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Cast a fracture: new limits and conditions for RNs


Oct 2, 2019

The BCCNP board on Sep. 26, 2019, approved new limits and conditions to RN scope of practice relating to casting a fracture.

Background

In 2011, the board of the College of Registered Nurses of BC (CRNBC) approved the activity of casting "a non-acute fracture of an extremity" by RNs following a formal delegation agreement between CRNBC and the College of Physicians and Surgeons of British Columbia (CPSBC). This limit and condition is included in Scope of Practice for Registered Nurses – Standards Limits Conditions:

Registered nurses may only cast a simple fracture of an extremity through delegation from a physician after the physician assesses the client, sets the fracture and provides a client-specific order for the cast application.

The formal delegation agreement between CRNBC and CPSBC was intended as a transition step until casting a fracture was included in the RN Regulation. Amendments to the Nurses (Registered) and Nurse Practitioner Regulation in December 2015 gave registered nurses the authority to "cast a fracture of a bone" with an order from a physician or nurse practitioner registered in British Columbia.      

Consultation

A variety of stakeholders were consulted on the proposed limits and conditions including those from:

  • the health authorities representing Emergency and Trauma Services, and Professional Practice;
  • urban and rural settings;
  • clinical nurses who currently cast fractures of bones; and,
  • the College of Physicians and Surgeons (CPSBC).

New limits and conditions

BCCNP recommended that the existing limit and condition for delegation be rescinded and replaced with the following new limits and conditions:​

Registered nurses who cast a fracture of a bone:

  • ​​​Must successfully complete additional education
  • Require a client-specific order from a physician or nurse practitioner registered in BC*

*Registered nurses may only act on a client-specific order to cast a fracture of a bone given by a medical practitioner or nurse practitioner who is registered in British Columbia as per the Nurses (Registered) and Nurse Practitioners Regulation Section 7 (3).

These revised limits and conditions come into effect Nov. 4, 2019.

Questions

Email practice@bccnp.ca