Updated Dec. 1, 2023
The BCCNM board on Sep. 21, 2023, approved a series of new and amended standards, limits, and conditions to create a new designation of certified practice for opioid use disorder (OUD) for registered nurses (RNs) and registered psychiatric nurses (RPNs).
RNs and RPNs who are currently diagnosing and treating clients with OUD under the Public Health Officer (PHO) order Registered Nurse and Registered Psychiatric Nurse Public Health Pharmacotherapy will have the opportunity to transition to this new certified practice designation. BCCNM will contact all nurses currently prescribing under the PHO order in late October inviting them to apply for certified practice OUD. There will be no application fee and certified practice OUD registration will be granted to eligible nurses by November 30, 2023.
New and revised standards, limits, and conditions
The following changes come into effect November 1, 2023.
New and amended RN and RPN scope of practice standards, limits, conditions for certified practice for opioid use disorder, in response to amendments to the
Nurses (Registered) and Nurse Practitioners Regulation and the
Nurses (Registered Psychiatric) Regulation.
Amendments to the
Use of Title practice standard to include the RN and RPN certified practice in opioid use disorder.
Amendments to the RN and RPN prescribing standards to address gaps identified by engagement with key informants and audiences.
Please note that after November 30th, 2023, RNs and RPNs are required to hold a certified practice designation in order to prescribe. Please refer to the
RN scope of practice and
RPN scope of practice.
Transitioning RNs and RPNs prescribing under the PHO order
All RNs and RPNs currently authorized to diagnose and treat opioid use disorder under the PHO order will be offered the opportunity to transition to this new certified practice designation. Nurses who do will continue to diagnose and treat opioid use disorder as before, meeting the standards, limits, and conditions for certified practice OUD.
The
education RNs and RPNs completed to diagnose and treat opioid use disorder under the PHO order meets the education requirements for certified practice in opioid use disorder.
About certified practice – OUD
RNs and RPNs who complete certification requirements can diagnose and treat opioid use disorder (OUD), including the prescribing of controlled drugs and substances. Additionally, they can issue orders that non-certified practice nurses can act on to compound, dispense, and administer drugs and Schedule I medications to clients for the treatment of OUD.
Nurses certified in OUD will need to attest during registration renewal that they have practised in their certified practice area in the past year, and to meet the Quality Assurance requirement to set one professional development goal annually relating to their certified practice.
Education program
The BCCNM board on Sep. 21, 2023, approved the
Provincial Opioid Addiction Treatment Support Program: Registered Nurses and Registered Psychiatric Nurses Certified Practices course, offered by the British Columbia Centre on Substance Use (BCCSU), as the required education program for certified practice OUD.
Decision support tools & competencies
BCCSU will also maintain the decision support tools (DSTs) and competencies for this certified practice.
FAQs
- What is certified practice?
Certified practices are restricted activities that can only be performed by nurses or nurse practitioners who have been certified by BCCNM.
Registered Nurses (Certified) and Registered Psychiatric Nurses (Certified) are allowed within their autonomous scope of practice to diagnose a disease, disorder, or condition and treat by prescribing, compounding, dispensing, administering, or ordering medications according to their certified practice designation. Certified practice RNs and RPNs may also diagnose and treat conditions that are within the autonomous scope of general RN or RPN practice and the nurse's individual competence.
Certified practices for registered nurses are outlined in Section 8: Restricted Activities for Certified Practice of the
Scope of Practice for Registered Nurses: Standards, Limits, Conditions, and set out within specific certified practice DSTs. The DSTs set the parameters for this expanded scope of practice.
Certified practices for registered psychiatric nurses are outlined in Section 6.1: BCCNM Limits and Conditions for Certified Practice Registered Psychiatric Nurses of the
Scope of Practice for Registered Psychiatric Nurses: Standards, Limits, Conditions, and set out within specific certified practice DSTs. The DSTs set the parameters for this expanded scope of practice.
The Certified Practice DSTs and the competencies for CP-OUD are maintained by the BC Centre on Substance Use. The Nurses and Nurse Practitioners of BC (NNPBC) maintain the
DSTs and competencies for the other certified practice areas (Remote, RN First Call, and Reproductive Health-Sexually Transmitted Infections/Reproductive Health-Contraceptive Management).
