Acting under​​ orders

To legally perform certain restricted activities, a nurse must be acting under a client-specific order. Nurses cannot perform these activities autonomously; they require an appropriate authorizing mechanism (typically a client-specific order). 

An order authorizes the nurse to perform the activity when all of the following are met:

• The activity is part of nursing scope of practice.
  

• Regulation states that the nurse's licensee class (LPN, RN, or RPN) is authorized to perform the activity when acting under an order.
• The order is given by a health professional authorized in Regulation to provide that type of order.

• The ordering health professional is allowe​d to perform the activity autonomously within their own scope of practice.

​The following health professionals can issue orders nurses may carry out:

For RNs and RPNs: Orders may be provided by a physician, nurse practitioner, dentist, midwife, naturopathic doctor, podiatrist, pharmacist, certified RN, or certified RPN.

For LPNs: Orders may be provided by a physician, nurse practitioner, dentist, midwife, naturopathic doctor, podiatrist, pharmacist, RN, RPN, or dietitian.

​​​​Practice examples

Order for wound ​care

An NP assesses a client with a diabetic foot ulcer and writes an order for specialized wound dressings and compression therapy.

A nurse may act with this order if:

• The activity (​applying dressings and compression) is within the nursing scope of practice.
• Regulation states that the nurse is authorized to perform the activity when acting under an order.
• T​he nurse meets all relevant BCCNM standards, limits, and conditions.
• The nurse is competent and authorized by employer policy to perform wound care and compression therapy.

• The NP ​is authorized to prescribe and order wound treatments under Regulation.

If these conditions are not met, the nurse must:

• ​Consult with the NP or another regulated health professional before proceeding, or

• Tra​​nsfer care to a health-care professional authorized and competent to perform the activity.

Note, LPNs may carry out components of wound care only if:

• ​They have the competence and employer authorization, and

• Th​​e order clearly specifies the treatment parameters. Otherwise, the LPN must seek clarification or a new order from an appropriate health professional.

​​​Oral diet orders

Determining an oral diet is a non-restricted activity, meaning nurses (and other health professionals) may autonomously decide on a client's oral diet. However, employers may narrow this scope and set policies and procedures. Nurses review and follow their organization's policies to ensure compliance.

Your resp​​onsibilities when acting under orders  

Regulatory requirements

Nurses are responsible and accountable to multiple layers of control when acting under a client-specific order. Before acting, be certain that what you're about to do is legally authorized. This means understanding: 

• Acting Under Client-specific Orders practice standard, limits, and conditions, and
• Four controls on practice.

The four controls on practice are a decision-making framework that guides nurses in determining their legal and professional authorization to perform activities. This structured process ensures that your actions align with legislation and regulation, BCCNM standards, employer policies, and your own competence. Learn more about controls on ​practice: LPN, RN, RPN​.​​​​​ ​​

Accountability and professional judgment

Nurses remain professionally accountable when acting under client-specific orders. Following an order does not remove accountability if the activity is unsafe, outside nursing scope, or beyond the nurse's competence. 

• Nurses question or decline orders they believe are unsafe, inappropriate, or inconsistent with standards.
• Nurses are expected to communicate and collaborate with the ordering professional to clarify uncertainties or concerns.
• Informed client consent must always be obtained before carrying out the ordered activity.

Documentation and accountability

Nurses document in accordance with BCCNM's Documentation practice standard. Clear, accurate, and timely documentation is essential for accountability, continuity of care, and legal protection.

Associate physicians

BCCNM recognizes licensees of the College of Physicians and Surgeons of BC (CPSBC) holding associate physician licences as health professionals under the regulations.

​Nurses may act under a client-specific order from an associate physician if the order: 

• Falls within the associate physician's permitted scope of practice. Nurses should consult their employer or the CPSBC to confirm the scope of practice for associate physicians.
• Is within the nurse's competence and ability to meet all relevant BCCNM standards of practice.
• Complies with applicable employer policies and procedures.​​

​​​Need help or support?​

For further guidance on understanding and applying the standards of practice, contact our team by completing the Standards Support intake form.​