Updated June 26, 2026
The situation
Reea, an LPN in a care facility, notices Mr. Paul is short of breath and anxious. He reports chest tightness and difficulty breathing. With a recent history of pneumonia, Reea assesses him and diagnoses hypoxia.
- Read the full case
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Reea notices that Mr. Paul's condition has changed. When she asks how he feels, he tells her, “It's hard to catch my breath" and “My chest feels tight." She observes that he is short of breath and anxious. Reea knows that Mr. Paul was admitted a few days earlier with pneumonia and general weakness. After completing her assessment, she makes a nursing diagnosis of hypoxia, likely related to his pneumonia.
As an LPN, Reea is aware that BCCNM requires her to have additional education and to follow an employer-approved decision support tool (DST) when administering oxygen within her autonomous scope of practice.
Reea explains her next steps to Mr. Paul and applies oxygen by face mask. She reassures him while monitoring closely, and notes improvement in both his respiratory rate and oxygen saturation.
She then consults with the treating physician, receives a client-specific order for ongoing management of the hypoxia, updates the care team, and documents her assessment, diagnosis, treatment, and communication.
If Reea had not obtained the competencies to administer oxygen, she would not meet the standard for Licensed Practical Nurses: Acting Within Autonomous Scope of Practice. She would still recognize and diagnose hypoxia, call for help, and request a competent colleague or a client-specific order to initiate oxygen therapy. While waiting, she would monitor Mr. Paul, provide reassurance, and support his breathing as best as possible. Reea would document her assessment and actions, notify the physician, and follow up with her manager to complete the training required to treat hypoxia autonomously.
Reea's actions
Step 1: Assessment – Observes Mr. Paul is short of breath and reports chest tightness.
Step 2: Diagnosis – Identifies hypoxia, likely related to pneumonia.
Step 3: Decision & Action – Applies oxygen using DST, reassures Mr. Paul, and monitors response.
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Step 4: Follow-up – Consults with physician, receives client-specific order for ongoing care, updates team, and documents assessment and treatment.
Apply the standard
Which action can Reea take within her autonomous scope of practice to address Mr. Paul’s hypoxia?
- Option A: Prescribe antibiotics to treat the underlying pneumonia.
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Not correct. Prescribing is not within LPN, RN, or RPN scope of practice.
- Option B: Order a chest X-ray to confirm the cause of hypoxia.
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Not correct. Ordering diagnostic imaging is not within LPN scope of practice and requires a prescriber’s order.
- Option C: Administer oxygen using an approved DST.
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Correct. Administering oxygen for hypoxia is a restricted activity permitted within LPN autonomous scope, provided the nurse is competent, follows BCCNM standards and limits, and acts according to employer policy.
- Option D: Wait for the physician to assess before giving any treatment.
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Not correct. Not correct. Delaying oxygen therapy could worsen the client’s condition. Nurses must act within their autonomous scope when competent to do so.
How Reea meets the standards
Reea demonstrates the standards by:
Reea may diagnose and treat hypoxia autonomously, provided she:
- Meets BCCNM standards, limits, and conditions.
- Follows employer policies and DSTs.
- Acts within her individual competence.
Acting within autonomous scope of practice – Recap
Within their autonomous scope of practice, LPNs can make independent decisions about activities they are educated, competent, and authorized to perform—provided they meet any limits and conditions set by BCCNM and employer policy. For some restricted activities, LPNs must also complete additional education and follow an employer-approved decision support tool (DST). This may include:
Non-restricted activities:
Restricted activities that do not require an order (within competence and BCCNM limits/conditions):
Outside LPN autonomous scope: Activities that require an order (e.g., initiating IV therapies without authorization, referring directly to medical specialists), or activities restricted by BCCNM standards, employer policy, or legislation.
Key point
Even when an activity falls within autonomous scope, LPNs must always apply the four controls on practice—legislation/regulation, BCCNM standards, employer policy, and individual competence—before acting.
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