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. Registered nurses have the authority to diagnose
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 (RN Scope, p. 15) 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 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.
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 catheter, suction a tracheostomy, irrigate an ostomy, or administer oxygen and IV fluids.
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 without an order (RN Scope, p. 12) requires a greater level of knowledge, skill and judgment than carrying out the same activity under an order from another health professional. The
Standards for Acting without an Order (RN Scope, p. 13) set out expectations for nurses carrying out activities without an order.
Think about the clients in your clinical practice, and consider the conditions you may diagnose and treat.
Standards for Acting without an Order establish the level of knowledge, skill and judgment required of you when carrying out any activity autonomously.
This includes having the competence to:
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 hemorrhaging post-partum client 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 (p. 15) of the Scope of Practice for RNs document.
Other standards that provide direction when diagnosing and treating conditions include:
Employer policies may also limit registered nurses’ scope of practice. Before carrying out an activity 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:
Be aware that when you carry out any activity without an order, even when following a DST, you are solely accountable.
If there are no existing organizational policies to support practice, check with your clinical resource or practice leaders.
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.
CRNBC would like to thank all the nurses across B.C. who contributed to developing this content.