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Overview of Scope of Practice standards

New and revised scope standards came into effect Feb. 28, 2017

What are scope of practice standards?

Scope of practice standards establish the standards, limits and conditions for registered nurses’ practice. These scope of practice standards link to other BCCNP standards, policies and bylaws and all legislation relevant to nursing practice.

The Autonomous Scope of Practice and Client-Specific Orders Standards outline the requirements for nurses when they are providing client care in the following ways:

RN scope of practice
  • Acting within their autonomous scope of practice
  • Acting with client-specific orders from listed and non-listed health professionals
  • Giving client-specific orders

What's the same, and what's changed?

 Here's a brief overview to help you understand the changes to the scope standards and consider how they will apply in your practice. It’s important to read the Autonomous Scope of Practice and Client-Specific Orders Standards in full.

Be aware that although these are in effect, they require organizational change. Your practice will not change until your organization puts the necessary supports, resource and processes in place.

Key concepts:

Standards for Acting Within Autonomous Scope of Practice

What's the same?

What’s changed?

In brief, these standards:

  • Contain updated language that more clearly reflects registered nursing’s autonomous scope of practice, including carrying out activities to treat, prevent or palliate an injury or illness.
  • Outline responsibilities for communicating and collaborating with clients, health care team members and ordering professionals when making decisions about client care, including changing or cancelling orders (for activities within autonomous scope of practice and individual competence)
  • Set the expectation that nurses clarify their role and responsibilities within the organization when acting within autonomous scope of practice.
Examples of acting within autonomous scope of practice
  • Diagnosing and treating a diabetic ulcer, following your organization’s decision support tool (DST).
  • Assessing a six-month old baby and determining that it’s appropriate to carry out the scheduled immunization, following BC Centre for Disease Control’s DST.
  • Teaching a newly diagnosed client to manage his diabetes, adapting tools and resources to his ability and level of understanding.
  • Diagnosing and treating pain in a labouring client by administering nitrous oxide following Perinatal Services BC DST.
  • Diagnosing anaphylaxis in a client post-immunization and treating with epinephrine according to your organization’s DST.
  • Suspecting urinary retention in a client, and carrying out a bladder scan. Confirming the diagnosis, treating it with an in-and-out catheterization.
Examples of acting within autonomous scope of practice for certified practice registered nurses
  • Diagnosing a corneal abrasion in a client with an eye injury, and treating it with topical anesthetic eye drops, according the RN First Call Certified Practice DST for corneal abrasions in adults.
  • Assessing a client seeking birth control, and dispensing a three month supply of an oral contraceptive, following the Certified Practice DSTs for Contraceptive Management Assessment and Combined Hormonal Contraceptives.
  • Diagnosing acute otitis media in a pediatric client and dispensing antibiotics to treat it, following the Remote Nursing Certified Practice pediatric DST for acute otitis media

​Standards for Acting With Client-specific Orders (from listed and non-listed health professionals)

What’s the same?

  • You’ll also be familiar with the standards in Acting With a Client-specific Order (previously Standards for Acting With an Order). These set out the requirements for acting with orders from health professionals and clarify that Section 7 restricted activities require an order from a listed health professional.

What’s changed?

  • Certified practice registered nurses and pharmacists have been added to the listed health professionals in the Regulation (others include dentists, midwives, naturopaths, physicians, podiatrists, and nurse practitioners).
  • Acting with client-specific orders from non-listed health professionals requires organizational supports, resources and processes, including policies and procedures that:
    • clarify the accountability and responsibility of the nurse and the non-listed health professional
    • outline the requirements for the non-listed health professional to complete an assessment and to ensure that the ordered activity is in the best interest of the client

Nurses are members of an interprofessional team. In your current practice, you may already follow direction for client-specific care from other health professionals for activities within your autonomous scope and individual competence. These standards support that interdisciplinary communication and collaboration, and the expertise of other team members in meeting client needs.
In brief, these standards:

RN scope of practice
  • Clarify when nurses must obtain an order for an activity within their autonomous scope of practice.
  • Clarify that nurses only act on orders from non-listed health professionals when activities are within autonomous scope of practice and their individual competence, and the necessary organizational supports, resources and processes are in place.
  • Set expectation that nurses assess a client and determine that the ordered activity is still appropriate before carrying it out.
  • Outline expectations when nurses hold, change, or cancel client-specific orders including following agency policy and communicating and collaborating the ordering health professional and healthcare team.
Examples of acting with client-specific orders from non-listed health professionals:
  • Carrying out conservative sharp wound debridement acting with a client-specific order from a wound care clinician.
  • Mobilizing a fresh post-operative client with complex mobility issues acting with a client-specific order from a physiotherapist.
  • Following isolation precautions for a newly admitted client with an infectious disease, acting with a client-specific order from an infection control nurse.
  • Altering a client’s enteral feed, acting with a client-specific order from a dietitian.
  • Preventing further contracture by applying a splint to your client’s hand, acting with an occupational therapist’s client-specific order.
  • Following a behaviour modification plan, acting with a client-specific order from a psychologist.

Standards for Giving Client-specific Orders

These are new!

We’ve introduced the concept of Giving Client-specific Orders. These scope standards set out the requirements when giving a client-specific order for an activity within autonomous scope of practice and individual competence. When giving a client-specific order, you will also need to meet the Standards for Acting Within Autonomous Scope of Practice. You may already give direction for client-specific care in your practice.

Note: Registered nurses are now listed health professionals in the LPN Regulation.

Giving client-specific orders requires organizational supports, processes and resources, including policies and procedures, that:

  • outline the accountability and responsibility of the nurse,
  • ensure continuity of care for the client including the requirements and procedures for responding to questions about orders, amending orders and evaluating client outcomes.

Briefly, these standards:

  • Require that the necessary organizational supports, processes and policies be in place before nurses give client-specific orders.
  • Outline expectation that nurses assess the client and diagnose condition to make sure ordered activity will improve or resolve the client’s condition.
  • Clarify that orders must consider client characteristics, wishes and be evidenced-based, clear, complete, documented in the client’s permanent and signed.
  • Outline how pre-printed orders and/or protocols may be used or referenced.
  • Set expectations for giving verbal or telephone client-specific orders.
Examples of giving client-specific orders
  • Diagnosing a wound as necrotic, you give a client-specific order for conservative sharp wound debridement.
  • Assessing a client, you diagnosis suicidal ideation and give a client-specific order for constant observation for suicide risk.
  • To assess for suspected urinary retention in client, you give a client-specific order for a bladder scan. Confirming your diagnosis, you give an order for urinary catheterization.
  • Diagnosing dry eyes in a client, you give a client-specific order for artificial tears.

What does this mean for my practice?

Consider your practice setting, interdisciplinary team and organizational supports. Ask yourself:

  • What conditions do I currently diagnose and treat?
  • What activities do I carry out to prevent, treat, or palliate injury or illness?
  • What organizational supports, resources, and processes are in place to support and direct me?
  • In what situations might I obtain an order from a non-listed health professional?
  • In what situations might I give a client-specific order?
  • Are the necessary organizational supports, resources and processes in place in my organization for nurses to act on or give client-specific orders?

What's next?

  • Be aware that although these standards are in effect, practice will not change until your organization puts the necessary supports, resources and processes in place.
  • If you have questions about the implementation of these standards in your organization, speak to your manager or Professional Practice office.
  • Watch the newsletter for updates and resources

Questions or suggestions?