Acting within autonomous scope of practice

Scope of practice refers to the activities that licensed practical nurses are educated and authorized to perform. Acting within autonomous scope of practice refers to licensed practical nurses:

• ​​​assuming accountability and responsibility for making decisions about client care, and

• ​performing activities that they are educated, competent, and allowed to perform without a client-specific order.

To ensure they are providing safe care, licensed practical nurses need to know when they are allowed to act within autonomous scope of practice and when they require a client-specific order before performing an activity.

The Nurses (Licensed Practical) Regulation allows licensed practical nurses to make a nursing diagnosis that identifies a condition – not a disease or disorder – as the cause of a client's signs or symptoms. Licensed practice nurses diagnose and determine a plan of care for a variety of conditions that can be improved, resolved, or prevented with nursing activities. Other conditions may be stabilized or improved by licensed practical nurses but require the involvement of another health professional to diagnose and treat the underlying disease or disorder.

The Nurses (Licensed Practical) Regulation lists restricted activities that are allowed to be performed by licensed practical nurses.  Restricted activities are clinical activities that pose a significant risk of harm to the public. These include restricted activities that 'do not require an order' (Section 6 of the Regulation) and restricted activities that 'require an order' (Section 7 of the Regulation). Some restricted activities are listed under section 6 and also under section 7 of the Regulation. The BCCNM Scope of Practice for Licensed Practical Nurses – Standards Limits Conditions provides additional details about Section 6 and Section 7 restricted activities.

Before acting within autonomous scope of practice, licensed practical nurses need to consider all four controls on practice to ensure they are allowed to perform the activity: 1) The Nurses (Licensed Practical) Regulation; 2) BCCNM standards of practice including standards, limits, and conditions; 3) organizational/employer policies, processes, and restrictions; and 4) the nurse's individual competence.    

Autonomous scope of practice includes:

• ​The performance of restricted activities that are listed in section 6 of the Nurses (Licensed Practical) Regulation, unless the activity is prohibited by any BCCNM standard, limit, or condition. These restricted activities do not require an order from a health professional who is listed^1​ in the Regulation.

• The provision of other care or services that are not restricted activities, unless the care or services are excluded from autonomous scope of practice by any BCCNM standard, limit, or condition.

Autonomous scope of practice does not include:

• ​ The per​​​formance of restricted activities that are listed in section 7 of the Nurses (Licensed Practical) Regulation (to the extent the care provided is not within the activities listed in section 6 of the Regulation). These are restricted activities that require an order from a health professional who is listed in the Regulation.
  

• ​​​The pr​​ovision of other care or services, including restricted or non-restricted activities, that are prohibited or otherwise excluded from autonomous scope of practice by:

• ​​​​​​​​​any​​ BCCNM​​​​​​​​ standard, limit, or condition, or

• ​​​​​​​​​​​organizational/​​​​​​​​​employer policies, processes, or restrictions.

• ​​The provisi​​on of a service that is prohibited by other legislation (see Legislation Relevant to Nurses' Practice).​