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Section 8: Restricted activities for certified practice


BCCN​M Limits and Conditions for Certified Practice Registered Nurses

Registered Nurses (Certified) are allowed within their autonomous scope of practice to diagnose a disease, disorder, or condition and treat by prescribing, compounding, dispensing, administering, or ordering medications according to their certified practice designation. Certified practice registered nurses may also diagnose and treat conditions that are within the autonomous scope of general registered nurse practice and the nurse’s individual competence.

These limits and conditions apply to certified practice registered nurses who are authorized to perform certain restricted activities within their autonomous scope of practice in one or more of the following certified practice areas:

  • Reproductive Health (Contraceptive Management) Certified 
  • Reproductive Health (Sexually Transmitted Infections) Certified 
  • Remote Practice Certified 
  • RN First Call Certified 

  • Opioid Use D​​isorder Certified  

  I. Certi​​fied practice registered nurses must:

  1. Successfully complete the relevant certified practice education program approved by BCCNM (see Table 1).

  2. Diagnose and treat only those diseases, disorders, or conditions or provide contraceptive management as outlined in the competencies of the BCCNM recognized education program for their certified practice designation and as set ​​out in Table 224.

  3. Follow the decision support tools managed by the Nurses a​nd Nurse Practitioners Association of British Columbia (NNPBC) and/or the British Columbia Centre on Substance Use (BCCSU) for their certified practice designation, and only diagnose and treat diseases, disorders, or conditions,  includ​ing the prescribing, compounding, dispensing, administering, or ordering of  medications and ordering of diagnostic tests, as outlined in the decision support tools for their certified practice designation. 

  4. Complete additional education25 and ensure ​they are c​​ompetent before performing a new activity added to their certified practice designation and as identified within their certified practice decision support tools such as diagnosing or treating a new disease, disorder, condition, or providing a new treatment.

  5. Diagnose and treat d​iseases, disorders, or conditions or provide contraceptive management as outlined for their certified practice designation, including prescribing, compounding, dispensing, administering, or ordering medications, and ordering diagnostic tests only when policies, processes and/or resources are in place for: 

​​

 ​a.

​Ensurin​g continu​​ity 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.

 II. Certified prac​​tice registered nurses who prescribe medications associated with their certified practice area26 must also:

  1. Have a BCCNM-assigned prescriber number.

  2. Prescribe only when they have the approval or are recognized by their organization/employer27 as a prescriber.

  3. Successfully complete certified practice education approved by BCCNM for their certified practice designation that includes competencies that align with BCCNM prescribing standards, limits, and conditions.  

  4. ​Prescribe for the treatment of Opioid Use Disorder only when they successfully complete the British Columbia Centre on Substance Use (BCCSU) Provincial Opioid Addiction Treatment Support Program: Registered Nurses and Registered Psychiatric Nurses course.

  5. Prescribe only those medications as outlined within the decision support tools for their certified practice designation.

  6. Have access to PharmaNet and document review of the client’s PharmaNet medication profile when prescribing controlled drugs and substances.

​Tab​le 1:​  RN Certified Practice Education Programs Required and Approved by BCCNM

CERTIFIED PRACTICE
 ​CERTIFIED PRACTICE EDUCATION PROGRAM ​ RESOURCES​

Reproductive Health: Contraceptiv​​e Management
  • British Columbia Institute of Technology (BCIT): Contraceptive Management

Reprodu​​ctive Health: Sexually Transmitted Infections
  • British Columbia Centre for Disease Control (BCCDC): Sexually Transmitted Infections Management
    OR
  • British Columbia Institute of Technology (BCIT): Sexually Transmitted Infections
Remote Practice
  • University of Northern British Columbia (UNBC): Remote Nursing
RN First Call
  • University of Northern British Columbia (UNBC): RN First Call
​Opioid Use Disorder
  • ​British Columbia Centre on Substance Use (BCCSU): Provincial Opioid Addiction Treatment Support Program– Registered Nurses and Registered Psychiatric Nurses​


​Table 2:  The Diagnosis and Treatment of Diseases, Disorders, Conditions by Certified Practice RNs in Accordance with Decision Support Tools

CERTIFIED PRACTICE
 DISEASES, DISORDERS, CONDITIONS
 DRUG SCHEDULES28  AND THERAPEUTIC CLASSES
Reproductive Health - Contraceptive Management May prescribe or dispense hormonal contraception.

