​Updated June 30, 2026

​​​​Introductio​​n

Licensed Practical Nurses (LPNs) provide care within a clearly defined scope of practice that is guided by the controls on practice—legislation/regulation, BCCNM standards, employer policy, and individual competence. Each situation requires LPNs to apply critical thinking, follow decision support tools, and act within limits and conditions that ensure client safety.

LPNs provide care within a scope of practice that includes activities performed with a client-specific order and activities performed autonomously (without an order).

In both situations, LPNs follow the controls on practice:

• Confirm the activity is authorized
• Meet BCCNM standards, limits, and conditions
• Meet employer policies and procedures

• Ensure they have the competence to provide safe care​​ 

Applying scope​​​​ of practice: LPN practice in action 

The following scenarios show how LPNs integrate regulatory requirements into everyday practice across different care settings. They highlight decision-making steps and BCCNM limits and conditions that apply to specific nursing activities.

Important note: In every situation, follow the controls on practice. If any control is not met, do not proceed and seek support or transfer care as appropriate.

​Scenario 1:​​ Using a restr​aint in long-term care

Acting with an order: Ally works on a Special Care Unit caring for Mr. Bain, an 86-year-old with Alzheimer's disease. He uses a wheelchair and has had multiple falls when trying to get up unassisted. Ally needs to decide how to keep him safe while respecting his rights.

Application to practice​​:​

• Follows standards: Ally applies the practice standard Lice​nsed Practical Nurses: Acting Under Client-specific Orders.
• Assessment first: Ally identifies reasons for Mr. Bain's falls and considers alternatives to restraints.
• Collaboration: She reviews facility policy, consults with Mr. Bain, his family, and the care team.
• Order and consent: She obtains a physician's order for a lap restraint and explains the risks and benefits to the family before seeking consent.
• Care plan: Mr. Bain's plan of care is updated to include use of the restraint, with daily reassessment for its continued use.
• Implementation: Ally instructs health care assistants on safe application, monitoring, and supporting Mr. Bain's basic needs.

• Documentation: She records the ra​tionale, actions, and Mr. Bain's responses.

BCCNM limits & conditions: ​​LPNs may apply restraints only with a client-specific order from an authorized health professional and follow the​ practice standard Lice​nsed Practical Nurses: Acting Under Client-specific Orders.

Reflective questions​​​:

• What alternatives to restraints could you try first?
• How does involving the family and team strengthen safe, ethical decision-making?
• Why is reassessment essential when restraints are in use?

​​Scenario 2: Changing a chest tube dressing

Acting autonomously: Kate works on a surgical unit and determines that Mrs. Rogers' chest tube dressing needs to be changed.

Application to practice:

• Follows standards: Kate applies the practice standard Licensed Practical Nurses: Acting Within Autonomous Scope of Practice.
  
• Client status: Kate first confirms Mrs. Rogers is stable or predictable.
• Communication: She explains the procedure to the client and answers questions.
• Safe practice: She performs the dressing change following organizational procedures and Decision Support Tools (DSTs).
• Accountability: She documents her assessment, the procedure, and Mrs. Rogers' response.

• Ongoing care: Kate continues monitoring​ and collaborates if the client's condition changes.

BCCNM limits & conditions: LPNs are required to verify client has a stable or predictable state of health, complete additional education, and follow employer policy and DSTs.

​Reflective questions:

• How would your approach change if Mrs. Rogers became unstable?

• What ​does “stable or predictable" mean in this context?

Scenario 3: Providing immunizations​​

Acting autonomously: Courtney works in community care providing influenza and pneumococcal immunizations after completing BCCDC education.

Application to practice:

• Follows standards: Courtney applies the practice standard Licensed Practical Nurses: Acting Within Autonomous Scope of Practice.
  
• Client status: Courtney first confirms client is stable or predictable.
• Assessment: Courtney reviews history, allergies, and risks.
• Decision support: She follows BCCDC DSTs to confirm it is appropriate.