Successfully completing certified practice education requirements allows nurses to:
Use the title Registered Nurse (Certified) or RN(C), or Registered Psychiatric Nurse (Certified) or RPN(C) if they are on BCCNM's certified practice roster
Diagnose diseases and disorders set out in DSTs
Autonomously carry out restricted activities set out in the DSTs that would otherwise require an order, e.g., diagnosing diseases/disorders
Prescribe, compound, dispense, and administer Schedule I medications as set out in the DSTs
Certified practice nurses must meet the annual Quality Assurance requirements for certified practice.
- What are the areas of certified practice?
Opioid Use Disorder (RN and RPN)
NEW
RNs and RPNs who complete certification can diagnose and treat opioid use disorder (OUD), including the prescribing of controlled drugs and substances
Additionally they can issue orders that non-certified practice nurses can act on to compound, dispense and administer drugs to clients for the treatment of OUD.
Remote nursing (RN only)
Remote Certified Practice frequently (but not necessarily) occurs in communities but where there is no physician or nurse practitioner in the community, but where physicians or nurses visit the community periodically and are available to provide consultation to the registered nurse.
Registered nurses who hold BCCNM certification in Remote Nursing may diagnose and treat minor acute illnesses as set out in the Remote Nursing DSTs.
RN First Call (RN only)
RN First Call frequently (but not necessarily) occurs in small acute care hospitals, diagnostic and treatment centres, and other settings where there is limited physician or nurse practitioner service available in the community
Registered nurses who hold BCCNM certification in RN First Call may diagnose and treat minor acute illnesses as set out in the RN First Call DSTs.
Reproductive Health: Sexually Transmitted Infections (RN only)
Reproductive Health: Contraceptive Management (RN only)
- I was prescribing OAT under the provincial Public Health Officer Order. What happens now?
BCCNM will contact all RNs and RPNs currently authorized to diagnose and treat opioid use disorder in late October, inviting them to apply for certified practice OUD. There will be no application fee and certified practice OUD registration will be granted to eligible RNs and RPNs by November 30, 2023.
Individuals who do not wish to maintain their ability to diagnose and treat opioid use disorder should inform BCCNM by November 30, 2023, by emailing
register@bccnm.ca.
- What is changing with the transition to CP-OUD?
The changes for prescribers are:
RNs and RPNs who transition to CP-OUD will have a new title.
Nurses certified in OUD will need to attest during registration renewal that they have practised in their certified practice area in the past year, and to meet the quality assurance requirement to set one professional development goal annually relating to their certified practice.
Certified practice nurses must ensure they are competent before performing any new activity added to their certified practice designation and as identified within their certified practice decision support tools such as diagnosing or treating a new disease, disorder, condition, or providing a new treatment.
Certified practice nurses are not required to notify BCCNM at the time they have attained competence for a new activity. It is appropriate to include this activity as a component of their annual professional development plan.
In this instance, RNs or RPNs who have been prescribing buprenorphine-naloxone for the treatment of opioid use disorder and have attained the competence to prescribe methadone or slow-release oral morphine, as outlined in the BCCSU competencies and decision support tools, do not need to notify BCCNM that they are now prescribing these medications.
- How do I become a certified practice-OUD nurse?
Nurses cannot apply for CP-OUD until they meet all the conditions set out in the BCCNM certified practice limits and conditions, including receiving approval or recognition from their organization/employer as a prescriber, and completing the required certified practice education program offered by BCCSU.
Nutsamaht—We are one
BCCNM would like to thank our many health-care system partners for their collaboration and expertise during this complex project. The creation of this new certified practice allowing RNs and RPNs to diagnose and treat opioid use disorder is part of the provincial response to the ongoing overdose crisis and also one way we are protecting the public. We have included some information on this work below.
