Acting within autonomous scope of practice

Scope of practice refers to the activities that registered nurses¹ are educated and authorized to perform. Acting within autonomous scope of practice refers to registered 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, registered 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 (Registered) and Nurse Practitioners Regulation allows registered nurses to make a nursing diagnosis that identifies a condition – not a disease or disorder – as the cause of a client’s signs or symptoms². Registered 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 registered nurses but require the involvement of another health professional to diagnose and treat the underlying disease or disorder.

The Nurses (Registered) and Nurse Practitioners​ ​Regulation lists restricted activities that are allowed to be performed by registered 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 Registered Nurses - Standards Limits Conditions provides additional details about Section 6 and Section 7 restricted activities. For certified practice registered nurses, in addition to Section 6 activities, restricted activities that do not require an order are listed in Section 8 of the Regulation.

Before acting within autonomous scope of practice, registered nurses need to consider all four controls on practice to ensure they are allowed to perform the activity: 1) The Nurses (Registered) and Nurse PractitionersRegulation; 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 6³ of the Nurses (Registered) and Nurse Practitioners 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 listed⁴ 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 performance of restricted activities that are listed in section 7⁴ in the Nurses (Registered) and Nurse Practitioners Regulation (to the extent the care provided is not within the activities listed in section 6 of the Regulation, or as noted for certified practice registered nurses, in section 8). These are restricted activities that require an order from a health professional who is listed in the Regulation.

• The provision 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 provision of a service that is prohibited by other legislation (see Legislation Relevant to Nurses’ Practice).

This Acting within Autonomous Scope of Practice standard applies to registered nurses, licensed graduate nurses, and certified practice nurses when acting within autonomous scope of practice.

Acting within autonomous scope of practice: Principles»

Footnotes