Section 7 of the Regulation lists restricted activities that may be carried out in the course of registered nursing practice but require an order from a listed health professional. RNs may not act with an order from a non-listed health professional for section 7 restricted activities.
Listed health professionals authorized to give orders to registered nurses under the Regulation are dentists, physicians, midwives, naturopaths, podiatrists, pharmacists, nurse practitioners, and certified practice nurses. A listed health professional must be registered to practise in British Columbia, except where the client has been transferred from Alberta, Yukon or the Northwest Territories for emergency treatment in British Columbia.
In addition, the health professional must also be authorized to provide or perform the restricted activity. For example, a registered nurse would not take an order from a midwife for a medication to treat congestive heart failure.
The BCCNM Autonomous Scope of Practice and Client-Specific Orders standard outlines ‘what is a client-specific order’ and ‘what is not a client-specific order’. Nurses are required to follow the BCCNM Acting with Client-specific Orders scope of practice standard and adhere to other standards, limits and conditions set by BCCNM when acting on a client-specific order from a listed health professional.
The Regulation also permits orders that refer to another document that includes instructions that set out the usual care for a particular client group or client problem. These are made client-specific by the health professional by adding the name of the individual client, making any necessary changes to reflect the needs of the individual client, and signing the order. For these types of orders, BCCNM and the College of Physicians and Surgeons of British Columbia agree that such references should be placed on the client’s chart.
Registered nurses must be sure that the restricted activity is considered to be nursing practice—even if they have an order to carry it out. Nurses who are not sure if a specific activity is considered within the scope of registered nurses’ practice should contact BCCNM.
List of restricted activities that require an order
Procedures below body surfaces
Administering substances
Putting items into body openings
Putting substances into ears
Hazardous forms of energy
Medications
Allergy testing and treatment