Section 6 restricted activities

Restricted Activity

Limits & Conditions

6 (a) make a nursing diagnosis identifying a condition as the cause of the signs or symptoms of an individual

None

6 (b) for the purpose of wound care, including the suturing of skin lacerations, perform a procedure on tissue below the dermis or below the surface of a mucous membrane;

1. Providing a client-specific order for conservative sharp wound debridement, negative pressure wound therapy, maggot debridement therapy or compression therapy
   • May be done only by those registered nurses who have successfully completed one of the following wound management education programs (or an equivalent):

   • Nurse Specializing in Wound Ostomy Continence Education Program NSWOCC - EP
   • International Interdisciplinary Wound Care Course
   • University of Toronto Master of Science in Community Health: Wound Prevention and Care
   • University of Western Ontario Master of Clinical Science: Wound Healing
   • Wound Ostomy Continence Nursing Education Program.

2. Carrying out conservative sharp wound debridement, negative pressure wound therapy, maggot debridement therapy or compression therapy
• May be performed within autonomous scope of practice by registered nurses who have successfully completed the education requirements in 1. (above).
• All other registered nurses must:
  • have a client-specific order  and
  •  successfully complete additional education.


3. Diagnosing conditions associated with wounds below the dermis or below the surface of a mucous membrane
   • May be done by registered nurses who have successfully completed the education requirements in 1. (above).
   • All other registered nurses must:
     • follow an established decision support tool, and - successfully complete additional education.
4. Suturing skin lacerations
• All registered nurses, including those who have successfully completed the education requirements in 1. (above):
  • May only suture uncomplicated skin lacerations as outlined in the Provincial Nursing Skin and Wound Committee decision support tool,
  • Must follow this decision support tool when suturing such lacerations, and
  • Must successfully complete additional education.

(c) for the purposes of collecting a blood sample or donation, perform venipuncture;

(d) for the purposes of establishing intravenous access, maintaining patency or managing hypovolemia,

(i)   perform venipuncture, or

(ii)   administer a solution by parenteral instillation

Registered nurses require a client-specific order from a listed health professional before inserting a central venous catheter.

(e) administer

(i)   the following by inhalation:

(A)  oxygen or humidified air;
(B)  a mixture of oxygen and nitrous oxide, for the purpose of pain management during labour,

Registered nurses who administer a mixture of oxygen and nitrous oxide must follow decision support tools established by perinatal Services BC (PSBC).

(e) administer

(ii)   nutrition by enteral instillation, or
(iii)   purified protein derivative by injection, for the purpose of tuberculosis screening;

Without a client-specific order from a listed health professional, registered nurses can administer enteral feeds only to stable clients with an established diet. Registered nurses must follow a client-specific order from an appropriate listed health professional for all other clients.

Registered nurses administering purified protein derivative must possess the competencies established by the B.C. Centre for Disease Control (BCCDC) and follow decision support tools established by BCCDC.

(f) for the purposes of assessment or ameliorating or resolving a condition identified through the making of a nursing diagnosis, administer a solution

(i)   by irrigation, or
(ii)   by enteral instillation;

none

(g) for the purposes of assessment or ameliorating or resolving a condition identified through the making of a nursing diagnosis, put an instrument or a device, hand or finger

(i)   into the external ear canal, up to the eardrum,
(ii)   beyond the point in the nasal passages where they normally narrow,
(iii)   beyond the pharynx,
(iv)   beyond the opening of the urethra,
(v)   beyond the labia majora,
(vi)   beyond the anal verge, or
(vii)   into an artificial opening into the body;

(g.1) put a wearable hearing instrument, or a part of or accessory for it, into the external ear canal, up to the eardrum;

Registered nurses who carry out pelvic exams or cervical cancer screening must possess the competencies established by the Provincial Health Services Authority (PHSA) and follow decision support tools established by PHSA.

Registered nurses require a client-specific order from a listed health professional to apply fetal scalp electrodes.

Registered nurses may not carry out endotracheal intubation.

Registered nurses require a client-specific order to fit a pessary

(h) for the purposes of assessment or ameliorating or resolving a condition identified through the making of a nursing diagnosis, put into the external ear canal, up to the eardrum,

(i)   air that is under pressure no greater than the pressure created by the use of an otoscope, or
(ii)   water that is under pressure no greater than the pressure created by the use of an ear bulb syringe;

none

(h.1) manage labour in an institutional setting if the primary maternal care provider is absent;

Registered nurses who manage labour in an institutional setting in the absence of the primary maternal care provider must demonstrate competencies established by Perinatal Services BC (PSBC) and follow decision support tools established by PSBC.

(i) apply ultrasound for the purposes of bladder volume measurement, blood flow monitoring or fetal heart monitoring;

(j) apply electricity for the purpose of defibrillation in the course of emergency cardiac care;

(j.01) apply electricity for the purpose of providing transcutaneous electrical nerve stimulation;

Registered nurses who, in the course of providing emergency cardiac care, apply electricity using a manual defibrillator must possess the competencies established by Providence Health Care and follow decision support tools established by Providence Health Care.

(j.1) in the course of assessment, issue an instruction or authorization for another person to apply, to a named individual,

(i)   ultrasound for diagnostic or imaging purposes, including any application of ultrasound to a fetus, or
(ii)   X-rays for diagnostic or imaging purposes, except X-rays for the purpose of computerized axial tomography;

Registered nurses give a client-specific order for  X-ray or ultrasound only under the following circumstances:

• Registered nurses who give a client-specific order for X-ray or ultrasound must follow established decision support tools.
• Registered nurses who order X-ray or ultrasound for the purpose of screening or triage or treating a condition must successfully complete additional education.
• Registered nurses give a client-specific order for X-ray or ultrasound for the purpose of routine management only when organizational processes are in place to direct test results to the appropriate health professional for follow-up.

