For public safety, registered psychiatric nurses need to know which activities they are allowed to perform within their autonomous scope of practice and which activities require a client-specific order before they are allowed to perform them. Registered psychiatric nurses also need to know which health professionals are authorized to give a client-specific order that they are allowed to act with.

A client-specific order is an instruction or authorization given by a regulated health professional for a nurse to provide care for a specific client, whether or not the care or service includes a restricted activity or a non-restricted activity.  A consultation, referral or professional recommendation is not an order.

The client-s​​pecific order must:

• be documented in the client's permanent record by the regulated health professional giving the client-specific order,

• include all the information needed for the ordered activity to be carried out safely (e.g., time, frequency, dosage), and

• include a written/electronic signature.

The Nurses (Registered Psychiatric) Regulation lists restricted activities that are allowed to be performed by registered psychiatric nurses.  Restricted activities are clinical activities that pose a significant risk of harm to the public. These include restricted activities t​hat 'do not require an order' (Section 6 of the Regulation) and restricted activities that 'require an order' (Section 7 of the Regulation). Some restricted activities are listed under section 6 and also under section 7 of the Regulation. The BCCNM Scope of Practice for Registered Psychiatric Nurses - Standards Limits Conditions provides additional details about Section 6 and Section 7 restricted activities.

Registered psychiatric nurses need to consider all four controls on practice to determine whether they require a client-specific order before performing an activity:

• The Nurses (Registered Psychiatric) Regulation

• BCCNM standards of practice

• Organizational/employer policies, processes, and restrictions

• The nurse's individual competence.    

A registered psychiatric nurse may act with a client-specific order given by a 'listed health professional' or a 'non-listed health professional':

• A listed health professional is a health professional listed in the Nurses (Registered Psychiatric) Regulation as authorized to give an order for a restricted activity to be performed by a registered psychiatric nurse. Only these health professionals are authorized to give orders for activities listed in section 7 ('restricted activities that require an order') of the Regulation¹ that allow the registered psychiatric nurse to perform that activity. Listed health professionals are physicians, nurse practitioners, certified practice registered nurses, certified practice registered psychiatric nurses, ​dentists, midwives, naturopaths, podiatrists, and ph​armacists.

• A non-listed health professional is a health professional who is NOT listed in the Nurses (Registered Psychiatric) Regulation. A non-listed health professional is not authorized to give orders for restricted activities in section 7 of the Regulation.¹ However, depending on organizational/employer policies and processes, they may give orders for activities that are within the registered psychiatric nurse's autonomous scope of practice. Non-listed health professionals have specialized competence within their profession's scope of practice and individual competence that allows them to assess a client and to design o​r recommend care to meet the client's needs. Examples of non-listed health professional include wound clinicians, registered psychiatric nurses, registered nurses (who are not certified practice registered nurses or nurse practitioners), and dietitians. ​
  

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