Schedule I (as per certified practice decision support tools):

  • Sex Hormones (hormonal contraception)
  • Schedule II/III/unscheduled: as per certified practice decision support tools

Reproductive Health –

Sexually Transmitted Infections

May diagnose and treat the following diseases and disorders:

  • Chlamydia Trachomatis
  • Neisseria Gonorrhea
  • Mucopurulent Cervicitis
  • Trichomoniasis
  • Bacterial Vaginosis
  • Urethritis
  • Recurrent Urethritis
  • Lower Urinary Tract Infection
  • Genital Warts

Treatment of sexually transmitted infections contacts

Schedule I (as per certified practice decision support tools):

  • Antibacterials
  • Antivirals
  • Antiprotozoals
  • Antimitotics

Schedule II/III or unscheduled: as per certified practice decision support tools​

Remote  Practice

 

 

 

May diagnose and treat the following diseases, disorders, and conditions for pediatric and adult clients unless indicated as adult only: 

  • Eye:  conjunctivitis, minor corneal abrasion
  • Ear-Nose-Throat:  acute otitis media, pharyngitis, ceruminosis (adult only), dental abscess (adult only)
  • Genitourinary:  urinary tract infection
  • Respiratory:  acute bronchitis (adult only)
  • Integumentary: abscess and furuncle (adult only), cellulitis, impetigo, bites,
  • Pain:  use of nitrous oxide/oxygen for pain management (adult only)

Schedule I (as per certified practice decision support tools):

  • Antibacterials
  • Antivirals
  • Antiprotozoals
  • Antihistamines
  • Bronchodilators

Schedule II/III or unscheduled: as per certified practice decision support tools
RN First Call

May diagnose and treat the following diseases and disorders and conditions for pediatric and adult clients unless indicated as adult only: 

  • Eye:  Conjunctivitis, minor corneal abrasion;​
  • Ear-Nose-Throat: Acute otitis media, pharyngitis, dental abscess (adult only);
  • Urinary Tract:  Lower urinary tract infection (adult only).

Schedule I (as per certified practice decision support tools):

  • Antibacterials
  • Antivirals
  • Antiprotozoals
  • Antihistamines

Schedule II/III or unscheduled: as per certified practice decision support tools
​Opioid Use Disorder
​May diagnose and treat opioid use disorder

​​​Schedule IA (as per certified practice decision support tools):

  • Opiate Agonist
  • Opiate Partial Agonist

Schedu​le I (as per certified practice decision support tools):

  • Alpha-Adrenergic Agonist
  • Schedule II/III/unscheduled: as per certified practice decision support tools


Footnotes

24
 ​Certified practice registered nurses may also diagnose and treat conditions that are within the autonomous scope of general RN practice and the nurse's individual competence.
​25
​Additional education is structured education (e.g., a workshop, course, or program of study) designed so that registered nurses can attain the competencies required to carry out a specific activity. Additional education builds on the entry-level competencies of registered nurses; identifies the competencies expected of learners on completion of their education; includes both theory and application to practice; and includes an objective, external evaluation of learners’ competencies on completion of the education.
​26
 ​In these standards, the term "prescribing" is used to describe the issuance of a prescription for a medication to be dispensed by a pharmacist. 
27
 ​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.​
28
 ​Drug schedules and definitions for Unscheduled, Schedule I, Schedule II, Schedule III:  Drug Schedules Regulation.

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