Registered nurses who give a client-specific order for chest X-ray for the purpose of tuberculosis screening must possess the competencies established by the B.C. Centre for Disease Control (BCCDC) and follow decision support tools established by BCCDC.

(k) in respect of a drug specified in Schedule I of the Drug Schedules Regulation,

(i) prescribe the drug
(ii) compound the drug,
(iii)  dispense the drug, or
(iv)  administer the drug by any method;

for the purposes of

(v)   treating

(A)  anaphylaxis,
(B)  cardiac dysrhythmia,
(C)  opiate overdose,
(D)  respiratory distress in a known asthmatic,
(E)  hypoglycemia,
(F)  post-partum hemorrhage, or
(G)  conditions that are symptomatic of influenza-like illness, or

(vi)   preventing disease using immunoprophylactic agents and post-exposure chemoprophylactic agents;

For prescribing medications, please see Prescribing limits, conditions. In addition, registered nurses who prescribe any Schedule I medication must comply with all other applicable limits ‎and conditions listed below that apply to the administration of that medication by a registered nurse ‎without an order.‎

Registered nurses may compound or administer:

• Salbutamol or ipratropium bromide to treat respiratory distress in known asthmatics
• Oral corticosteroids to treat respiratory distress in known asthmatics in emergency care settings
• Oxytocin to treat post-partum hemorrhage
• D50W to treat hypoglycemia
• Epinephrine to treat anaphylaxis
• Epinephrine, atropine, amiodarone or lidocaine to treat cardiac dysrhythmia.

Registered nurses who administer salbutamol, ipratropium bromide or oral corticosteroids must successfully complete additional education and follow an established decision support tool.

Registered nurses who administer oxytocin must possess the competencies established by Perinatal Services BC (PSBC) and follow decision support tools established by PSBC.

Registered nurses who administer D50W must follow an established decision support tool.

Registered nurses who administer epinephrine to treat anaphylaxis must follow an established decision support tool.

Registered nurses who administer epinephrine, atropine, amiodarone or lidocaine must possess the competencies established by Providence Health Care and follow decision support tools established by Providence Health Care.

Registered nurses who compound, dispense or administer antivirals to treat symptoms of influenza-like illness must successfully complete additional education and follow the decision support tool established by the Provincial Government – Registered Nurse Decision Support Tool (Clinical Practice Guidelines): Identification and Early Treatment of Influenza-Like Illness (ILI) symptoms in the absence of Medical Practitioner or Nurse Practitioner.

Registered nurses who carry out insulin dose adjustment must possess the competencies and follow the decision support tools set out by Fraser Health Authority.

Registered nurses compound, dispense or administer immunoprophylactic or chemoprophylactic agents only under the following circumstances:

• Registered nurses who compound, dispense or administer immunoprophylactic or chemoprophylactic agents identified by the BC Centre for Disease Control (BCCDC) must possess the competencies established by BCCDC and follow decision support tools established by BCCDC.
• Registered nurses who compound, dispense or administer immunoprophylactic agents for the purpose of preventing disease in travelers must successfully complete BCCDC’s basic immunization course and additional education in the area of travel health. These registered nurses must follow the Canadian Immunization Guide in conjunction with the Canada Communicable Disease Reports. They must be employed, on contract to an employer or have a written collaborative agreement with an authorized prescriber

• Registered nurses may compound and administer experimental vaccines as part of a formal research program involving a physician. These registered nurses must successfully complete BCCDC’s basic immunization course as well as additional education related to the specific experimental vaccine. They must follow established decision support tools.
• Registered nurses who compound, dispense or administer immunoprophylactic or chemoprophylactic agents to prevent infection following sexual assault must either:
  • possess the competencies established by the B.C. Women’s Sexual Assault Service (BCW SAS) and follow decision support tools established by BCW SAS (Note: This will apply to sexual assault nurse examiners), or
  • possess the competencies established by the B.C. Centre for Disease Control (BCCDC) and follow decision support tools established by BCCDC (Note: This will apply to registered nurses who hold BCCNP certification in STI management).
• Registered nurses who compound, dispense or administer immunoprophylactic agents for the purpose of preventing respiratory syncytial virus infection must possess the competencies established by the Provincial Health Services Authority and follow decision support tools established by the Provincial Health Services Authority.

(l ) in respect of a drug specified in Schedule II of the Drug Schedules Regulation,

(i prescribe the drug
(ii)   compound the drug,
(iii)   dispense the drug, or
(iv)   administer the drug by any method;

For prescribing medications, please see Prescribing limits, conditions. In addition, registered nurses who prescribe any Schedule II medication must comply with all other applicable limits ‎and conditions listed below that apply to the administration of that medication by a registered nurse ‎without an order.‎

Registered nurses only compound, dispense or administer Schedule II medications within autonomous scope of practice to treat a condition following an assessment and nursing diagnosis. Registered nurses require a client-specific order from a listed health professional before compounding, dispensing or administering Schedule II medications to treat a disease or disorder.

Registered nurses require a client-specific order before compounding or injecting dermal fillers.

(m) if nutrition is administered by enteral instillation, compound or dispense a therapeutic diet.

Within autonomous scope of practice, registered nurses can compound and dispense a therapeutic diet administered through enteral instillation only to stable clients with an established diet. Registered nurses must obtain a client-specific order from an appropriate listed health professional for all other clients