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Autonomous Scope of Practice and Client-specific Orders

Scope of practice standards for registered nurses

The effective date for these scope standards is February 28, 2017.

What are the changes?

The changes to RN scope of practice include one new and two revised scope of practice standards. We've made some language changes and introduced a new concept—giving client-specific orders.

How will I get ready?

Review the three scope standards:

Download the PDF

CRNBC's role

  • CRNBC will be rolling out resources and supports in the months leading up to the in-effect date
  • Contact us if you have questions or ideas for resources practice@crnbc.ca

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

For the purposes of these scope of practice standards, the "RN Regulation" refers to the Nurses (Registered) and Nurse Practitioners Regulation which applies to registered nurses, licensed graduate nurses and nurse practitioners in British Columbia.

Organizations establish processes, supports and resources such as policies, procedures and decision support tools to ensure that nurses meet the standards of practice set out by CRNBC.

Introduction

These scope of practice standards outline the requirements for nurses when they are providing client care in the following ways:

  • acting within autonomous scope of practice
  • acting on client-specific orders
  • giving client-specific orders

Depending on the controls on practice, including the RN Regulation, autonomous scope of practice, organizational policies and restrictions, and the nurse’s individual competence, nurses may provide care to clients by:

  • acting within autonomous scope of practice and the nurse’s individual competence when carrying out
    • non-restricted activities, and
    • restricted activities within section 6 of the RN Regulation
  • acting on a client-specific order from a listed health professional for a restricted activity that is within section 71 of the RN Regulation (to the extent the care provided is not within  autonomous scope of practice under section 6)
  • acting on a client-specific order from another regulated health professional for an activity that is within  autonomous scope of practice and the nurse’s individual competence
  • giving a client-specific order for an activity within autonomous scope of practice and the nurse’s individual competence

What IS an order?

An "order" is any instruction or authorization given by a regulated health professional to provide care for a specific client, whether or not the care or service includes any restricted activity.
Orders can include instructions that set out the usual care for a particular client group or client problem and are made client-specific by the ordering regulated health professional.
The order must:

    • be documented in the client’s permanent record by the regulated health professional
  • include all the information needed for the ordered activity to be carried out safely (e.g. time, frequency, dosage, etc.)
  • include a unique identifier such as a written signature or an electronically generated identifier

Once given, orders may be transcribed in other documents such as a client care plan.

What IS NOT an order?

  • An instruction that is recorded in any type of communication tool, for example a kardex, that is not signed or recorded in the client’s permanent record, is NOT an order
  • A consultation, referral or recommendation is NOT an order.

Related Standards of Practice

Other CRNBC Resources

Questions?

Footnotes

1 Depending on the controls on practice, certified practice registered nurses do not require an order for the parts of section 8 of the regulation that apply to their area of certified practice.

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