As Jasmine enters the room she sees her client Ms. Chui’s lying with her eyes closed. She notices that she is quite pale and diaphoretic. She calls Ms. Chui’s name but gets no response. Concerned, she calls her name louder and tries to rouse her by shaking her arm. Still not getting a response, Jasmine calls for help. She asks her colleague to bring the glucometer and get a blood sugar on Ms. Chui while she does a set of vital signs and completes a focused assessment. Her colleague reports Ms. Chui’s blood sugar is low.
Based on her assessment, the low blood sugar reading and her clinical judgment, Jasmine concludes that Ms. Chui is showing signs of hypoglycemia.
Can Jasmine treat Ms. Chui’s condition within her autonomous scope of practice?
Yes. If Jasmine has obtained the competencies to treat hypoglycemia and meets the standards for acting within autonomous scope of practice, Jasmine can treat Ms. Chui’s hypoglycemia with nursing activities.
In deciding to treat Ms. Chui, Jasmine considers the risks, benefits and possible outcomes. Before treating a condition, Jasmine must first collect information using her assessment and critical thinking skills to formulate a nursing diagnosis of a condition. Jasmine determines the outcome is reasonably predictable, and the benefits outweigh the risks. She knows she has the competencies to treat hypoglycemia with D50W and manage any intended or unintended outcomes. She follows her organization’s/employer’s decision support tool (DST). Jasmine knows she is responsible and accountable for her decision to treat Ms. Chui.
After Jasmine treats Ms. Chui’s hypoglycemia, she documents the incident and her actions and informs the NP and other members of the health care team.
No. If Jasmine has not obtained the competencies to treat hypoglycemia with D50W, she does not meet the standard for acting within autonomous scope of practice. Nurses can only perform activities within their autonomous scope of practice if they have obtained competence. As Jasmine does not have the competence to perform the activities required to treat Ms. Chui’s hypoglycemia, she requires a client-specific order from a listed health professional to administer the D50W (or alternate treatment).
Jasmine asks a colleague to treat Ms. Chui’s hypoglycemia. She documents the incident and informs the NP. She follows up with her manager to arrange the required training for treating hypoglycemia.
Treating conditions within autonomous scope of practice
Under the
Nurses (Registered) and Nurse Practitioners Regulation RNs are authorized to diagnose and treat a variety of
conditions in their autonomous scope of practice that can be improved or resolved with nursing treatment. The regulationsets out the type of diagnosis RNs can make. Specifically, RNs make a nursing diagnosis of a condition – not a disease or disorder – as the cause of a client’s signs and symptoms. A limited number of Schedule I medications (medications that usually require an order), can be administered without an order to treat certain emergency conditions. For example, D50W for hypoglycemia.
The Scope of Practice standard for RNs sets the standards, limits and conditions under which RNs treat hypoglycemia. Specifically, when administering D50W (Schedule I) to treat hypoglycemia RNs:
- follow an organization/employer approved decision support tool
Note that individual organizations/employers may have further requirements that limit your scope of practice.
Acting Within Autonomous Scope of Practice
The standard, Acting Within Autonomous Scope of Practice, outlines the requirements for nurses when they carry out an activity within their autonomous scope of practice.
Nurses assumes accountability and responsibility for their decisions about client care activities they are educated, competent and authorized to make when acting within their autonomous scope of practice.
A nurse’s autonomous scope of practice includes:
- Carrying out restricted activities listed in section 6 of the regulation, and
- Providing care or services that are considered non-restricted activities (i.e. general nursing activities)
Autonomous scope of practice does not include any activities, care or services excluded from autonomous scope of practice under BCCNM standards, limits, conditions and other controls on practice such as organizational policies or legislation.
Resources
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