Acting with Client-Specific Orders: Principles

1.

Registered nurses require a client-specific order from a listed health professional to perform any restricted activity listed in section 7 (restricted activities that require an order) of the Nurses (Registered) and Nurse Practitioners Regulation (to the extent the care provided is not within the activities or related limits and conditions listed in section 6 of the Nurses (Registered) and Nurse Practitioners Regulation, or, as noted for certified practice registered nurses, in Section 8¹).

2.

Registered nurses acting with a client-specific order ensure the ordered activity is:

a.

within the scope of practice as set out in the Nurses (Registered) and Nurse Practitioners Regulation,

b.

consistent with standards, limits and conditions established by BCCNM,

c.

consistent with organizational/employer policies, processes, and restrictions, and

d.

within their individual competence.

3.

Registered nurses acting with a client-specific order ensure that they have the competence to:

a.

perform the activity safely and ethically,

b.

manage the intended outcomes of the activity, and

c.

recognize unintended outcomes of the activity and implement a plan for dealing with these unintended outcomes.

4.

Registered nurses acting with a client-specific order ensure that the order:

a.

is client-specific,

b.

is clear and complete,

c.

is documented, legible, dated and signed with a written/electronic signature, and

d.

contains enough information for the nurse to carry it out safely.

5.

Registered nurses accept a verbal or telephone client-specific order only when there is no reasonable² alternative, according to organizational/employer policies and processes, and when doing so is in the best interest of the client. Nurses repeat the client-specific order back to the ordering health professional to confirm its accuracy and promptly document the order.

6.

Registered nurses conduct assessments to ensure that the client's condition continues to warrant the activity before acting with a client-specific order.

7.

Registered nurses may not change or cancel a client-specific order given by a listed health professional when the activity is outside of the nurse’s autonomous scope of practice or the nurse’s individual competence.

8.

Registered nurses communicate and collaborate with the health professional (or their delegate) who gave the client-specific order, follow organizational/employer policies and processes, take action as needed, and document in the client record, when:

a.

the ordered activity may no longer be appropriate because the client’s condition, needs or wishes have changed (e.g.to ‘hold’ the order),

b.

they are not able to carry out a client-specific order,

c.

the client-specific order does not appear to consider a client’s individual characteristics, values/beliefs, and preferences,

d.

the client-specific order does not appear to reflect current evidence or be in the best interest of the client,

e.

they change or cancel a client-specific order for activities that are within their autonomous scope of practice, or

f.

the safeguards and resources are not available to manage the outcomes of performing the activity, including reasonably foreseeable unintended outcomes.

9.

Registered nurses follow the standards for Acting within Autonomous Scope of Practice when they change or cancel a client-specific order that is within their autonomous scope of practice and individual competence.

10.

Registered nurses are responsible and accountable for any changes or cancellations they make to a client-specific order that is within their autonomous scope of practice and individual competence.

11.

Registered nurses obtain a client-specific order to perform an activity or provide care or a service that is within their autonomous scope of practice when:

a.

It is required by organizational/employer policies, processes, or restrictions, 

b.

there are insufficient organizational/employer supports, processes and resources in place (such as decision support tools or clinical practice documents) to enable the nurse to meet BCCNM standards, limits, or conditions related to the activity, care or service, or

c.

the nurse does not have the individual competence to make a nursing diagnosis or carry out an assessment to determine whether the client would benefit from the activity, care, or service, but is competent to carry out the activity. 

12.

Registered nurses ONLY act with a client-specific order from a non-listed health professional when:

a.

the activity is within the nurse’s autonomous scope of practice,

b.

the nurse is able to meet BCCNM standards, limits, or conditions related to the activity,

c.

the activity is within the nurse's individual competence, and

d.

organizational/employer policies, and processes exist that:

i.

clarify the accountability and responsibility of the nurse and the non-listed health professional, and

ii.

outline the requirements for the non-listed health professional to complete an assessment and to ensure that the ordered activity is in the best interest of the client.