Certified Registered Nurses: Remote Practice

Practice standard for certified registered nurses

Introduction

The Certified Registered Nurses: Remote Practice practice standard applies to registered nurses who hold current certification^[1] in the Remote Practice certification program and sets out expectations when they act within their autonomous scope of practice (without an order).

Acting within autonomous scope of practice refers to certified 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.

Under the Regulated Health Practitioners Regulation and the Nurses and Midwives Regulation, certified registered nurses are authorized to:

Make a nursing diagnosis and treat physical or mental conditions that are within the autonomous scope of general registered nurse practice and the nurse's individual competence.
Diagnose a disease, disorder, or condition and treat by prescribing, compounding, dispensing, administering, or ordering medications according to their BCCNM certification program(s)^[2].
Give an order to perform a restricted activity listed in section 21(1), 36(1) or 51(1) of the Nurses and Midwives Regulation that is within the certified registered nurse's autonomous scope of practice, and

a licensed practical nurse may act under that order if the activity is listed in section 36(1), and
a registered nurse may act under that order if the activity is listed in section 21(1), and
a registered psychiatric nurse may act under that order if the activity is listed in section 51(1).

Certified registered nurses follow all relevant practice standards for registered nurses, including:

Registered Nurses: Acting under Client-specific Orders practice standard when performing activities that are not within their autonomous scope of practice.
Certified Registered Nurses: Prescribing practice standard when prescribing a medication to be dispensed by a pharmacist for use by a specific client.
Registered Nurses: Acting by Giving Client-specific Orders practice standard when giving a client-specific order (such as dispensing or administering a medication to a client) to be acted on by another nurse (RN, LPN or RPN) or other health professional, other than a pharmacist.

Standards

1.	Certified 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.	Certified registered nurses acting within autonomous scope of practice ensure that the activity they will perform is:
	a.	Within the scope of practice for certified 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
	d.	Within their individual competence
3.	Certified 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 how to minimize those risks
		ii. The benefits to the client
		iii. The predictability of outcomes of performing the activity
		iv. Other relevant factors specific to the client or situation
	b.	Carry out the activity safely and ethically
	c.	Safely manage the intended and unintended outcomes of performing the activity
4.	Before performing an activity within autonomous scope of practice, certified 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
	b.	Manage intended and unintended outcomes of the activity
5.	Certified 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.	Certified registered nurses 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.	Certified registered nurses use current evidence to support their decision‑making and the activity to be performed.
8.	Certified registered nurses follow a clinical decision‑making process when they:
	a.	Assess the client’s health status
	b.	Make a diagnosis of a disease, disorder, or condition that is within the autonomous scope of the nurse's certification program(s) and individual competence
	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
	k.	Manage and evaluate the outcomes of the activity
9.	Certified registered nurses communicate and collaborate with the client (or the client’s representative) about 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.	Certified registered nurses communicate and collaborate with the health‑care team about diagnoses, decisions, actions, and outcomes.
11.	Certified registered nurses 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.	Certified registered nurses 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, processes, or restrictions
	c.	Client care would benefit from the expertise of other health care professionals

Limits & conditions

1.	Registered nurses who want to obtain certification in Remote Practice must successfully complete the University of Northern British Columbia (UNBC): Remote Nursing education program recognized by BCCNM.
2.	Certified registered nurses meet the relevant certified practice competencies in the Nurses and Nurse Practitioners of British Columbia (NNPBC) Certified Practice Registered Nurse and Registered Psychiatric Nurse Competencies)^[3].
3.	Certified registered nurses follow the decision support tools for their certification program(s), and only diagnose and treat diseases, disorders, or conditions, including the prescribing, compounding, dispensing, administering or ordering of medications and ordering of diagnostic tests, as outlined in the decision support tools for their certification program(s) and as set out in Table 1.

Table 1: The diagnosis and treatment of diseases, disorders, conditions by Certified Registered Nurses: Remote Practice in accordance with decision support tools

Certified Registered Nurses: Remote Practice
Decision Support Tools	Nurses and Nurse Practitioners of British Columbia (NNPBC) Certified Practice Remote Practice Decision Support Tools (RN Certified Practice Decision Support Tools & Competencies – NNPBC)
Diseases, Disorders, Conditions	May diagnose and treat the following diseases, disorders, and conditions for pediatric and adult clients unless indicated as adult only: 1. Eye: conjunctivitis, minor corneal abrasion 2. Ear-Nose-Throat: acute otitis media, pharyngitis, ceruminosis (adult only), dental abscess (adult only) 3. Genitourinary: lower urinary tract infection 4. Respiratory: acute bronchitis (adult only) 5. Integumentary: abscess and furuncle (adult only), cellulitis, impetigo, bites 6. Pain: use of nitrous oxide/oxygen for pain management (adult only)
Drug Schedules^[4] and Therapeutic Classes	Schedule I: 1. Antibacterials 2. Antivirals 3. Antiprotozoals 4. Antihistamines 5. Bronchodilators Schedule II/III/unscheduled

