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Administering immunizations safely requires competencies beyond that of routine medication administration. All nurses administering immunizations must possess the required knowledge, skills, and judgment to safely do so. Nurses comply with federal and provincial regulations, as well as with BC College of Nurses and Midwives’ (BCCNM) standards of practice and organization/employer policies, when administering immunizations. Your individual competencies may impact whether you can prescribe, dispense, compound, or administer immunizations in your practice.

All nurses are expected to use evidence-based information when educating clients or the public about immunizations. When engaging with clients and the public, nurses are accountable for identifying the effect of their own values, beliefs, and experiences about immunizations, recognizing potential conflicts, and taking action to meet the client’s needs.

Scope of Practice – Standards, limits & conditions

It is within the nursing scope of practice for nurses of all designations to administer immunizations with a client-specific order. It is also within the nursing scope of practice for nurses of all designations to administer immunizations within their autonomous scope of practice (i.e. without a client-specific order from an authorized provider) if:

  • They have the competencies
  • Adhere to BCCNM standards, limits and conditions
  • Follow employer/organizational policies

Before prescribing (RN and RPN only), dispensing, com​pounding, or administering immunizations, nurses must meet and follow certain limits and conditions.

Restricted activities that do not require an order: Immunizations

RNs are authorized to prescribe, compound, dispense or administer immunoprophylactic agents for the purpose of preventing disease (Schedule I & II drugs)  within their autonomous scope of practice (without an order)  as follows:

Immunization Type

Limits and Conditions

BCCDC identified immunoprophylactic agents 

  • Have the competencies outlined by BCCDC Immunization Competencies for BC Health Professionals
  • Follow BCCDC decision support tools in the Communicable Disease Control manual

Influenza

  • Have the competencies outlined by BCCDC Immunization Competencies for BC Health Professionals
  • Follow BCCDC decision support tools in the Communicable Disease Control manual

Pneumococcal

  • Have the competencies outlined by BCCDC Immunization Competencies for BC Health Professionals
  • Follow BCCDC decision support tools in the Communicable Disease Control manual

Travel immunizations

  • Complete BCCDC immunization competency course
  • Follow Canadian Immunization Guide and Canada Communicable Disease Reports
  • Complete additional education in travel health
  • Be employed, or on contract to an employer, or have a written collaborative agreement with an authorized prescriber

Experimental immunizations

  • Only compound and administer as part of a formal research program involving a physician
  • Complete BCCDC immunization competency course
  • Complete additional education related to the experimental vaccine
  • Follow established decision support tools

Post-sexual assault

Respiratory syncytial virus infection

  • Have the competencies set by the Provincial Health Services Authority
  • Follow decision support tools established by the Provincial Health Services Authority

Achieving Immunization Competencies

The BC Centre for Disease Control’s (BCCDC) education is the standard for assessment of immunization competencies. BCCDC offers the education online. The education has several parts:

  • Online Immunization Competency Course (available for any nurse)
  • Immunization Skills Checklist (may require additional support from your employer)
  • Ongoing competency refresher courses 

Nurses should assess their competencies regularly and refresh as needed.

See below for additional information about competence requirements by nursing designation:

I am a Registered Nurse

Administering immunizations is a restricted activity within autonomous scope of practice (‘without an order’) under the Nurse (Registered) and Nurse Practitioners Regulation. BCCNM requires RNs who autonomously prescribe, compound, dispense or administer immunizations to possess the competencies established by BCCDC and follow its decision support tools where indicated. RNs must also successfully complete the BCCDC immunization competency course regarding some immunizations. See table.

RNs providing immunizations are accountable and responsible for assessing their immunization competencies regularly and undertaking additional education as needed to maintain their competence.

Review the following standards:

  • RN Scope of Practice standards for limits and conditions on immunizations
  • Acting Within Autonomous Scope of Practice standard
  • Acting With Client-specific Orders standard 

FAQs

What additional education do I need in order to give the COVID-19 vaccine?
For nurses who will be administering only the COVID-19 vaccine, the BC Centre for Disease Control (BCCDC) is providing a condensed immunization competency education process. Please visit the BCCDC website for details.
For personal reasons, I don’t want to/or can’t have a flu shot. Will I lose my licence if I refuse?

