Acting Within Autonomous Scope of Practice (Certified Practice)

Practice Standard for registered psychiatric nurses (Certified Pracitce)

BCCNM limits and conditions for registered psychiatric nurses (certified practice)

RPN Certified Practice education programs required and approved by BCCNM

The diagnosis and treatment of diseases, disorders, conditions by Certified Practice RPNs in accordance with decision support tools

Glossary

Introduction

The Registered Psychiatric Nurse (Certified Practice): Acting within Autonomous Scope of Practice standards, limits, and conditions apply to registered psychiatric nurses who have met BCCNM requirements to be certified by BCCNM in Opioid Use Disorder.

Certified practice nurses are authorized to:

Perform certain restricted activities within their autonomous scope of practice per section 8 (restricted activities for certified practice registrants) of the Nurses (Registered Psychiatric) Regulation.
Diagnose opioid use disorder and treat by prescribing, compounding, dispensing, administering, or ordering medications for the treatment of opioid use disorder.
Make a nursing diagnosis and treat conditions that are within the autonomous scope of general registered psychiatric nurse practice and the nurse's individual competence.

Acting within autonomous scope of practice (without a client-specific order) refers to certified practice registered psychiatric nurses:

Assuming accountability and responsibility for making decisions about client care, and
Performing activities that they are competent and allowed to perform without a client-specific order.

Certified practice registered psychiatric nurses may provide care or services to clients by acting within their autonomous scope of practice when the care or services are:

Within the certified practice registered psychiatric nurse's autonomous scope of practice (without an order),
Provided in alignment with BCCNM standards, limits, and conditions,
Allowed by organizational/employer policies, processes, and
Within the certified practice registered psychiatric nurse's individual competence.

Certified practice RPNs who meet the additional BCCNM requirements to prescribe also follow the Registered Psychiatric Nurse (Certified Practice): Prescribing standards when prescribing a medication to be dispensed by a pharmacist for use by a specific client.

Certified practice RPNs follow the standards for Registered Psychiatric Nurse: Acting by Giving Client-specific Orders when giving a client-specific order (such as dispensing or administering a medication to a client) to be acted on by another nurse (LPN, RN, or RPN) or other health professional, other than a pharmacist.

Certified practice RPNs who perform activities within general registered psychiatric nurse practice also follow the Registered Psychiatric Nurse: Acting within Autonomous Scope of Practice standards, limits, and conditions.