4.	Certified registered nurses complete additional education and ensure they are competent before performing any new activity associated with their certification program(s) and as identified within their certified practice decision support tools such as the addition of a disease, disorder, or condition, and its treatment; or changes or additions to treatment for a disease, disorder or condition.
5.	Certified registered nurses diagnose and treat diseases, disorders, or conditions, as outlined for their certification program(s), including prescribing, compounding, dispensing, administering, or ordering medications, and ordering screening and diagnostic tests only when policies, processes, and/or resources are in place for:
	a.	Ensuring continuity of care for the client, including appropriate follow-up of diagnostic testing results, questions about the prescription, and the monitoring and management of client outcomes related to their treatment plan.
	b.	Consulting with, referring to, or transferring care to other health professionals (e.g., nurse practitioners, medical practitioners, addiction specialists, pharmacists, primary care providers) about the treatment plan or as needed to meet the client's needs.
6.	Certified registered nurses who want to prescribe medications associated with their certification program must also successfully complete the University of Northern British Columbia: Safe Prescribing for Registered Nurses with Certified Practice that has been recognized by BCCNM, and:
	a.	Have a BCCNM-assigned prescriber number.
	b.	Prescribe only when they have the approval or are recognized by their organization/employer^[5]as a prescriber.
	c.	Prescribe only those medications as outlined within the decision support tools for their certification program.
	d.	Have access to PharmaNet and document review of the client's PharmaNet medication profile when prescribing controlled drugs and substances.

Glossary

Additional education: additional education is structured education (e.g., workshop, course, program of study) designed for the nurse to attain the competencies required to carry out a specific activity. Additional education:

builds on entry-level competencies,
identifies the competencies expected of learners on completion of the education,
includes both theory and application to practice, and
includes an objective evaluation of learners' competencies on completion of the education.

Advanced activities: activities that are within a nurse's scope of practice but require additional education, training and/or clinical experience that build on the foundational knowledge, skills, and judgement attained during entry-level nursing education.

Client: person receiving health services.

Client's Representative: a person with legal authority to give, refuse or withdraw consent to health care on a client's behalf, including, as appropriate:

a. a “committee of the patient" under the Patients Property Act,
b. the parent or guardian of a client under 19 years of age with parental responsibility to give, refuse or withdraw consent to health care for the child under section 41(f) of the Family Law Act,
c. a representative authorized by a representation agreement under the Representation Agreement Act to make or help in making decisions on behalf of a client,
d. a temporary substitute decision maker chosen under section 16 of the Health Care (Consent) and Care Facility (Admission) Act, or
e. a substitute decision maker chosen under section 22 of the Health Care (Consent) and Care Facility (Admission) Act.

Client-specific order: an instruction or authorization given by a regulated health professional to provide care for a specific client, whether or not the care or service includes a restricted activity or a non-restricted activity.

Competence: the integration and application of current knowledge, skills, ability, and judgment required to perform ethically, safely and in accordance with all applicable ethics standards and practice standards.

Competencies: the knowledge, skills, ability, and judgment required to provide safe, competent, and ethical care within an individual's practice or in a designated role or setting.

Decision support tools (DSTs): evidence-based documents used by nurses to support clinical judgment and decision-making by guiding the assessment, diagnosis and treatment of client-specific clinical problems.

Medication: refers to Schedule I, IA, II, III, and unscheduled drugs as defined in the provincial Drug Schedules Regulation under the Pharmacy Operations and Drug Scheduling Act (PODSA).

Nursing diagnosis: a clinical judgment made by a nurse of a client's mental or physical condition to determine whether the condition can be prevented, improved, ameliorated or resolved by the performance of activities or provision of other care or services that is within the nurse's scope of practice to provide without an assessment or diagnosis of the client by another regulated health professional.

Prescribing: the issuance of a prescription for a medication to be dispensed by a pharmacist or pharmacy.

Restricted Activity: an activity that is performed in the course of providing a health service and is prescribed by the regulations under the Health Professions and Occupations Act as a restricted activity.

Footnotes

[1] Certification requires the successful completion of the BCCNM recognized certified practice course(s) specified in the limits and conditions of this practice standard and meeting the requirements set out in the BCCNM General Bylaws, Part 7.

[2] BCCNM General Bylaws, Part 7.

[3] Certified registered nurses may also diagnose and treat conditions that are within the autonomous scope of general RN practice and the nurse's individual competence.

[4] Drug schedules and definitions for Unscheduled, Schedule I, Schedule II, Schedule III: Pharmacy Operations and Drug Scheduling Act: Drug Schedules Regulation.

[5] For nurses working for non-health authority agencies or organizations or who are otherwise engaged with a third-party, the “organization/employer" refers to the agency or organization with primary responsibility for the care of the client.

Revision history

Approved by board: March 1, 2026 | Bylaw in-force: April 1, 2026

Effective April 1, 2026, this ethics standard, and any amendments to it, is made a bylaw under the authority of the Health Professions and Occupations Act, B.C.

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Certified Registered Nurses: Remote Practice

​​I​​ntroduction

​​​Standards​​

​Lim​its & conditions​​

​​​Glossary

​​Footnotes

Revisio​​n history​​​

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