Skip to main content

Diagnosing and treating conditions

What's your accountability?

Although the terms may not be familiar to you, it’s li​​kely that you’re already diagnosing and treating conditions in your pr​actice. When you plan for and provi​​de nursing care, you’r​e making clinical judgments about your client’s status a​nd carrying out appropriate nursing treatment.

 

For example​

  • You diagnose hypoglycemia in your client, and treat it, following your organization's hypoglycemic decision support tool (DST).
  • Based on your assessment, you diagnose respiratory distress in your asthmatic client. You treat it, following your organization's asthma DST.
  • Diagnosing urinary retention in your post-operative client, you treat it following your organization's DST.

Diagnosing

In B.C., diagnosing (a disease, disorder or condition) is a restricted activity granted to some regulated health professionals. For instance, physicians and nurse practitioners are authorized to diagnose diseases, disorders and conditions; and certified practice registered nurses are authorized to diagnose a very limited number of diseases and disorders. Registered nurses (other than certified practice nurses) have the authority to diagnose conditions only.

Under the Nurses (Registered) and Nurse Practitioner Regulation, you can make a nursing diagnosis that identifies a condition as the cause of a client’s signs or symptoms. A nursing diagnosis​ is a clinical judgment about your client’s physical or mental condition. It involves drawing a conclusion about what’s causing the signs or symptoms you’ve recognized.

Conditions

Conditions always have associated signs and symptoms. A condition may result from a known disease or disorder or its treatment. For example, a registered nurse may diagnose hypoglycemia in a client with diabetes, urinary retention in a post-operative client or angina in a client with a history of coronary artery disease.

Other conditions, such as hypoxia or postpartum hemorrhage, may result from a medical problem such as an undiagnosed disease or disorder. In these situations, a registered nurse may diagnose and stabilize the condition until a physician or nurse practitioner diagnoses the underlying disease or disorder.​

Examples of conditions
​​

Conditions that nurses may diagnose and
treat to resolve

Possible Condition Disease or disorder
Healable diabetic ulcerDiabetes
Constipation related to medicationPost-operative
Urinary retentionPost-operative
PainLabouring woman
Healable venous ulcerPeripheral vascular disease
Hypoglycemia Diabetes

Conditions that nurses may diagnose and
treat to stabilize

Possible Condition Disease or disorder
Respiratory distressAsthma
Hypoxia Asthma, pulmonary disease, sepsis
AnaphylaxisAllergies
AnginaCoronary artery disease
Post-partum hemorrhageRetained placenta
Respiratory depressionOpiate overdose
Suicidal ideationMental health disorder
HypovolemiaSepsis, trauma

​​ ​​

​Treating conditions within autonomous scope of practice

The Regulation also authorizes you to carry out certain restricted activities without an order to assess for or treat a condition you’ve diagnosed. For example, you may insert a urinary catheter, suction a tracheostomy, irrigate an ostomy, or administer oxygen or administer IV fluids.

What’s my accountability?

When you diagnose and decide to treat a condition, you are solely accountable for the diagnosis, appropriate treatment, and your client’s outcomes. Deciding to carry out an activity within autonomous scope of practice requires a greater level of knowledge, skill and judgment than carrying out the same activity with a client-specific order from another health professional. The standards for acting within autonomous scope of practice set out expectations for nurses carrying out activities autonomously.​

 What should I consider?

Controls on registered nurses' practice

​ There are four levels of control on registered nurses' practice

  1. The Nurses (Registered) ​and Nurse Practitioners Regulation sets out the scope of practice in fairly broad strokes.
  2. CRNBC standards, limits and conditions complement and further define and limit the scope of practice set out in the Regulation.
  3. Employer policies may restrict registered nurses’ practice in a particular organization or unit.
  4. An individual registered nurse’s competence to carry out a particular activity.

Controls on nursing practice

Controls on practice 

Key elements of diagnosing and treating conditions
  • Diagnosing always involves critical thinking and judgment.
  • Diagnosing always involves an assessment prior to the diagnosis.
  • Conditions always have associated signs and symptoms.
  • Diagnosing a condition always involves determining the cause of your client’s signs and symptoms.
  • You diagnose the condition to determine whether you can improve or resolve it with nursing treatment.
  • Diagnosing a condition is linked to treating it within autonomous scope of practice. You determine the plan for treating a condition; your plan is based on what you’ve decided the likely cause is.
  • Your assessment might identify a medical problem and lead to a request for assistance/orders.
  • You do not treat if you cannot manage the intended and unintended outcomes.
  • Evaluating treatment can help rule out, refine or validate your diagnosis.
Diagnosing and treating conditions in my practice

Think about the clients in your clinical practice, and consider the conditions you may diagnose and treat.

Ask yourself:

  • What's the clinical decision-making process I use when I plan for and provide care?
  • How does diagnosing conditions fit into my process?
  • What additional knowledge, skill and judgment may be required?
CRNBC standards, limits and conditions

The standards for acting within autonomous scope of practice establish the level of knowledge, skill and judgment required of you when carrying out any activity autonomously.

This includes having the competence to:

  • diagnose the condition, based on your assessment of your client’s signs or symptoms
  • determine that the condition requires treatment and that the planned treatment is appropriate for this client at this time
  • carry out the treatment safely and ethically
  • manage any intended and unintended outcomes

Depending on the activities you are carrying out, there may also be CRNBC limits and conditions in place. For example, nurses who administer oxytocin to treat a post-partum client who is hemorrhaging must possess the competencies established by Perinatal Services BC and follow their decision support tool. You’ll find the limits and conditions for each activity in Section 6 of the Scope of Practice for RNs.

Other standards that provide direction when diagnosing and treating conditions include:

Ask yourself:

Employer policies and resources

Employer policies may also limit registered nurses’ scope of practice. Before carrying out an activity within autonomous scope of practice (without an order), you’ll need to make sure it is within any restrictions set by your employer. Your employer may use decision support tools (DSTs) to outline expectations and support evidence informed nursing practice when diagnosing and treating conditions. These DSTs may be called:

  • registered nurse initiated activities (RNIAs)
  • clinical practice standards and procedures
  • protocols
  • algorithms
  • clinical decision support tools (CDSTs)

Be aware that when you carry out any activity within autonomous scope of practice (without an order), even when following a DST, you are solely accountable for your decisions and actions.

If there are no existing organizational policies to support practice, check with your clinical resource or practice leaders.

Ask yourself:

  • What employer resources guide and support me to diagnose and treat conditions?
Communication, documentation and collaboration

Nurses work with other members of the health care team to provide clients with safe and effective care. Consider how you communicate and consult with others on the team. You may seek advice from a colleague before arriving at a nursing diagnosis, finalizing a plan of care, or determining the most appropriate treatment for a client. You might consult with a physician or NP for assistance or orders.

Ask yourself:

  • How do I communicate my diagnosis, plan, treatment and client outcomes to other team members?
  • How does my documentation reflect this process?

Putting it all together

Collaboration across the province

CRNBC would like to thank all the nurses across B.C. who contributed to developing this content. 

Feedback? Questions?

Home > Nursing standards > Case studies & practice resources > Client care > Scope of practice > Diagnosing and treating conditions