Standards

1.	Certified practice registered psychiatric nurses are accountable and responsible when they make a decision that the client’s condition would benefit from an activity and act within autonomous scope of practice to perform the activity.
2.	Certified practice registered psychiatric nurses acting within autonomous scope of practice ensure that the activity they will perform is:
	a.	Within the scope of practice for certified practice registered psychiatric nurses acting without a client-specific order as set out in the Nurses (Registered Psychiatric) Regulation,
	b.	Consistent with BCCNM’s standards of practice including standards, limits, and conditions,
	c.	Consistent with organizational/employer policies, processes, restrictions, and
	d.	Within the nurse’s individual competence.
3.	Certified practice registered psychiatric nurses acting within autonomous scope of practice ensure they have the competence to:
	a.	Make decisions about whether the client would benefit from the activity, having considered:
		i.	Potential risks to the client and how to minimize those risks,
		ii.	The benefits to the client,
		iii.	The predictability of outcomes of performing the activity, and
		iv.	Other relevant factors specific to the client or situation,
	b.	Carry out the activity safely and ethically, and
	c.	Safely manage the intended and unintended outcomes of performing the activity.
4.	Before performing an activity within autonomous scope of practice, certified practice registered psychiatric nurses consider applicable employer/organizational policies, processes, and resources, and other relevant human and system factors that may impact their ability to:
	a.	Perform the activity competently and safely within their practice setting, and
	b.	To manage intended and unintended outcomes of the activity.
5.	Certified practice registered psychiatric nurses perform advanced activities within their autonomous scope of practice only when they have obtained the additional education, training and/or clinical experience needed to gain and maintain the competence to perform the activity safely.
6.	Certified practice registered psychiatric nurses acting within autonomous scope of practice identify the effect of their own values, beliefs, and experiences in decision-making, recognize potential conflicts, and take action for the needs of the client to be met.
7.	Certified practice registered psychiatric nurses acting within autonomous scope of practice use current evidence to support their decision-making and the activity to be performed.
8.	Certified practice registered psychiatric nurses acting within autonomous scope of practice follow a clinical decision-making process when they:
	a.	Assess the client’s health status,
	b.	Make a diagnosis of a disease, disorder or condition that is within the autonomous scope of the nurse's certified practice designation and individual competence,
	c.	Determine a plan of care,
	d.	Determine an activity to be performed,
	e.	Implement an activity to prevent, treat, or palliate an illness or injury and/or improve, ameliorate, or resolve a condition,
	f.	Change or cancel a client-specific order for activities within the nurse’s autonomous scope of practice,
	g.	Give a client-specific order,
	h.	Manage the intended and unintended consequences of carrying out the activity,
	i.	Manage and evaluate the outcomes of the activity.
9.	Certified practice registered psychiatric nurses acting within autonomous scope of practice communicate and collaborate with the client (or their substitute decision-maker) about diagnoses, decisions, actions, and outcomes to support the client to be an active participant in making informed decisions about the care to meet the client’s needs.
10.	Certified practice registered psychiatric nurses acting within autonomous scope of practice communicate and collaborate with the health care team about diagnoses, decisions, actions, and outcomes.
11.	Certified practice registered psychiatric nurses acting within autonomous scope of practice communicate and collaborate with the health care professional who gave the order (or their delegate), the client, and other members of the health care team when changing or cancelling a client-specific order for activities that are within the nurse’s autonomous scope of practice and individual competence.
12.	Certified practice registered psychiatric nurses acting within autonomous scope of practice consult with, or refer clients to, other health care professionals when:
	a.	The needs of the client exceed their scope of practice or individual competence,
	b.	Required by organizational/employer policies or processes, or
	c.	Client care would benefit from the expertise of other health care professionals.

BCCNM limits and conditions for registered psychiatric nurses (certified practice)
1. Certified practice registered psychiatric nurses must successfully complete the relevant certified practice education program approved by BCCNM as set out in Table 1:

Table 1: RPN Certified Practice education programs required and approved by BCCNM

Certified Practice	Certified Practice Education Program
Opioid Use Disorder	British Columbia Centre on Substance Use (BCCSU): Provincial Opioid Addiction Treatment Support Program– Registered Nurses and Registered Psychiatric Nurses

2.	Certified practice registered psychiatric nurses must diagnose and treat only those diseases, disorders, or conditions outlined in the competencies of the BCCNM recognized education program for their certified practice designation and as set out inTable 2.
3.	Certified practice registered psychiatric nurses must follow the decision support tools for their certified practice designation, and only diagnose and treat diseases, disorders, or conditions, including the prescribing, compounding, dispensing, administering, or ordering medications, and ordering diagnostic tests as outlined in the decision support tools for their certified practice designation and as set out inTable 2.

Table 2: The diagnosis and treatment of diseases, disorders, conditions by certified practice RPNs in accordance with decision support tools

Certified Practice: Opioid Use Disorder
Decision Support Tools	BCCSU Certified Practice Opioid Use Disorder Decision Support Tools
Diseases, Disorders, Conditions	May diagnose and treat opioid use disorder
Drug Schedules^[1] and Therapeutic Classes	Schedule IA: Opioid Agonist Opioid Partial Agonist Schedule I: Alpha-Adrenergic Agonist Schedule II/III/unscheduled

