1. | Use of restraint and seclusion |
a. When using restraint or seclusion[5] interventions, registered psychiatric nurses must follow applicable legislation[6] specific to their practice setting. b. When using mechanical restraint[7] or seclusion interventions with clients certified under the
Mental Health Act, registered psychiatric nurses must act with a client-specific order from an authorized health professional, except in an emergency situation.
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2.
| Pronounce death |
a. Registered psychiatric nurses must follow a decision support tool approved by their employer when pronouncing unexpected death.
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3. | Do not pronounce death related to medical assistance in dying (MAiD) |
a. Registered psychiatric nurses
must not pronounce death related to medical assistance in dying (MAiD). |
4.
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Financial incapability assessment
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a. Registered psychiatric nurses must successfully complete the educational program titled
A Guide to the Certificate of Incapability Process under the Adult Guardianship Act, provided by the Ministry of Health (Certificate of Incapability process for healthcare professionals | Public Guardian and Trustee of British Columbia)
b. Registered psychiatric nurses must follow the guidelines contained in the document
A Guide to the Certificate of Incapability Process under the Adult Guardianship Act" prepared by the Ministry of Health and the Public Guardian and Trustee of British Columbia (Certificate of Incapability process for healthcare professionals | Public Guardian and Trustee of British Columbia)
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5. | Incapability assessment for care facility admission |
a. Registered psychiatric nurses must successfully complete the Ministry of Health “Consent to Care Facility Admission in British Columbia: A Course for Managers and Assessors" (LearningHub: Consent to Care Facility Admission in British Columbia: A Course for Managers and Assessors) b. Registered psychiatric nurses must follow the Ministry of Health guidelines, “Practice Guidelines for Seeking Consent to Care Facility Admission"
(Province of British Columbia: Practice Guidelines for Seeking Consent to Care Facility Admission)
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6.
| Perform wound care |
a. Registered psychiatric nurses must successfully complete additional education before carrying out: i. Conservative sharp wound debridement ii. Negative pressure wound therapy iii. Biological debridement therapy iv. Compression therapy
b. Registered psychiatric nurses must follow an employer approved decision support tool in carrying out:
i. Conservative sharp wound debridement ii. Negative pressure wound therapy iii. Biological debridement therapy iv. Compression therapy
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7. | Perform venipuncture |
a. Registered psychiatric nurses must successfully complete additional education to perform venipuncture. b. Registered psychiatric nurses are limited to using short peripheral venous access devices to take blood.
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8.
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Perform venipuncture:
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Do not take blood for donation
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a. Registered psychiatric nurses
must not take blood for the purpose of donation.
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9.
| Establish intravenous (IV) access |
a. Registered psychiatric nurses must successfully complete additional education to perform venipuncture or establish intravenous access.
b. Registered psychiatric nurses are limited to using short peripheral venous devices to establish intravenous access.
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10.
| Administer nutrition by enteral instillation |
a. Registered psychiatric nurses are limited to administering enteral feeds to clients with stable and predictable physiological health and an established diet.
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11.
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Administer purified protein derivative by injection for tuberculosis (TB) screening
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a. Registered psychiatric nurses who administer purified protein derivative must possess the
competencies outlined in
Competencies for Tuberculosis Screening
Competencies established by the British Columbia Centre for Disease Control (BCCDC) (TB_screening_competencies.pdf) or equivalent approved by their employer. b. Registered psychiatric nurses who administer purified protein derivative must follow the
BCCDC Decision Support Tool: Non-Certified Practice - Tuberculosis Screening (BCCDC Clinical Prevention Services Decision Support Tool: Non-Certified Practice - Tuberculosis Screening) or equivalent approved by their employer.
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12.
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Administer a solution by irrigation:
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irrigate bladder
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administer a solution by enteral instillation
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a. Registered psychiatric nurses must act with a client-specific order from an authorized health professional to irrigate a bladder. b. Registered psychiatric nurses are limited to administering a solution through enteral instillation to clients with stable and predictable physiological health.
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13.
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Put an instrument or device beyond the point in the nasal passages where they normally narrow:
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nasopharyngeal suctioning
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nasogastric tubes
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a. Registered psychiatric nurses must follow a decision support tool approved by their employer when carrying out nasopharyngeal suctioning. b. Registered psychiatric nurses are limited to re-inserting previously established nasogastric tubes (e.g., replacing a blocked tube) within their autonomous scope of practice. Initial insertion of a nasogastric tube requires a client-specific order from an authorized health professional.
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14.
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Put an instrument or device beyond the pharynx:
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Do not perform endotracheal Intubation
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a. Registered psychiatric nurses
must not carry out endotracheal intubation.
