Key standards for immunization practice
When providing immunizations, nurses must follow BCCNM standards of practice, which set out the professional and legal expectations that apply in all settings:
Introduction
Immunization is a core public health intervention. In British Columbia, nurses are responsible and accountable for ensuring that every immunization is provided safely, ethically, and within their scope of practice.
This means:
Scope of practice: The four controls on practice
Before giving an immunization, nurses must confirm that all four
controls on practice are met:
Legislation &
regulation – Does the regulation allow this activity? For example, does it require an order?
BCCNM standards – Do I meet the standards, limits, and conditions for this activity? For example, can I do this activity withinout an order (within autonomous scope of practice) or do I require a client-specific order)?
Employer policies – Does my workplace authorize me to perform this activity, and under what circumstances?
Individual competence – Do I have the current knowledge, judgment, and skills (including BCCDC competencies) to do this safely?
If any control is not met, do not proceed. Stop, consult, or obtain a client-specific order.
To learn more about the controls on practice, check out our
learning modules on scope of practice.
Competencies and training requirements
Giving immunizations safely requires specialized competencies (knowledge, judgment, and practical skills).
- Nurses must meet the competencies outlined in their practice standards and keep them current.
- Most nurses can meet requirements by completing the
BCCDC Immunization Competency Course or employer-approved training.
- Competence includes being able to recognize and manage adverse events, including anaphylaxis.
- Refer to your
Acting with Client-specific Orders and Acting Within Autonomous Scope of Practice standards for specific limits and conditions associated with immunizations.
Important: BCCNM does not provide immunization training. Nurses are responsible for completing BCCDC courses (or equivalent) and ensuring they meet employer expectations.
Consent & cultural safety
Nurses must ensure that every immunization is provided with valid consent and in a way that promotes cultural safety.
Consent
- Follow BCCNM's
Consent practice standards.
Cultural safety
In B.C. nurses are responsible and accountable for practising in ways that promote cultural safety, humility, and respect, consistent with BCCNM standards and the province's commitments under DRIPA/UNDRIP. This means:
Practice scenarios
- Scenario 1 – Giving a flu shot within autonomous scope of practice
Clarie, an LPN in a primary care clinic, is asked to give a routine flu shot to a new client. Before proceeding, Clarie considers the controls on practice and:
After obtaining informed consent, ensuring emergency readiness, and checking the vaccine, Clarie administers and documents the immunization. If any control had not been met, Clarie would stop, consult, or obtain a client-specific order.
What if…
a. Clarie had not completed BCCDC competencies.
She could not give the vaccine autonomously. She would need a client-specific order from an authorized health professional, follow BCCNM's
Acting with a Client-specific Order practice standard, and confirm she is competent to give injections and administer medications.
b. The employer did not authorize nurses to give immunizations autonomously.
- Even if Clarie met all competencies, she could not proceed without following employer policy.
- Scenario 2 – Flu campaign in long-term care
Robert's manager tells him to immunize all clients based on a physician's standing order. What should Robert do?
Accept the general order and immunize all residents. Incorrect. Blanket or standing orders (e.g., “all clients should receive the flu vaccine") are not valid client-specific orders. Orders must be client-specific. Do not proceed. Ensure each client has a client-specific order. Correct. Each resident requires a client-specific order, unless Robert is acting autonomously with competencies and standards met.
- Scenario 3 – LPN giving flu shots
Augusta, an LPN, is asked to give flu immunizations. Does Augusta need supervision to give a flu immunization?
a. Yes, because only RNs can immunize autonomously.
- Incorrect. LPNs may immunize autonomously within a team approach if they have competed the requirements and are competent.
b. No, immunizing is within the autonomous scope of practice for LPNs.
- Correct. LPNs may immunize autonomously within a team approach if they have completed required competencies, meet BCCNM standards, and client needs are stable and predictable. However, if client needs are complex or outside the LPN's competence, they must collaborate with the health-care team.
- Scenario 4 – Nurse without competencies
Britt, an RN, is asked by their manager to give a pneumonia vaccine but has not completed BCCDC competencies. What should Britt do?
a. Give the vaccine anyway because the manager asked.
b. Get a client-specific order from an authorized prescriber.
FAQs
Do I need to be vaccinated to keep my licence?
No. Vaccination is not required for BCCNM registration. However, nurses are expected to protect clients from infection and follow all applicable employer and Ministry of Health policies. Employers may require vaccination as part of their infection prevention and control measures. See the Communicable Diseases: Preventing Nurse-to-Client Transmission practice standards for more information.
Resources
Training, competency courses, resources
BCCNM resources and tools
Regulations and policies