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 Understanding Scope of Practice

Nursing scope of practice reflects care across the health-illness continuum and includes health promotion, health prevention and protection, health maintenance, health restoration, rehabilitation, and palliation.

Scope of Practice standards are based on the legislated definition of nursing practice under each nursing designation's regulation. For RPNs, this is the Nurses (Registered Psychiatric) Regulation.

BCCNM Scope of Practice standards set out the activities that nurses are educated and authorized to perform.  These activities are linked to relevant legislation, BCCNM standards, limits and conditions, and BCCNM policies and bylaws.

In this section

Nurses have:

  • a legislated scope of practice based on the nursing regulations, and
  • an individual scope of practice based on meeting the BCCNM standards, limits and conditions, organization/employer policies and processes, and their own level of competence. 

The legislated scope of practice refers to the restricted activities nurses are educated and authorized to perform under their applicable regulation.

Restricted activities are clinical activities that pose a significant risk of harm to the public.  These include restricted activities that 'do not require an order' (section 6 of the nursing regulation) and restricted activities that 'require an order' (section 7 of the nursing regulation).  Some restricted activities are listed under section 6 and section 7 of the nursing regulation.

The individual scope of practice refers to the nurse's unique scope of practice that reflects:

  • BCCNM standards, limits and conditions they need to meet when performing any nursing activity,
  • activities that their organization/employer allows them to perform, and  
  • a nurse's own competence.  Competence is a nurse's ability to integrate and apply the knowledge, skills and judgment for safe and appropriate performance in their practice.

Key Concepts

Many of the terms and concepts used throughout the standards have specific legislative meaning, which can differ from the words in everyday use.

Autonomous scope of practice

Autonomous scope of practice is a nurse's ability to make decisions about client care activities in which they are educated, competent and authorized to make. Autonomous scope of practice includes acting to perform these activities within the BCCNM Scope of Practice without the direction of another health care provider.  Acting within autonomous scope of practice refers to nurses assuming accountability and responsibility for:

  • making decisions about client care, and
  • performing activities that they are educated, competent, and allowed to perform (i.e. non-restricted and restricted activities listed in section 6 of their applicable regulation)

Autonomous scope of practice does not include any activities, care or services excluded from autonomous scope of practice under BCCNM standards, limits, conditions, and controls on practice.

Client-specific order

A client-specific order, often just called 'order', is an instruction or authorization given by a regulated health professional to provide care for a specific client that includes performing an activity described in section 7 of the regulations. A client-specific order can include non-restricted or restricted activities.

 A client-specific order must:

  • be documented in the client's permanent record, and
  • include all information to carry out the activity safely (e.g. time, frequency, dosage, etc.), and
  • include the health professional's unique identifier (written signature or electronic identifier).
Controls on practice

The nursing regulations set out the restricted activities nurses are authorized to perform based on their designation. However, the reality is that nurses do not perform all these activities due to controls on their practice.

There are four controls on nursing practice limiting activities nurses can perform. Each level narrows nurses’ scope of practice.

 

Let's look at an example. According to the regulations, all nursing designations are allowed to administer oxygen by inhalation. For RNs and RPNs, BCCNM has placed no limits or conditions on this activity; however, BCCNM requires LPNs to have additional education and to follow their organization/employer's decision support tool (DST) to perform this activity. The LPNs' scope of practice has been limited, or 'controlled', by BCCNM requirements. These requirements must be met before an LPN can consider performing this activity.

The organization/employer where the nurse works may further limit scope of practice by not allowing them to perform this activity at that worksite. Organization/employer policies and requirements are controls on nursing practice that can further limit nurses' scope. If an organization/employer doesn't allow a particular activity, nurses do not perform the activity at that worksite.

Finally, the nurse has their own scope of practice based on their individual competence. So, their competence to perform oxygen administration also controls their practice. Nurses are limited to the activities they have the competence to perform. If a nurse does not have the competencies to perform an activity, even though the regulation, BCCNM and the organization/employer allow it, the nurse does not perform that activity. Performing an activity that is outside their scope of practice or individual competence is a breach of the Standards of Practice.  Nurses are responsible for ensuring they have the competence to perform their role.

Nursing diagnosis (diagnosing a condition)

A nursing diagnosis is a clinical judgment of a client's mental or physical condition. Nurses make nursing diagnoses that identify conditions, not diseases or disorders, as the cause of a client's signs or symptoms. A nursing diagnosis is used to determine if the nurse can improve or resolve the client's condition. Note, certified practice RNs are allowed to diagnose a limited number of diseases and disorders.

Prescribe

Prescribe means to issue a prescription (i.e. dispense a specified drug or device for use by a designated individual) as defined in the Pharmacy Operations and Drug Scheduling Act.

Regulated health professional

A regulated health professional is a health professional registered with the regulatory body of their profession. They must meet specific requirements to be registered and abide by the bylaws and standards set by their regulatory body. Not all health professions are regulated – homeopaths, clinical counsellors, and health care aides are unregulated.

Each BCCNM designation has its own set of Standards of Practice.

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