Updated June 25, 2026
The situation
Marcie notices several reddened areas on Mr. Dimitri’s foot, but it’s the open wound on his big toe that concerns her. She assesses the wound and diagnoses it as a healable diabetic ulcer.
- Read the full case
Marcie is caring for Mr. Dimitri when she notices several reddened areas on his foot as she removes his sock. What concerns her most, however, is an open wound on his big toe.
Marcie conducts a focused assessment of the wound and both lower legs. Based on her findings, she diagnoses the wound as a healable diabetic ulcer. To support her decision, Marcie refers to the BC Provincial Nursing Skin and Wound Committee Guideline for diabetic ulcers.
Marcie knows that under the LPN, RN, and RPN regulations, nurses are authorized to diagnose and treat conditions within their autonomous scope of practice. She also knows there are limits and conditions: for example, if she is an LPN, she must follow an existing wound care treatment plan and may be required to complete additional education.
Using her organization’s decision support tool (DST) for wound care, Marcie determines the most appropriate dressing for the ulcer. She discusses her nursing diagnosis and treatment plan with Mr. Dimitri, updates his plan of care, and documents the care she provides.
Marcie plans to update the health care team about her assessment and actions and will evaluate the wound’s progress at the next dressing change.
In treating Mr. Dimitri, Marcie demonstrates accountability and responsibility. She considered the risks, benefits, and expected outcomes, judged the outcome to be reasonably predictable, and acted within her competence. By following a DST, applying her knowledge, and working within organizational policy, Marcie ensured that her actions remained within her autonomous scope of practice.
Marcie’s actions
Step 1: Assessment – Examines Mr. Dimitri’s foot, notes reddened areas and an open wound.
Step 2: Diagnosis – Identifies the wound as a healable diabetic ulcer, confirms using provincial guideline.
Step 3: Decision & action – Uses DST to select an appropriate dressing, discusses plan with Mr. Dimitri.
Step 4: Follow-up – Updates plan of care, documents treatment, and plans to evaluate progress at the next dressing change.
Apply the standard
Which action can Marcie take within her autonomous scope of practice when caring for Mr. Dimitri’s diabetic foot ulcer?
- Option A: Prescribe antibiotics for wound healing.
Not correct. Prescribing is not within LPN, RN, or RPN scope of practice.
- Option B: Order a diagnostic imaging to assess circulation.
Not correct. Ordering imaging generally requires a prescriber’s order, unless specifically authorized under employer policy.
- Option C: Select and apply a wound dressing using an approved DST.
Correct. Within her autonomous scope, Marcie may diagnose and treat a diabetic ulcer, select an appropriate dressing, and document care, provided she is competent and follows organizational DSTs and policies.
- Option D: Refer Mr. Dimitri directly to an endocrinologist.
Not correct. Nurses cannot make direct referrals to medical specialists; this requires a prescriber.
How Marcie meets the standards
Marcie demonstrates that she is meeting all expectations in the
Acting Within Autonomous Scope of Practice standard. This includes:
Marcie may diagnose and treat diabetic ulcers 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, nurses can make independent decisions about activities they are educated, competent, and authorized to perform―provided they have the necessary competence and meet any limits and conditions set by BCCNM and employer policy. This may include:
Non-restricted activities:
- Monitoring vital signs
- Supporting daily living needs (feeding, mobility, hygiene)
- Health teaching and counselling
Restricted activities that do not require an order (within competence and BCCNM limits or conditions):
- Initiating wound care and selecting dressings using an approved DST
- Administering oxygen to a hypoxic client
- Giving immunizations following required competencies and DSTs
- Inserting a urinary catheter (when permitted by designation and conditions)
Outside autonomous scope: Restricted activities that require an order (e.g., prescribing medications, ordering some diagnostics, performing procedures outside nursing scope), or those limited by BCCNM standards, employer policy, or legislation.
Key point
Even when an activity falls within autonomous scope, nurses must apply all four controls on practice—legislation/regulation, BCCNM standards, employer policy, and individual competence—before acting.