Standards, Limits, Conditions - BCCNM

1 900 200 Granville St Vancouver, BC V6C 1S4 Canada T: Toll-free: Last Updated: February 2023 Scope of Practice REGISTERED NURSES standards , Limits, Conditions SCOPE OF PRACTICE: standards , LIMITS, Conditions BC COLLEGE OF NURSES AND MIDWIVES / 2 FOR REGISTERED NURSES Scope of Practice for Registered Nurses This document contains information for registered nurses (includes licensed graduate nurses) and nurse practitioners in British Columbia about scope of practice*that is established by the BC College of Nurses and Midwives ( BCCNM ). The scope of practice for registered nurses and nurse practitioners in British Columbia is set out in the Nurses (Registered) and Nurse Practitioners Regulation under the Health Professions Act. Additional scope of practice information is included in BCCNM s Bylaws and standards of Practice.

2 The purpose of this document is to: Explain the Regulation and those parts of the Health Professions Act that have an impact on scope of practice for registered nurses Set out BCCNM standards , limits and Conditions related to scope of practice Explain the restricted activities for registered nurses that are outlined in the Regulation Explain delegation as it applies under the Health Professions Act and BCCNM standards of Practice. In formation in this document is subject to change as BCCNM policy is revised or legislation is amended. BCCNM registrants will be notified of changes. * Terms defined in the Glossary (Appendix 1) are highlighted in bold type in this document the first time they appear. BCCNM standards of Practice BCCNM is responsible under the Health Professions Act for setting standards of practice for its registrants.

3 BCCNM standards include: Professional standards Practice standards Scope of Practice standards , Limits and Conditions These can be found on the BCCNM website SCOPE OF PRACTICE: standards , LIMITS, Conditions BC COLLEGE OF NURSES AND MIDWIVES / 3 FOR REGISTERED NURSES Revision Log Revision Date Revisions Made September 2020 Published by BCCNM (new college) Oct. 26, 2020 Revised Acting within Autonomous Scope of Practice and Acting with a Client-Specific Orders March 1, 2021 New limits and Conditions for prescribing for opioid use disorder April 6, 2021 Revisions to bring MAiD standards , limits and Conditions in line with changes to the Criminal Code August 27, 2021 Revised definition of Insulin Dose Adjustment September 23, 2021 Revision related to making a prescribing decision during a virtual care encounter when a visual assessment is not possible June 30, 2022 Updated MAiD standards , limits, and Conditions related to returning unused substances to pharmacy.

4 Removed COVID-19 temporary exemption June 30, 2022 Added new standards , limits and Conditions for the provision of medical aesthetics October 4, 2022 Removed references and links to rescinded joint statements October 4, 2022 Revisions to standards , limits and Conditions related to prescribing; new limits and Conditions for RN Certified Practice October 4, 2022 Moved limits and Conditions for medical aesthetics November 24, 2022 Updated scope of practice and requirements for Remote Practice certified practice (removal of Reproductive Health requirements and scope of practice) including updated table of certified practice education programs required and approved by BCCNM and updated table of diseases, disorders, Conditions diagnosed and treated by certified practice RNs February 7, 2023 Removed Limits & Conditions from Appendices SCOPE OF PRACTICE: standards , LIMITS, Conditions BC COLLEGE OF NURSES AND MIDWIVES / 4 FOR REGISTERED NURSES Table of Contents Part 1: The Basis for Scope of Practice.

5 6 What the Regulation Covers .. 6 Reserved Titles .. 6 Scope of Practice .. 6 Exceptions .. 7 Restricted Activities .. 7 standards , Limits and Conditions .. 7 Controls on Nursing Practice .. 8 Figure 1. Controls on Practice .. 8 Two Key Principles .. 8 How Practice is Described in the Regulation .. 9 General Practice .. 9 Certified Practice .. 9 Nurse Practitioner Practice .. 10 Part 2: Scope of Practice standards for Registered Nurses .. 11 Autonomous Scope of Practice and Client-specific Orders .. 11 Introduction .. 11 Acting within Autonomous Scope of Practice .. 12 Introduction .. 12 Principles .. 13 Acting with Client-specific Orders .. 16 Introduction .. 16 Principles .. 17 Giving Client-specific Orders .. 20 standards for Giving Client-specific 20 Applying the standards for Giving Client-specific Orders.

