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Acting with client-specific orders

Part 2: Scope of practice standards

Introduction

For public safety, registered nurses1 need to know which activities they are allowed to perform within their autonomous scope of practice and which activities require a client-specific order before they are allowed to perform them. Registered nurses also need to know which health professionals are authorized to give a client-specific order that they are allowed to act with.

A client-specific order is an instruction or authorization given by a regulated health professional for a nurse to provide care for a specific client, whether or not the care or service includes a restricted activity or a non-restricted activity.  A consultation, referral or professional recommendation is not an order.

The client-specific order must:

  • be documented in the client’s permanent record by the regulated health professional giving the client-specific order,

  • include all the information needed for the ordered activity to be carried out safely (e.g., time, frequency, dosage), and

  • include a written/electronic signature.

The Nurses (Registered) and Nurse Practitioners Regulation lists restricted activities that are allowed to be performed by registered nurses. Restricted activities are clinical activities that pose a significant risk of harm to the public. These include restricted activities that ‘do not require an order’ (Section 6 of the Regulation) and restricted activities that ‘require an order’ (Section 7 of the Regulation). Some restricted activities are listed under section 6 and also under section 7 of the Regulation. The BCCNM Scope of Practice for Registered Nurses - Standards Limits Conditions provides additional details about Section 6 and Section 7 restricted activities.

For certified practice registered nurses, restricted activities that do not require an order are listed in Section 8 of the Nurses (Registered) and Nurse Practitioners Regulation.

Registered nurses need to consider all four controls on practice to determine whether they require a client-specific order before performing an activity:

  • The Nurses (Registered) and Nurse Practitioners Regulation

  • BCCNM standards of practice

  • Organizational/employer policies, processes, and restrictions

  • The nurse’s individual competence.

A registered nurse may act with a client-specific order given by a ‘listed health professional’ or a ‘non-listed health professional’:

  • A listed health professional2 is a health professional listed in theNurses (Registered) and Nurse Practitioners Regulation as authorized to give an order for a restricted activity to be performed by a registered nurse. Only these health professionals are authorized to give orders for activities listed in section 7 (‘restricted activities that require an order’) of the Regulation3 that allow the registered nurse to perform that activity.Listed health professionals are physicians, nurse practitioners, certified practice registered nurses, dentists, midwives, naturopaths, podiatrists, and pharmacists.

Figure 5. Acting With a Client-specific Order from a Listed Health Professional

Acting with a client-specific order from a listed health professional 



A non-listed health professional is a health professional who is NOT listed in the Nurses (Registered) and Nurse Practitioners Regulation. A non-listed health professional is not authorized to give orders for restricted activities in section 7 of the Regulation. However, depending on organizational/employer policies and processes, they may give orders for activities that are within the registered nurse’s autonomous scope of practice. Non-listed health professionals have specialized competence within their profession’s scope of practice and individual competence that allows them to assess a client and to design or recommend care to meet the client’s needs. Examples of non-listed health professional include wound clinicians, registered nurses (who are not certified practice registered nurses or nurse practitioners), registered psychiatric nurses, and dietitians. 

Figure 6. Acting With a Client-specific Order from a Non-Listed Health Professional

Acting with a client-specific order from a non-listed health professional


 

This standard applies to registered nurses, licensed graduate nurses, and certified practice nurses when acting with client-specific orders.

Footnotes

1 References in this standard to registered nurses include licensed graduate nurses.
2 A listed health professional must be registered to practise in British Columbia, except where the client has been transferred from Alberta, Yukon or the Northwest Territories for emergency treatment in British Columbia. In addition, an order for a registered nurse or licensed graduate nurse to cast a fracture of a bone may only ever be given by a physician or nurse practitioner who registered in British Columbia. 
3 To the extent the activity is not within the activities or related limits and conditions listed in section 6 of the Regulation.​​