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15.
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Put an instrument or a device beyond the opening of the urethra:
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a. Registered psychiatric nurses must follow a decision support tool approved by their employer when inserting or flushing a catheter.
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16.
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Put an instrument or a device, or finger beyond the labia majora:
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pelvic exams
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cervical cancer screening
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a. Registered psychiatric nurses who carry out pelvic exams or cervical cancer screening must i. successfully complete additional education and ii. possess the
competencies (BCCDC: Competencies for Pelvic Examination) established by the Provincial Health Services Authority (PHSA) or equivalent approved by their employer.
b. Registered psychiatric nurses who carry out pelvic exams or cervical cancer screening must follow the
Pelvic Exam by Registered Nurses and Registered Psychiatric Nurses
decision support tool established by PHSA (PHSA: Pelvic Exam by Registered Nurses and Registered Psychiatric Nurses) or an equivalent approved by their employer.
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17. |
Put an instrument or a device, hand or finger into an artificial opening into the body:
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suprapubic and gastrostomy tubes
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ostomy care
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tracheostomy care
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a. Registered psychiatric nurses are limited to inserting suprapubic and gastrostomy tubes in clients with stable and predictable physiological health. b. Registered psychiatric nurses are limited to carrying out ostomy care for clients with stable and predictable physiological health. c. Registered psychiatric nurses are limited to carrying out tracheostomy care for clients with stable and predictable physiological health.
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18.
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Apply electricity:
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Do not use a manual defibrillator
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a. Registered psychiatric nurses
must not apply electricity using a
manual defibrillator.
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19.
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Apply electricity:
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use an automated external defibrillator (AED)
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a. Registered psychiatric nurses must successfully complete, and maintain currency in, a course on cardiopulmonary resuscitation and automated external defibrillator (AED) use for health care professionals in order to apply electricity using an AED.
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20.
| Order X-rays for tuberculosis screening except computerized axial tomography (CAT scan) |
a. Registered psychiatric nurses who issue an instruction or authorization for a chest X-ray for the purpose of tuberculosis screening must possess the
competencies outlined in
Tuberculosis Screening
Competencies established by the British Columbia Centre for Disease Control (BCCDC) (BCCDC: TB Screening Competencies) or equivalent approved by their employer.
b. Registered psychiatric nurses who issue an instruction or authorization for a chest X-ray for the purpose of tuberculosis screening must follow the
BCCDC Decision Support Tool: Non-Certified Practice - Tuberculosis Screening (BCCDC Clinical Prevention Services Decision Support Tool: Non-Certified Practice - Tuberculosis Screening) or equivalent approved by their employer.
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21.
| Prescribe medications |
a. Registered psychiatric nurses only prescribe medications[4] when they:
i. Have a certified practice designation; AND ii. Meet the requirements for certified practice registered psychiatric nurses to prescribe for the treatment of opioid use disorder.
This restriction against a non-certified practice RPN prescribing does not prevent them from issuing a client-specific
order to be acted on by another nurse to compound, dispense or administer a medication for a
specific client that is within the ordering RPN's autonomous scope of practice.
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22. |
Treat anaphylaxis
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a. Registered psychiatric nurses are limited to administering epinephrine to treat anaphylaxis. b. Registered psychiatric nurses who administer epinephrine to treat anaphylaxis must follow
decision support tools (BCCDC: Communicable Disease Control Manual Chapter 2: Immunization Part 3 - Management of Anaphylaxis in a Non-Hospital Setting) in the Communicable Disease Immunization Program Section V - Management of Anaphylaxis in a Non-hospital Setting2 established by British Columbia Centre for Disease Control (BCCDC) or equivalent approved by their employer. c. Registered psychiatric nurses who administer epinephrine must successfully complete additional education.
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23.
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Administer medications:
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a. Registered psychiatric nurses
must not administer, compound or dispense a Schedule I drug to treat a suspected opiate overdose
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24. | Treat respiratory distress (clients with known asthma) |
a. Registered psychiatric nurses are limited to administering salbutamol or ipratropium bromide to treat respiratory distress in known asthmatics. b. Registered psychiatric nurses who administer salbutamol or ipratropium bromide to treat respiratory distress in a known asthmatic must follow a decision support tool approved by their employer. c. Registered psychiatric nurses who administer salbutamol or ipratropium bromide must successfully complete additional education.
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25. | Treat hypoglycemia |
a. Registered psychiatric nurses are limited to administering D50W to treat hypoglycemia. b. Registered psychiatric nurses who administer D50W to treat hypoglycemia must follow a decision support tool approved by their employer. c. Registered psychiatric nurses who administer D50W must successfully complete additional education.
