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Acting with client-specific orders

Part 2: Scope of practice standards

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, 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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Footnotes​​

1 To the extent the activity is not within the activities or related limits and conditions listed in section 6 of the Regulation​. ​​

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With great respect, we acknowledge that BCCNM’s office is located on the unceded territories of the hən̓q̓əmin̓əm̓ speaking peoples – xʷməθkʷəy̓əm (Musqueam), and sel̓íl̓witulh (Tsleil-Waututh) Nations, and the Sḵwx̱wú7mesh-ulh Sníchim speaking peoples - Sḵwx̱wú7mesh Úxwumixw (Squamish Nation) whose historical relationships with the land continue to this day.​