While you’re not required to have a flu shot to be registered with BCCNM, you are responsible for protecting your clients from the risk of infection. Nurses have a professional, ethical and legal duty to provide clients with safe care. Review the BC Ministry of Health’s and your employer’s/organization’s policies about immunizations and influenza control.

Your designation’s Communicable Diseases: Preventing Nurse-to-Client Transmission practice standard provides more information about your responsibilities to provide safe care to clients.

I work at a facility and have been told by my manager that the physician wants all clients in the facility to have flu vaccines. Do I need a client-specific order for each client, or can the physician just give one order that applies to all clients?

The physician needs to give a client-specific order for each client that is to be immunized. There is no such thing as an order that is applied to a group or a population of clients.

Who can give a client-specific order for immunizations?

Health care professionals who are authorized to give a client-specific order is laid out in your designation’s nursing regulation. Not all nursing designations have the same list of authorized prescribers. Review your nursing regulation to see who is authorized to give client-specific orders.

Does an LPN need supervision to give an immunization?

No. Administering an immunization is within the autonomous scope of practice for LPNs and they do not need to be supervised by another health professional when giving an immunization to a client. However, LPNs who administer immunizations work within a team approach to access support as needed.  Working within a team approach means that when client care includes activities outside the LPN scope of practice or the individual LPN’s competencies, the LPN seeks out other members of the health care team to jointly review and determine how the client’s care needs will be met.

Can I take a client-specific order from a pharmacist to immunize a client?

No. It is not within a pharmacist’s scope of practice to give a client-specific order for an immunization. It is within a pharmacist’s scope of practice to administer an immunization, but not to prescribe it. If a client-specific order is required, you need to get it from a health professional who is authorized to prescribe as laid out in your nursing regulation.

I have a client who needs an MMR booster and I do not meet the BCCDC immunization competencies or taken the immunization competency course. Can I give this immunization autonomously or do I need an order?

You cannot give this immunization within your autonomous scope of practice as you do not meet the BCCNM conditions/limits for this activity. You need to get a client-specific order from an authorized prescriber before administering it.

When you do not meet the requirements to act autonomously then you absolutely need a client-specific order to administer the immunization.  You do not need to meet the BCCDC immunization competencies to act on a client-specific order, however, you would need to ensure you have the competence to give an injection and administer medication.

Review your scope of practice standard to see what the requirements needed to administer immunizations within your autonomous scope of practice.

Resources

  • BCCDC
  • Immunization refresher/renewal course
  • Immunize BC
When do I need to get a client specific order to administer an immunization?

Nurses must get a client-specific order to administer an immunization if they do not meet the standards, limits and conditions set out in their Scope of Practice standards. 

Can I administer a flu immunization within my autonomous scope of practice (i.e ‘without an order’)?

Yes, if meet the conditions in your Scope of Practice standard, possess the competencies set by the B.C. Centre for Disease Control (BCCDC), follow BCCDC decision support tools, and adhere to your employer/organizational policies.

For LPNs

Within their autonomous scope of practice, LPNs can compound or administer immunoprophylactic for the purpose of preventing disease to clients four years of age or older with stable or predictable states of health in a team approach.  LPNs must have the competencies set by BCCDC and follow BCCDC decision support tools.

For RNs

Within their autonomous scope of practice, RNs can prescribe, compound, dispense, or administer immunoprophylactic agents for the purpose of preventing disease if they have the competencies set by BCCDC and follow BCCDC decision support tools.

For RPNs

Within their autonomous scope of practice, RPNs can prescribe, compound, dispense or administer immunoprophylactic agents for the purpose of preventing disease to clients four years of age or older. RPNs must successfully complete additional education, have the competencies set out in BCCDC’s Immunization Competencies for BC Health Professionals and follow BCCDC’s decision support tools in the Communicable Disease Control manual.

  • Refer to BCCNM self-employment resources if you are self-employed, in Independent practice, or on contract to provide flu immunizations. Nurses who are self-employed adhere to rele​​vant legislation and BCCNM Bylaws. BCCNM Scope of Practice for RPN's

    • Acting within autonomous scope of practice
    • Acting with client specific orders

Additional Resources

BC Centre for Disease Control

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