In the course of practising psychiatric nursing, RPNs may apply physical or mechanical restraint or seclusion interventions subject to the following BCCNP RPN Limits and Conditions:
To apply restraint or seclusion, RPNs must have consent or some form of legal authority that overrides the requirement for consent, such as a legislative exemption or a court order. Otherwise, the act of applying restraint or seclusion would be an assault, which could be a tort or criminal offence.
The requirement of consent for health care is governed by the
Health Care (Consent) and Care Facility (Admission) Act (the
“HCCFA”) for adults and the
Infants Act for children. Health care is defined in these two acts as anything done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other purpose related to health. When obtaining consent, RPNs should follow BCCNP's RPN practice standard on Consent.
There may be legislative exceptions to the requirement for consent. For example, the HCCFA does not apply to involuntary psychiatric treatment provided in designated facilities under the
Mental Health Act.
There are also legislative exemptions for emergency situations:
It is important to recognize that although restraint or seclusion is often initiated in response to an emergency situation, continuing restraint or seclusion may no longer be an emergency, so different legislation applicable to a non-emergency situation will be required for this continued use.
BCCNP Professional Standards for RPNs require RPNs to know the relevant legislation governing psychiatric nursing practice.
In many practice settings RPNs require an order (or written agreement from a doctor or nurse practitioner) for the use of restraint or seclusion in non-emergency situations. The authorizing legislation may or may not specify whether an order is required. For example, the
Mental Health Act does not specify whether an order is required for the use of restraint or seclusion. However, the
Residential Care Regulation (Community Care and Assisted Living Act) requires a written agreement as noted by s. 74(1)(b).
In addition, the BCCNP and/or the employer may also require an order for the use of restraint or seclusion. Below is as an example:
If restraint or seclusion is being applied for non-health care purposes, legal authority is required. Some examples of legislation that may be applicable are the
Correction Act, Criminal Code of Canada, and
Corrections and Conditional Release Act. For example, RPNs working for federal corrections may, as peace officers, use restraint or seclusion for security purposes.
RPNs whose jobs may require restraint or seclusion for non-health care purposes will have to constantly ask themselves whether the particular application of restraint or seclusion is for health care or not, as this may impact whether consent is required. For example, an RPN working in federal Corrections may sometimes be acting as a nurse and sometimes as a peace officer depending on the purpose of the restraint or seclusion. If the restraint or seclusion is strictly for security reasons, then no consent is required since legislation governing the corrections setting authorizes the use of reasonable force. However, if restraint or seclusion is required for health care, then consent is required, unless an exemption applies, such as in an emergency or certification under the
Mental Health Act.
Restraint and Seclusion Decision Tree assists RPNs in identifying the relevant legislation that may authorize the use of restraint or seclusion, and when an order is required.
It is important to remember that having the legal and regulatory authority to carry out restraint or seclusion is not necessarily reason to do so. Just because you can does not mean you should.
RPNs need to consider four controls on practice when using restraint or seclusion. For additional information related to controls on practice, see Scope of Practice for RPNs: Standards, Limits and Conditions. The
Restraint and Seclusion Decision Tree provides a visual guide to understanding the shared controls on RPN practice of restraint or seclusion. In addition, the four levels of control on RPN practice, with examples related to the use of restraint or seclusion, have been provided in the diagram and accompanying text below.
Health Professions Act and
(Registered Psychiatric) Regulation: Under the
Health Professions Act, the
Nurses (Registered Psychiatric) Regulation allows RPNs to carry out a variety of psychiatric nursing activities, including restraint or seclusion. The HCCFA requires consent for these activities, but does not apply to facilities designated under the
Mental Health Act.
BCCNP RPN Standards, Limits and Conditions: BCCNP provides the following directions regarding the use of restraint or seclusion:
Employer Policies: RPNs are responsible for following any employer policies related to restraint or seclusion (e.g. policies requiring an order).
Individual competence: RPNs are responsible for ensuring they have the competencies required to apply restraint or seclusion in both emergency and non-emergency situations.
For further information on the Standards of Practice or professional practice matters, contact us: