Introduction
The Registered Nurses: Acting within Autonomous Scope of Practice standards, limits, and conditions set the expectations that registered nurses[1] must meet when performing activities within their autonomous scope of practice (that do not require an order), and also apply to certified registered nurses when performing activities within their autonomous scope of practice that are not included in their certification.
Registered nurses' scope of practice under the Nurses and Midwives Regulation includes providing health services for the purpose of promoting, maintaining and restoring clients' physical and mental health.
Acting within autonomous scope of practice refers to registered nurses:
Assuming accountability and responsibility for making decisions about client care, and
Performing activities that they are competent and allowed to perform without a client-specific order.
Registered nurses' autonomous scope of practice includes:
Making a nursing diagnosis of the mental or physical condition of a client (as authorized by section 11 of the Nurses and Midwives Regulation);[2]
Performing the restricted activities outlined in sections 12 to 20 of the Nurses and Midwives Regulation that do not require a client-specific order;[3] and
Providing other care or services that do not involve the performance of any restricted activities listed in section 4 of the Schedule of Restricted Activities in the Regulated Health Practitioners Regulation.
Registered nurses follow the Registered Nurse: Acting under Client-specific Orders standards, limits, and conditions when performing activities that are not within their autonomous scope of practice.
Standards
1. Registered nurses are accountable and responsible when they make a decision that a client's physical or mental condition would benefit from a specific activity and when they perform that activity within their autonomous scope of practice (without an order).
2. Registered nurses acting within autonomous scope of practice ensure that the activity they will perform is:
a. Within the scope of practice for registered nurses acting without a client-specific order under the Nurses and Midwives Regulation,
b. Consistent with BCCNM's ethics standards and practice standards including any applicable limits, and conditions on performing the activity,
c. Consistent with organizational/employer policies, processes, and restrictions, and
d. Within their individual competence.
3. Registered nurses acting within autonomous scope of practice ensure they have the competence to:
a. Make decisions about whether the client would benefit from the activity, having considered:
i. Potential risks to the client and know how to minimize those risks,
ii. The benefits to the client,
iii. The predictability of outcomes of performing the activity, and
iv. Other relevant factors specific to the client or situation,
b. Carry out the activity safely and ethically, and
c. Safely manage the intended and unintended outcomes of performing the activity.
4. Before performing an activity within autonomous scope of practice, registered nurses consider applicable employer/organizational policies, processes, restrictions, and resources, and other relevant human and system factors that may impact their ability to:
a. Perform the activity competently and safely within their practice setting, and
b. To manage intended and unintended outcomes of the activity.
5. Registered nurses perform advanced activities within their autonomous scope of practice only when they have obtained the additional education, training, and/or clinical experience needed to gain and maintain the competence to perform the activity safely.
6. Registered nurses acting within autonomous scope of practice identify the effect of their own values, beliefs, and experiences in decision-making, recognize potential conflicts, and take action for the needs of the client to be met.
7. Registered nurses acting within autonomous scope of practice use current evidence to support their decision-making and the activity to be performed.
8. Registered nurses acting within autonomous scope of practice follow a clinical decision-making process when they:
a. Assess the client's health status,
b. Make a nursing diagnosis of a client's physical or mental condition that can be prevented, improved, ameliorated, or resolved through nursing activities,
c. Determine a plan of care,
d. Determine an activity to be performed,
e. Implement an activity to prevent, treat, or manage physical and mental diseases, disorders and conditions,
f. Monitor, provide, and coordinate care to clients,
g. Advise on physical and mental health,
h. Change or cancel a client-specific order for activities within the nurse's autonomous scope of practice,
i. Give a client-specific order,
j. Manage the intended and unintended consequences of carrying out the activity, or
k. Manage and evaluate the outcomes of the activity.
9. Registered nurses acting within autonomous scope of practice communicate and collaborate with the client (or the client's representative) about nursing diagnoses, decisions, actions, and outcomes to support the client to be an active participant in making informed decisions about the care to meet the client's needs.
10. Registered nurses acting within autonomous scope of practice communicate and collaborate with the health care team about nursing diagnoses, decisions, actions, and outcomes.
11. Registered nurses acting within autonomous scope of practice communicate and collaborate with the health care professional who gave the order (or their delegate), the client, and other members of the health care team when changing or cancelling a client-specific order for activities that are within the nurse's autonomous scope of practice and individual competence.
12. Registered nurses acting within autonomous scope of practice consult with, or refer clients to, other health care professionals when:
a. The needs of the client exceed their scope of practice or individual competence,
b. Required by organizational/employer policies or processes, or restrictions, or
c. Client care would benefit from the expertise of other health care professionals.