Introduction
This practice standard outlines
nurses' accountabilities for providing safe nursing care to
clients when performing screening and diagnostic tests & imaging activities.
Under the
Nurses and Midwives Regulation, nurses may:
- Act under a
client-specific order from a health professional to perform certain screening and diagnostic tests & imaging activities; or
- Act within their autonomous scope of practice (without a client-specific order) to order or perform certain screening and diagnostic tests & imaging activities.
Nurses may give client-specific orders[1] for screening and diagnostic tests or imaging[2] to screen for conditions based on a
nursing diagnosis. These tests or images may also support other health professionals to make a diagnosis of a disease or disorder.
Certified RNs and RPNs have an expanded scope of practice. In addition to their scope of practice as an RN/RPN, they may also order or perform screening and diagnostic tests & imaging autonomously in accordance with their BCCNM certification program[3] to support a diagnosis of a disease, disorder, or condition. They do so in accordance with their certification-specific practice standard, and as outlined in their certified practice
decision support tools.
Medical Service Plan (MSP) Practitioner Numbers
The
Laboratory Services Regulation allows RNs and RPNs[4] to apply for and use an Medical Services Plan (MSP) practitioner number to order screening and diagnostic laboratory tests for the purpose of communicable disease prevention and management. Per BCCNM standards, applying for and using an MSP practitioner number requires organizational/employer approval and established organizational/employer policies and processes. MSP practitioner numbers will generally only be needed when nurses are ordering tests that are to be completed or processed in outpatient settings.
Standards
1. Nurses order, perform, interpret, and/or manage screening and diagnostic tests & imaging according to:
a. relevant legislation and regulations,
b. BCCNM ethics standards and practice standards, including any applicable limits and conditions,
c. organizational/employer policies, processes, and restrictions,
d. current evidence, relevant guidelines, and other resources, and
e. their individual
competence.
2. When nurses receive test or imaging results/reports ordered by another health professional, they communicate the results/reports to the ordering health professional and/or the health- care team in a timely manner.
3. Nurses take part in required and relevant reporting programs such as those related to communicable diseases listed in the
Public Health Act.
Acting under a client-specific order
4. When nurses perform screening and diagnostic tests and/or imaging under a client-specific order, they:
a. consider the client's physical, mental, emotional, spiritual, social, and cultural needs relevant to the tests and/or imaging,
b. review the client's relevant health history, recent test and/or imaging result(s)/report(s), and other relevant factors,
c. perform and document appropriate clinical assessments,
d. provide the client with information about the test(s) and/or imaging, as appropriate, and
e. complete requisitions and labels completely and accurately and specify the health professional(s) who should receive the results/reports, as applicable.
Acting within autonomous scope of practice (without a client-specific order)
5. Nurses are solely accountable and responsible for their clinical decision making when they order, perform, interpret, and/or manage screening and diagnostic tests & imaging within their autonomous scope of practice to:
a. screen for a condition based on a
nursing diagnosis,
b. support other health professionals to make a diagnosis of a disease or disorder, or
c. screen for and diagnose a disease, disorder, or condition in accordance with their certification-specific practice standard.
6. When nurses order, perform, interpret, and/or manage screening and diagnostic tests & imaging within their autonomous scope of practice, they:
a. consider the client's physical, mental, emotional, spiritual, social, and cultural needs relevant to the test & imaging recommendations,
b. review the client's relevant health history, recent test and/or imaging result(s)/report(s), and other relevant factors,
c. perform and document appropriate clinical assessments and document clinical indication(s) for test(s)/imaging,
d. initiate consultation, referrals, and/or transfer care to other health professionals when:
i. client care would benefit from the expertise of other health professionals,
ii. required by organizational/employer policies, processes, restrictions, and/or
iii. client care needs exceed the scope of practice and/or individual competence of the nurse.
e. provide the client information about the test(s) and/or imaging, document the informed choice discussion and the client's choice, as applicable,
f. review and follow up on test or imaging result(s)/report(s) following organizational/employer policies, processes, and restrictions,
g. communicate and collaborate with the client and health-care team in a timely manner about the test(s) and/or imaging results/reports, proposed follow-up care, and/or treatment plan, as applicable, and
h. document:
i. client follow-up (and follow-up attempts),
ii. the test or imaging result(s)/report(s), follow-up care, and/or treatment plan, as applicable, and
iii. consultations, referrals, and/or transfers of care to other health professionals, as applicable.
7. Nurses do not order screening and diagnostic tests or imaging for themselves, or anyone who is not their client.
Medical Services Plan (MSP) number for non-certified practice nurses
8. Nurses only apply for and use their Medical Service Plan (MSP) practitioner number to order tests for communicable disease prevention and management when:
a. they have the approval of their organization/employer, and
b. their organization/employer has policies and processes to review and follow up on test results, and processes for the nurse to refer or transfer care to another health professional, as applicable.
Glossary
Client: person receiving health services.
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.
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.
Nurses: refers to registered nurses and registered psychiatric nurses licensed with BCCNM.
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.
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] Giving a client-specific order may also refer to issuing an authorization.
[2] See Nurses and Midwives Regulation s. 18 (RN) and s. 48 (RPN), and limits and conditions in
Registered Nurses: Acting Within Autonomous Scope of Practice and
Registered Psychiatric Nurses: Acting Within Autonomous Scope of Practice.
[3] BCCNM General Bylaws, Part 7.
[4] The
Laboratory Services Regulation also allow certified registered nurses or certified registered psychiatric nurses to apply for and use an MSP practitioner number.
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.