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26.
| Compound, dispense or administer antivirals for influenza-like illness |
a. Registered psychiatric nurses who compound, dispense or administer antiviral medication to treat symptoms of influenza-like illness must successfully complete additional education. b. Registered psychiatric nurses who compound, dispense or administer antiviral medication to treat symptoms of influenza-like illness must follow, the decision support tool established by the Provincial Government:
RN and RPN Decision Support Tool (Clinical Practice Guidelines) for Identification and Early Treatment of Influenza-Like Illness (ILI) Symptoms during an Influenza Pandemic in the Absence of a Medical Practitioner or Nurse Practitioner. (BC Government: RN and RPN Decision Support Tool (Clinical Practice Guidelines) for Identification and Early Treatment of Influenza-Like Illness (ILI) Symptoms during an Influenza Pandemic in the Absence of a Medical Practitioner or Nurse Practitioner or equivalent approved by their employer.
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27.
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Do not compound, dispense or administer antiviral medication to treat symptoms of influenza-like illness for children under 4 years
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a. Registered psychiatric nurses
must not compound, dispense or administer antiviral medication to treat symptoms of influenza-like illness for children under the age of 4.
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28.
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Compound, dispense or administer Immunoprophylactic agents and post-exposure chemoprophylactic agents
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a. Registered psychiatric nurses who, within their autonomous scope of practice, compound, dispense or administer immunoprophylactic or chemoprophylactic agents identified by the BC Centre for Disease Control (BCCDC) must: i. possess the
competencies established by BCCDC (BCCDC: Immunization Competencies for BC Health Professionals). ii. follow
decision support tools established by BCCDC.
b. Registered psychiatric nurses who compound, dispense or administer post-exposure chemoprophylactic agents for sexual assault purposes must:
i. possess the BC Women's Sexual Assault Service (BCWSAS) Competencies for (registered nurse) sexual assault nurse examiners (Sexual Assault Service Resources for Health Professionals), and ii. follow
Decision Support Tools (DST) for Sexual Assault Nurse Examiners (SANES) for (registered nurse) sexual assault nurse examiners (Sexual Assault Service Resources for Health Professionals) established by BC Women's Sexual Assault Service (BCWSAS).
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29.
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Do not compound, dispense or administer immunoprophylactic or post-exposure chemoprophylactic agents for:
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preventing disease in travellers
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children under 4 years
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a. Registered psychiatric nurses
must not compound, dispense or administer immunoprophylactic or post-exposure chemoprophylactic agents for the purpose of preventing disease in travellers (also known as travel health). b. Registered psychiatric nurses
must not, within their autonomous scope of practice, compound, dispense or administer immunoprophylactic agents or post-exposure chemoprophylactic agents for children under the age of 4 years old.
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30. | Do not compound or administer experimental vaccines for research purposes |
a. Registered psychiatric nurses
must not compound or administer experimental vaccines for research purposes. |
31.
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Compound, dispense, or administer Schedule II drugs
(Drug Schedules Regulation)
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a. Registered psychiatric nurses require a client-specific order from an authorized health professional to compound, dispense or administer Schedule II medications
to treat a disease or disorder.
For example, nurses would not administer insulin without knowing that a physician had diagnosed diabetes and ordered insulin therapy.
b. Registered psychiatric nurses may only compound, dispense or administer Schedule II medications
to treat a condition following an assessment and nursing diagnosis. Vaccines do not require the identification of a condition.
c. Registered psychiatric nurses who administer Schedule II drugs intravenously via a peripheral venous access device must either:
d. Registered psychiatric nurses who administer medication via central venous access devices must:
i. act with a client-specific order from an authorized health professional, and
ii. successfully complete additional education to administer medication via central venous access devices.
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32.
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Compound, dispense, or administer Schedule II drugs:
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b. Registered psychiatric nurses
must not administer medication via intrathecal, epidural, intraosseous or perineural routes because it is not within RPN scope of practice
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33.
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Medical aesthetics[5]
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a. Registered psychiatric nurses successfully complete additional education before providing medical aesthetic procedures. b. Registered psychiatric nurses administering injectable drugs or substances or implantable devices for medical aesthetic purposes only do so: i. with a client-specific order from an authorized health professional, and ii. when the ordering health professional, or another health professional who has assumed responsibility for the care of the client, is present within the facility when the procedure is being performed and immediately available for consultation.
c. Registered psychiatric nurses
do not prescribe dermal fillers.
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