Acting within autonomous scope of practice

Scope of practice refers to the activities that registered psychiatric nurses are educated and authorized to perform. Acting within autonomous scope of practice refers to registered psychiatric nurses:

• assuming accountability and responsibility f​or making decisions about client care, and

• perform​ing activities that they are educated, competent, and allowed to perform without a client-specific order.

To ensure they are providing safe care, registered psychiatric nurses need to know when they are allowed to act within autonomous scope of practice and when they require a client-specific order before performing an activity.

The Nurses (Registered Psychiatric) Regulation allows registered psychiatric nurses to make a nursing diagnosis that identifies a condition – not a disease or disorder – as the cause of a client's signs or symptoms. Registered psychiatric nurses diagnose and determine a plan of care for a variety of conditions that can be improved, resolved, or prevented with nursing activities. Other conditions may be stabilized or improved by registered psychiatric nurses but req​uire the involvement of another health professional to diagnose and treat the underlying disease or disorder.

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 acti​​​vities that '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.

Before acting within autonomous scope of practice, registered psychiatric nurses  need to consider all four controls on practice to ensure they are allowed to perform the activity: 1) The Nurses (Registered Psychiatric) Regulation; 2) BCCNM standards of practice including standards, limits, and conditions; 3) organizational/employer policies, processes, and restrictions; and 4) the nurse's individual competence.

Autonomous scope of practice includes:

• The performance of restricted activities that are listed in section 6 of the Nurses (Registered Psychiatric) Regulation, unless the activity is prohibited by any BCCNM standard, limit, or condition. These restricted activities do not require an orde​​r from a health professional who is listed¹​ in the Regulation.

• The provision of other care ​or services that are not restricted activities, unless the care or services are excluded from autonomous scope of practice by any BCCNM standard, limit, or condition.

Autonomous scope of practice does not include:

• The performance of restricted activities that are listed in section 7 of the Nurses (Registered Psychiatric) Regulation (to the extent the care provided is not within the activities listed in section 6 of the Regula​tion). These are restricted activities that require an order from a health professional who is listed in the Regulation.
  

• The provision of other care or services, including restr​icted or non-restricted activities, that are prohibited or otherwise excluded from autonomous scope of practice by:

  • an​y BCCNM standard, limit, or condition, or

  • organization​​al/employer policies, processes, or restrictions.​   ​

• The provision of a service that is prohi​​​bited by other legislation (see Legislation Relevant to Nurses' Practice).
  

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​Footnotes​