Jessie has worked at the group home as an RPN for three months now. As he watches the boys playing a pickup game of basketball in the yard, he is glad to see that Dylan has joined in. Jessie knows that Dylan’s been struggling with his self-image related to his diabetes and has been reluctant to join.
During a time out, Dylan comes up to Jessie and says he’s not feeling well – nauseous, shaky and lightheaded. Jessie also notices that Dylan is pale and sweaty. He assists Dylan to sit on the ground so that he can assess Dylan’s condition. Suddenly, Dylan slumps forward, unresponsive.
Jessie calls for help. He assesses Dylan and looks at Dylan’s insulin pump to see what his current blood sugar reading is. Based on his assessment, the low blood sugar reading and his clinical judgment, Jessie concludes that Dylan is showing signs of hypoglycemia. He asks a colleague to call 9-1-1.
Can Jessie treat Dylan’s condition within his autonomous scope of practice?
Yes. If Jessie has obtained the competencies to treat hypoglycemia and meets the standards for Acting Within Autonomous Scope of Practice, Jessie can treat Dylan’s condition with nursing activities that align with his organization’s/employer’s policies and processes.
In deciding to treat Dylan, Jessie considers the risks, benefits and possible outcomes. Before treating a condition, Jessie must first collect information using his assessment and critical thinking skills to formulate a nursing diagnosis of a condition. He determines the outcome to be reasonably predictable, and the benefits outweigh the risks. He knows he has the competencies to treat hypoglycemia safely and manage any intended or unintended outcomes. He follows a decision support tool (DST) and knows his actions are within his organization’s/employer’s policy. Jessie knows he is responsible and accountable for his decision to treat Dylan.
Jessie treats Dylan. The ambulance arrives and he gives a report to the paramedics. Jessie documents the incident and his actions. Jessie also reports this incident to the other members of the health care team, including Dylan’s physician.
No. If Jessie has not obtained the competencies to treat hypoglycemia, he 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 the competence. As Jessie does not have the competence to administer glucagon, he requires a client-specific order from a listed health professional to administer the glucagon (or alternate treatment).
Jessie asks a colleague to treat Dylan’s hypoglycemia. The ambulance arrives, and he gives a report to the paramedics. Jessie documents the incident and his actions. Jessie also reports this incident to the other members of the health care team, including Dylan’s physician. He follows up with his manager to arrange the required training for treating hypoglycemia.
Treating conditions within autonomous scope of practice
Under the
Nurses (Registered Psychiatric) Regulation RPNs are authorized to diagnose and treat a variety of
conditions in their autonomous scope of practice that can be improved or resolved with nursing activities. The regulation sets out the type of diagnosis RPNs can make. Specifically, RPNs 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 RPNs sets the standards, limits and conditions under which RPNs treat hypoglycemia. Specifically, when administering D50W (Schedule I) to treat hypoglycemia RPNS:
- have additional education, and
- follow an organization approved decision support tool
Note that individual organization’s 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 act 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/employer policies or legislation
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Acting Within Autonomous Scope of Practice