6 22 related standards of Practice .. 22 Other BCCNM Resources .. 22 standards for Prescribing .. 23 Introduction .. 23 Principles .. 24 Part 3: Activities That Are Not Restricted .. 27 Limits and Conditions on Activities that are Not Restricted .. 27 1. Cardiac Stress Testing .. 27 2. Financial Incapability Assessment .. 28 3. Incapability Assessment for Care Facility Admission .. 28 Part 4: Restricted Activities for Registered Nurses .. 29 Section 6: Restricted Activities that Do Not Require an Order .. 29 Diagnosis .. 29 Wound Care .. 30 Intravenous .. 31 Inhalation .. 32 Instillation and Injection .. 32 Assessing Clients and Treating Conditions .. 33 SCOPE OF PRACTICE: standards , LIMITS, Conditions BC COLLEGE OF NURSES AND MIDWIVES / 5 FOR REGISTERED NURSES Managing Labour .. 34 Hazardous Forms of Energy.

7 35 Ordering the Application of Energy .. 35 36 Schedule I medications .. 37 Schedule II medications .. 38 Medical Aesthetics Limits and Conditions .. 40 Prescribing Medications: Limits and 41 Registered nurse scope of practice limits and Conditions for the diagnosis and treatment of opioid use disorder .. 41 Therapeutic Diets .. 43 Section 7: Restricted Activities that Require an Order .. 44 Procedures Below Body Surfaces .. 44 Administering 45 Putting Items into Body Openings .. 46 Putting Substances into Ears .. 47 Hazardous Forms of Energy .. 47 48 Allergy Testing and Treatment .. 49 Section 8: Restricted Activities for Certified Practice .. 50 BCCNM Limits and Conditions for Certified Practice Registered Nurses .. 50 Part 5: Medical Assistance in Dying .. 54 Introduction .. 54 Witnessing and Signing MAiD Requests, Acting as a Proxy, and Witnessing Virtual Assessments.

8 55 Independent Witness for MAiD Requests .. 55 Acting as a Proxy .. 56 Acting as a Witness to a Virtual Assessment .. 56 Conscientious Objection .. 56 standards , Limits and Conditions .. 57 standards .. 57 Limits and Conditions .. 57 Part 6: Delegation .. 59 Introduction .. 59 Activities Approved for Delegation to Registered Nurses .. 59 BCCNM standards for Delegating to Registered Nurses .. 60 Appendices .. 61 Appendix 1: Glossary .. 61 Appendix 2: Resources .. 65 BCCNM Resources .. 65 Other Resources .. 65 SCOPE OF PRACTICE: standards , LIMITS, Conditions BC COLLEGE OF NURSES AND MIDWIVES / 6 FOR REGISTERED NURSES Part 1: The Basis for Scope of Practice WHAT THE REGULATION COVERS The Nurses (Registered) and Nurse Practitioners Regulation sets out, among other things: 1. Reserved titles for nurses 2. A scope of practice statement 3.

9 Restricted activities for registered nurses and nurse practitioners Reserved Titles BCCNM registrants can use the following reserved titles: Registered nurse Licensed graduate nurse Nurse Nurse practitioner is also a reserved title under the Regulation. Only registered nurses who are registered with BCCNM in the nurse practitioner category can use the title nurse practitioner or registered nurse practitioner. More information about reserved titles can be found in the BCCNM Bylaws and the Practice Standard Use of Title available at Scope of Practice Scope of practice refers to the activities that registered nurses are educated and authorized to perform. These activities are established through the legislated definition of nursing practice and are complemented by standards , limits and Conditions set by BCCNM .

10 The Regulation states that registrants of BCCNM may practise nursing. Nursing is defined as the health profession in which a person provides the following services: a. health care for the promotion, maintenance and restoration of health; b. prevention, treatment and palliation of illness and injury, primarily by i. assessing health status, ii. planning, implementing and evaluating interventions, and iii. coordinating health services; c. medical assistance in dying; The Regulation does not refer to education, administration and research in the scope of practice statement for nurses or any other health professionals in However, BCCNM s Professional SCOPE OF PRACTICE: standards , LIMITS, Conditions BC COLLEGE OF NURSES AND MIDWIVES / 7 FOR REGISTERED NURSES standards make it clear that clinical practice, education, administration and research are all considered part of the practice of registered nursing.