• Consent and care: She o​btains informed consent, immunizes, observes the client, and provides aftercare information.

BCCNM limits & conditions: Working in a team approach, LPNs may immunize clients ≥4 years in stable or predictable health after completing additional education and following employer policies. 

Reflective questions:

• How do DSTs guide safe immunization practice?

• When would you need t​o defer immunization or seek a client-specific order?

Scenario 4: Tuberculosis skin testing​​

Acting autonomously: Hong Wei works in corrections and is performing a TB skin test for Robert. She has completed BCCDC TB screening training.

Application to practice:

• Follows standards: Hong Wei applies the practice standard Licensed Practical Nurses: Acting Within Autonomous Scope of Practice.
  
• Communication: Hong Wei explains the procedure to Robert and ensures he understands before proceeding.
• Safe practice: She administers the purified protein derivative (PPD) intradermally, following employer policy and BCCDC Decision Support Tools.
• Monitoring: She observes Robert for 15 minutes to check for signs of an allergic reaction.
• Follow-up: She informs Robert she will return in 48–72 hours to read the results and refers him to an appropriate health professional if the test is positive.

• Accountability: Hong Wei docume​nts the procedure, results, and any referrals, including who was consulted and what was recommended.

BCCNM limits & conditions: LPNs must possess BCCDC competencies and follow their DSTs.

Reflective questions:

• What would you do if Robert showed signs of anaphylaxis following the injection?

• Why is timel​y follow-up essential in TB testing?

Scenario 5: Changing IV bags with potassium ​chloride

Acting with an order: Joe is caring for Mr. Fenwick, who is post-operative and has 20 mEq potassium chloride (KCL) in 1L normal saline infusing through a peripheral IV.

Application to practice:

• Follows standards: Joe applies the practice standard Lice​nsed Practical Nurses: Acting Under Client-specific Orders.
• Order check: Joe reviews the client record and confirms there is a valid order for the IV solution containing KCL.
• Communication: He explains the procedure to Mr. Fenwick and answers any questions.
• Safe practice: Joe assesses the IV insertion site for signs of complications, changes the IV bag as needed, and monitors the client and the infusion closely.

• Accountability: He documents​ his actions and Mr. Fenwick's responses in the health record, supporting safe handover and continuity of care.

BCCNM limits & conditions: LPNs may change KCL IV bags only when compounded commercially/by a pharmacist and with an order and via a peripheral line.

Reflective questions:

• What safety risks are associated with KCL administration?

• How would y​ou respond if infiltration or phlebitis occurred at the IV site?

​Scenario 6: Initiating IVs

Acting with an order: Steven works in an acute unit. His client, Mr. Janson's peripheral IV is interstitial, and needs to be reinserted. Steven has completed additional education in IV insertion and is competent.

Application to practice:

• Follows standards: Steven applies the practice standard Lice​nsed Practical Nurses: Acting Under Client-specific Orders.
• Order check: Steven reviews the client record and confirms there is a valid order for the IV.
• Communicates: Explains the procedure to Mr. Janson and answers questions.
• Provides care: Removes the old IV, assesses the site, applies a sterile dressing, and initiates a new IV with a short device.

• Documents: Records assessments and actions, monitors fo​r complications, and collaborates with the team.

BCCNM limits & conditions: LPNs can insert peripheral IVs if they successfully gained competence as part of an entry-level practical nursing program, completed additional education; and  insertion is limited to short peripheral devices.

Reflective questions:

• What client factors would make you reconsider starting a new IV?

• How do you ensure safe monitoring a​​fter initiating a peripheral IV?

​​​Resources​​

• Lice​nsed Practical Nurses: Acting Under Client-specific Orders
• Licensed Practical Nurses: Acting Within Autonomous Scope of Practice​
• Nurses: Documentation
• Nurses: Medication
• Controls on practice
• Nursing in a team approach: Stable or predictable
• Risk assessment tool

• Additional ed​​​ucation​​​​