4.	Certified practice registered psychiatric nurses must complete additional education and ensure they are competent before performing a new activity added to their certified practice designation and as identified within their certified practice decision support tools such as diagnosing or treating a new disease, disorder, or condition, or providing a new treatment.
5.	Certified practice registered psychiatric nurses diagnose and treat diseases, disorders, or conditions as outlined for their certified practice designation, including prescribing, compounding, dispensing, administering, or ordering medications, and ordering diagnostic tests only when policies, processes and/or resources are in place for:
	a.	Ensuring continuity of care for the client, including appropriate follow-up of diagnostic testing results, questions about the prescription, and the monitoring and management of client outcomes related to their treatment plan.
	b.	Consulting with, referring to, or transferring care to other health professionals (e.g., nurse practitioners, medical practitioners, addiction specialists, pharmacists, primary care providers) about the treatment plan or as needed to meet the client’s needs.
6.	Certified practice registered psychiatric nurses who prescribe^[2] medications for the treatment of opioid use disorder must also:

	a.	Have a BCCNM-assigned prescriber number.
	b.	Prescribe only when they have the approval or are recognized by their organization/employer^[3] as a prescriber.
	c.	Successfully complete certified practice education approved by BCCNM for their certified practice designation that includes competencies that align with BCCNM prescribing standards, limits, and conditions.
	d.	Prescribe for the treatment of Opioid Use Disorder only when they successfully complete the British Columbia Centre on Substance Use (BCCSU) Provincial Opioid Addiction Treatment Support Program: Registered Nurses and Registered Psychiatric Nurses.
	e.	Prescribe only those medications as outlined within the decision support tools for their certified practice designation
	f.	Have access to PharmaNet and document review of the client’s PharmaNet medication profile when prescribing controlled drugs and substances.

Glossary

Additional education: Additional education is structured education (e.g., workshop, course, program of study) designed for the nurse to attain the competencies required to carry out a specific activity. Additional education

Builds on the entry-level competencies
Identifies the competencies expected of learners on completion of the education,
Includes both theory and application to practice, and
Includes an objective evaluation of learners' competencies on completion of the education.

Advanced activities: Activities that are within a nurse's scope of practice but require additional education, training and/or clinical experience that build on the foundational knowledge, skills, and judgement attained during entry-level nursing education.

Competence: The integration and application of current knowledge, skills, attitudes, and judgment required to perform safely, ethically, and appropriately within an individual's practice.

Competencies: The knowledge, skills, attitudes, and judgment required to provide safe, competent, and ethical care within an individual's practice or in a designated role or setting.

Decision support tools (DSTs): Evidence-based documents used by nurses to support clinical judgment and decision-making by guiding the assessment, diagnosis and treatment of client-specific clinical problems. DSTs come in various forms and are created by organizations or specialists in a specific area of health care.

Footnotes

[1] Drug schedules and definitions for Unscheduled, Schedule I, Schedule IA, Schedule II, Schedule III: Drug Schedules Regulation.

[2] In these standards, the term “prescribing" is used to describe the issuance of a prescription for a medication to be dispensed by a pharmacist or pharmacy.

[3] For nurses working for non-health authority agencies or organizations or who are otherwise engaged with a third-party, the “organization/employer” refers to the agency or organization with primary responsibility for the care of the client.

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Acting Within Autonomous Scope of Practice (Certified Practice)

Int​rod​​​u​ction

​​Sta​ndards

BCCNM limits and conditions for registered psychiatric nurses (certified practice)1. ​ Certified practice registered psychiatric nurses must successfully complete the relevant certified practice education program approved by BCCNM as set out in Table 1:

Table 1: RPN Certified Practice education programs required and approved by BCCNM

Table 2: The diagnosis and treatment of diseases, disorders, conditions by certified practice RPNs in accordance with decision support tools

​​Glossary​

​​Foot​​​notes​

​​​Need help or support?​

Introduction

Standards

BCCNM limits and conditions for registered psychiatric nurses (certified practice)
1. Certified practice registered psychiatric nurses must successfully complete the relevant certified practice education program approved by BCCNM as set out in Table 1:

Glossary

Footnotes

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