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Can a nurse autonomously diagnose and treat hypoxia?

At first glance, Reea can tell Mr. Paul’s condition has changed. She asks him how he feels and notes he is short of breath. She hears anxiety in his voice as he replies, “it’s hard to catch my breath” and “my chest feels tight".  Reea knows Mr. Paul was admitted a few days ago with pneumonia and general weakness. She assesses Mr. Paul and makes a nursing diagnosis of hypoxia, likely caused by his pneumonia.

Is treating Mr. Paul’s hypoxia an activity within Reea’s autonomous scope of practice?

Yes, under the LPN, RN and RPN nursing Regulations nurses are authorized to diagnose and treat conditions within their autonomous scope of practice.

As Reea is an LPN, BCCNM sets conditions that require her to have additional education and following an organization’s/employer’s decision support tool (DST) when administering oxygen within autonomous scope of practice.

What does Reea do?

Explaining her next steps to Mr. Paul, Reea applies oxygen by face mask. Reassuring him, she watches as Mr. Paul’s respiratory rate and his oxygen saturation improve.

Reea consults with his treating physician and receives a client-specific order to address the hypoxia. She updates the care team and documents her ongoing assessment, diagnosis, treatment, and communication with the physician.

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

Before treating Mr. Paul, Reea assesses him.  She diagnoses Mr. Paul’s condition as hypoxia, likely associated with his current medical diagnosis of pneumonia, his shortness of breath and chest tightness.

In deciding to treat Mr. Paul, Reea considers the risks, benefits and possible outcomes. In her judgment, the outcome is reasonably predictable, and the benefits outweigh the risks. She has the competencies to treat hypoxia and manage any intended and unintended outcomes.

She follows an evidence-based protocol/DST and knows her actions are within her organization’s/employer’s policy. Reea understands she is accountable and responsible for her decision to treat Mr. Paul. She communicates and collaborates with the client and with the health care team about her nursing diagnosis, treatment decisions, actions. and outcomes. 

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, and act 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)

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With great respect, we acknowledge that BCCNM’s office is located on the unceded territories of the hən̓q̓əmin̓əm̓ speaking peoples – xʷməθkʷəy̓əm (Musqueam), and sel̓íl̓witulh (Tsleil-Waututh) Nations, and the Sḵwx̱wú7mesh-ulh Sníchim speaking peoples - Sḵwx̱wú7mesh Úxwumixw (Squamish Nation) whose historical relationships with the land continue to this day.​