- Background + context
A provincial Public Health Officer (PHO) order,
Registered Nurse and Registered Psychiatric Nurse Public Health Pharmacotherapy, issued on September 16, 2020, authorized RNs and RPNs to diagnose and treat a problem substance use condition or substance use disorder, including by prescribing medications. In September 2020, the BCCNM Board
approved RN and RPN scope of practice prescribing standards, limits, and conditions enabling RNs and RPNs to prescribe, with additional limits and conditions when prescribing for the treatment of OUD.
Certified practice (CP) is a regulatory mechanism used to direct RN scope of practice as outlined in section 8 of the
Nurses (Registered) and Nurse Practitioner Regulation. Until recently, there was no comparable section in the
Nurses (Registered Psychiatric) Regulation and, therefore, CP has not been available to RPNs. A CP designation authorizes an RN to diagnose diseases, disorders, and conditions; order diagnostic tests; and autonomously treat with schedule 1 drugs within the parameters of their CP competencies and decision support tools. Certified practice requirements are outlined in Division 8 and Schedule H of the
BCCNM Bylaws.
On April 4, 2023, the BC Ministry of Health
approved amendments to the
Nurses (Registered) and Nurse Practitioners Regulation and the
Nurses (Registered Psychiatric) Regulation to enable RNs and RPNs who have completed additional education and have been certified by their regulatory college to diagnose OUD and prescribe Schedule I and IA (controlled) drugs for the treatment of OUD. On April 27, 2023, the BCCNM Board approved amendments to
BCCNM bylaws to add CP in OUD in alignment with the amended RN and RPN regulations. CP in OUD will become the fourth area of CP for RNs and the first CP designation for RPNs.
- Process + consultation
A policy approach to establish scope of practice limits and conditions for RN and RPN certified practice in opioid use disorder was informed by literature and jurisdictional scans identifying potential risks of harm to clients and risk mitigation strategies related to nurse prescribing including the prescribing of controlled drugs and substances; legal opinions; and consultation feedback from key informants and audiences.
Feedback from key audiences validated that the proposed limits and conditions to be met by RNs and RPNs with CP in OUD are clear and would support safe nursing practice and mitigate risk to client safety. Suggestions to strengthen the limits and conditions included ensuring clarity regarding the need for the RN or RPN to complete education prior to performing any new activity for their certified practice designation, allowing for flexibility related to the Schedule II, III, and unscheduled medications that may be prescribed in accordance with decision support tools, and changes to the Controlled Prescription Program requirements.
Following review of the RN and RPN standards for prescribing, those consulted highlighted gaps regarding the care needs of Indigenous clients and others such as inclusion of traditional medicines when taking a best possible medication history. Other gaps were noted related to mental health considerations, assessing for substance use, and compliance with the College of Pharmacists of BC (CPBC) bylaws that outline standards for prescriptions. Since this feedback was also applicable to NP and RM prescribing standards, further consultation was conducted regarding
addressing these gaps within NP and RM prescribing standards.
Those consulted emphasized the need for accompanying learning and informational resources. A legal review provided additional clarity and accuracy in wording.
- Risk assessment + mitgation
The diagnosis and treatment of a disease or disorder, including the prescribing of medications, are not entry level competencies for RNs or RPNs. While opioid agonist medications are considered standard treatment for OUD, there is a higher risk when prescribing these medications. Establishing scope of practice limits and conditions for the CP in OUD designation ensures that RNs and RPNs safely diagnose and treat clients with OUD. Risk is mitigated by requiring successful completion of additional education that is approved by BCCNM and in alignment with BCCNM standards to attain the necessary competencies, and to follow applicable decision support tools.
Risk related to nurse prescribing is further mitigated by allowing only those nurses with a certified practice designation to be eligible to prescribe. In addition, certified practice RNs and RPNs who prescribe must be recognized or approved by their organization/employer as a prescriber and they must consult and refer when client care requirements exceed the nurse's individual competency or scope of practice. They only prescribe medications specified in the DSTs. BCCNM has established internal processes to ensure that only those RNs and RPNs who meet the necessary requirements are issued a prescriber number. Risk is further mitigated when RNs and RPNs follow their standards of practice for prescribing, acting within autonomous scope of practice, medication management, and other standards applicable to meeting the care needs of their clients when prescribing.