As an RPN, to determine if the controls on practice permit the activity, you follow the four steps below:
You must check if the activity is within RPN scope of practice as defined in the Regulation and whether an order is required by a listed health professional.
These first two steps determine the scope of practice for all RPNs and steps three and four are specific to you as an individual RPN.
The following example, using the restricted activity of venipuncture, demonstrates how RPN scope of practice and controls on practice fit together.
The Health Professions Act and the Regulation states that an RPN does not require an order to carry out venipuncture for the purpose of collecting a blood sample, or for the purpose of establishing intravenous access, maintaining patency or managing hypovolemia. However, having the activity described in the Regulation as an activity that does not require an order is not enough. RPNs must determine if the activity is within scope of practice for RPNs and assess further controls on practice to determine if they should carry out this activity.
The following BCCNM RPN standards, limits and conditions apply to this activity:
Standards: An RPN must follow either scope of practice standard Acting within Autonomous Scope of Practice or Acting with a Client-specific Order, whichever applies to the situation.
Limits: RPNs are limited to using short peripheral venous access devices to take blood or to establish intravenous access. RPNs cannot take blood for the purpose of donation.
Conditions: Venipuncture is not included in basic RPN education. Therefore, a condition for carrying out this activity is that the RPN must successfully complete additional education that meets certain requirements (see Part 4: Restricted activities for registered nurses).
Consequently, venipuncture is restricted to RPNs who meet all the standards, limits and conditions.
Further, employer/organization policies will state if venipuncture can be carried out in a particular work setting, who can carry out venipuncture in that setting, and whether a client-specific order is required. These policies may limit an RPN from carrying out venipuncture in a certain setting. For example, an organizational policy may establish that the practice in that work setting is for blood to be drawn by a lab technician and that an RPN may not draw blood.
RPN individual competence is the final control on practice. The preceding controls may indicate that an RPN can carry out venipuncture in the work setting. However, the RPN must also assess their own competence. Education, knowledge, skills, experience and currency all contribute to individual RPN competence. Perhaps the RPN has completed additional education a number of years ago and has not carried out venipuncture since then. Or perhaps the RPN has recently completed additional education but has not had the opportunity to consolidate the skill. Or perhaps the RPN feels competent with the technical skill, but not with the ability to manage unintended outcomes in this particular setting. Only if an RPN determines they are competent to carry out venipuncture should they do so.
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