems.

C. Keep working as an RN but complete NP activities informally.

Incorrect. Mixing roles informally is unsafe and may breach standards.

D. Ask a colleague to document for you to save time.

Incorrect. Documentation must always be completed by the person providing care.

Reflection questions

• What risks might arise if you try​ to “blend" both roles in the same shift?

• Why​​ is it important for documentation to reflect the role you are practising in?

When you step into the RN role as an NP, it's important to remember which “hat" you're wearing. Staying within the RN scope, being clear with clients and colleagues, and documenting accurately are essential to protect both your clients and your practice. If in doubt, pause and ask: Am I acting in the right role, within the right scope, and to the right standard?

Next steps

• Review the BCCNM professional and practice standards.
• Check your employers' policies on dual roles and role conflict.
• Contact CNPS for legal advice about liability if you are working in both NP and RN roles.

• Reflect on how you will maintain your fitness to practise wh​​ile balancing dual responsibilities.​​​