Nurses act on client-specific orders from both listed and non-listed health professionals. Let’s look at each of these in detail.
Listed health professionals are regulated health professionals authorized under the nursing regulations to give orders for activities listed in section 7 of the Regulations. Listed health professionals may also give client-specific orders for activities in section 6 of the regulations and for activities that are not restricted. Even though activities in section 6 do not always need an order from a listed health professional, orders for these activities are frequently given. For example, a physician may give a client-specific order for bladder scans or for dressing changes.
An organization/employer may have restrictions on activities nurses can perform autonomously (those activities in section 6). If nurses are not permitted to perform an activity due to organization/employer restrictions, even if it is within their autonomous scope of practice, an order from a listed health professional is required.
Before carrying out an order, the nurse must determine if the ordered activity is:
If an activity is not listed, then nurses cannot legally perform that activity. Remember, just because a listed health professional orders an activity doesn’t mean that it falls within the legislated nursing scope of practice.
Sometimes BCCNM puts limits or conditions on nursing practice to ensure client safety. An example of a condition is undertaking additional education or following a clinical decision support tool before performing the activity. If you are unsure of any limits or conditions on an activity, check with your nursing supervisor or consult your Scope of Practice standard.
Not all organization/employers allow nurses to work to their full scope of practice. Each organization/employer is different, and nurses need to be familiar with the policies at the organization/employer(s) at which they work.
Each nurse has their own scope of practice based on their education, skills and knowledge. Before acting on a client-specific order the nurse must determine if they have the competence to perform the activity. Competence includes performing the activity safely and ethically and recognizing and managing intended and unintended outcomes. If a nurse does not have the competence to act on an order, they must communicate this to their nurse supervisor or to the ordering health professional.
The listed health professionals authorized to give client-specific orders are different for each nursing designation. This is because some nursing designations can act on orders from other nursing designations while others cannot.
Non-listed health professionals are regulated health professionals not listed within the nursing regulations. Non-listed health professionals are not authorized to give orders for activities in section 7 of the regulations. Non-listed health professionals have specialized competence within their profession to assess a client and design or recommend care to meet the client's needs. Depending on organization/employer policies and processes, they may give orders for activities appropriate for the client's condition that are within the nurse's autonomous scope of practice.
Examples include dietitians, wound care nurse-clinicians, non-certified practice RNs, RPNs. Some examples of orders given by non-listed health professionals include orders for enteral feeds, wound management, or mobilization plans. Note, RNs and RPNs are included in the list of non-listed health professionals for RNs and RPNs because RNs and RPNs are allowed to give orders for section 6 activities to other RNs, RPNs.
Raj is a wound care RN. He writes a client-specific order for a dressing change (a section 6 activity) to be carried out by another RN, Wynn. Because Raj has specialized wound care knowledge, and the activity he is ordering is within his autonomous scope of practice (i.e. it is a section 6 activity), he can give an order for wound care for the client. Wynn can follow that order if the activity is within her autonomous scope of practice, she has the competence, and her organization/employer supports this practice.
Note: RNs are not included in the list of health professionals of the RN Regulation; therefore, they are a non-listed health professional to other RNs.