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Can a nurse autonomously diagnose and treat a diabetic ulcer?

Marcie notices several reddened areas on Mr. Dimitri’s foot as she removes his sock, but it’s the open wound on his big toe that concerns her.

Based on her assessment of the wound and lower legs, Marcie diagnoses Mr. Dimitri’s wound as a (healable) diabetic ulcer. She confirms her diagnosis using the BC Provincial Nursing Skin and Wound Committee Guideline for diabetic ulcers.

Is treating Mr. Dimitri’s diabetic ulcer an activity within Marcie’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.

The scopes of practice for LPNs, RNs and RPNs set the standards, limits and conditions under which Marcie can provide the appropriate treatment for Mr. Dimitri’s wound. BCCNM sets conditions that require Marcie, if she is an LPN, to follow an existing wound care treatment plan.

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 Marcie do?

Marcie uses a DST to determine the appropriate dressing for the wound. She discusses her nursing diagnosis and treatment plan with Mr. Dimitri, updates his plan of care and documents the care she provided. She will update the team on his condition and evaluate his progress at the next dressing change.

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

Before treating Mr. Dimitri, Marcie assesses him.  Having obtained the required competencies (and additional education if she is an LPN or RPN), she knows she can improve or resolve Dr. Dimitri’s condition with nursing activities.

In deciding to treat Mr. Dimitri, Marcie considers the risks, benefits and possible outcomes. In her judgment, the outcome is reasonably predictable, and the benefits outweigh the risks. She knows she has the competencies to dress the wound appropriately and manage any intended and unintended outcomes. She follows a DST and knows her actions are within her organization’s/employer’s policy (including self-employed nurses). Marcie documents her plan of care to communicate to the health care team. Marcie understands she is accountable and responsible for her decision to treat Mr. Dimitri.

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)

Autonomous scope of practice does not include any activities, care or services excluded from autonomous scope of practice under BCCNM standards, limits, conditions and other controls on practice such as organization 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.

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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.​