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Can a nurse autonomously diagnose and treat anaphylaxis?

Mike works as a nurse at a local mental health group home.  Mike’s 22-year old client, Simon, arrives at the nurses’ station and tells Mike that he has just been stung by a wasp. Simon says he doesn’t feel well, and he shows Mike his red, swollen shoulder where he was stung.

Mike sits Simon down to examine him more closely. Mike asks Simon if he is allergic to bees or wasps, but Simon says he doesn't know as he has never been stung before. He also says he doesn’t have any allergies that he knows of.  Based upon his assessment and clinical judgment, Mike concludes Simon is showing signs of anaphylaxis and he asks a colleague to call 9-1-1.

Is treating Simon’s anaphylactic reaction an activity within Mike’s autonomous scope of practice?

Yes, under the LPN, RN and RPN nursing regulations nurses are allowed to diagnose and treat conditions in their autonomous scope of practice. Also, a limited number of Schedule I medications, medications that normally require an order, can be administered without an order to treat certain emergency conditions.

The scope of practice for LPNs, RNs and RPNs sets the standards, limits and conditions under which Mike is allowed to give a specific medication to treat anaphylaxis, without an order. BCCNM sets conditions that require Mike to have additional education (if he is an LPN or RPN) and follow an organization/ employer approved decision support tool (DST).

The standard, Acting Within​ Autonomous Scope of Practice, outlines the requirements for nurses when they carry out an activity within their autonomous scope of practice.

What does Mike do?

Mike calmly explains to Simon that he’s likely reacting to the wasp sting and will need a shot to help his breathing. Following his organization’s/ employer's decision support tool, Mike administers the dose of epinephrine.

The ambulance arrives and Mike gives a report to the paramedics. Mike documents the incident and his actions.

How is Mike meeting the standards for acting within autonomous scope of practice?

Before treating Simon, Mike assesses him.  He diagnoses Simon’s condition as anaphylaxis associated with a wasp sting as the likely cause of the signs and symptoms. Having previously obtained the required competencies, Mike knows he can improve or resolve Simon’s condition with nursing activities.

In deciding to treat Simon, Mike considers the risks, benefits and possible outcomes. In his judgment, the outcome was reasonably predictable, and the benefits outweighed the risks. He knew he had the competencies to administer the epinephrine safely and manage any intended or unintended outcomes. He follows a DST and knows his actions are within his organization’s/employer’s policy. Mike understands he is accountable and responsible for his decision to treat Simon.

Acting Within Autonomous Scope of Practice

Within their autonomous scope of practice, a nurse can independently make decisions about client care activities they are educated, competent and authorized to make.  A nurse’s autonomous scope of practice also includes acting independently to perform these activities.

A nurse’s autonomous scope of practice includes:

  • Carrying out restricted activities listed in section 6 of their applicable Regulation, and
  • Providing care or services that are considered non-restricted activities (i.e. general nursing activities)

Autonomous scope of practice does not include any activities, care or services excluded from autonomous scope of practice under section 7 of the applicable Regulation, BCCNM standards, limits and conditions, and other controls on practice such as employer policies or legislation.

When acting without an order nurses follow their designation’s Scope of Practice standards and the Acting Within Autonomous Scope of Practice standard.

Resources

Acting within Autonomous Scope of Practice standard

Scope of Practice Standards

Medication Practice Standard

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