Section 8: Restricted activities for certified practice

BCCNM Limits and Conditions for Certified Practice Registered Nurses

Registered Nurses (Certified) are allowed within their autonomous scope of practice to diagnose a disease, disorder, or condition and treat by prescribing, compounding, dispensing, administering, or ordering medications according to their certified practice designation. Certified practice registered nurses may also diagnose and treat conditions that are within the autonomous scope of general registered nurse practice and the nurse’s individual competence.

These limits and conditions apply to certified practice registered nurses who are authorized to perform certain restricted activities within their autonomous scope of practice in one or more of the following certified practice designations:

Reproductive Health (Contraceptive Management) Certified
Reproductive Health (Sexually Transmitted Infections) Certified
Remote Practice Certified
RN First Call Certified
Opioid Use Disorder Certified

I. Certified practice registered nurses must:

Successfully complete the relevant certified practice education program approved by BCCNM (see Table 1).
Diagnose and treat only those diseases, disorders, or conditions or provide contraceptive management as outlined in the competencies of the BCCNM approved certified practice education program for their certified practice designation and as set out in Table 2.²²
Follow the decision support tools for their certified practice designation(s), and only diagnose and treat diseases, disorders, or conditions, including the prescribing, compounding, dispensing, administering, or ordering of medications and ordering of diagnostic tests, as outlined in the decision support tools for their certified practice designation(s) and as set out in Table 2.
Complete additional education²³ and ensure they are competent before performing any new activity associated with their certified practice designation(s) and as identified within their certified practice decision support tools such as the addition of a disease, disorder, or condition, and its treatment; or changes or additions to treatment for a disease, disorder or condition or contraceptive management.
Diagnose and treat diseases, disorders, or conditions or provide contraceptive management as outlined for their certified practice designation(s), including prescribing, compounding, dispensing, administering, or ordering medications, and ordering screening and diagnostic tests only when policies, processes and/or resources are in place for:

	a.	Ensuring continuity of care for the client, including appropriate follow-up of diagnostic testing results, questions about the prescription, and the monitoring and management of client outcomes related to their treatment plan.
	b.	Consulting with, referring to, or transferring care to other health professionals (e.g., nurse practitioners, medical practitioners, addiction specialists, pharmacists, primary care providers) about the treatment plan or as needed to meet the client's needs.

II. Certified practice registered nurses who prescribe medications associated with their certified practice designation²⁴ must also:

Successfully complete certified practice education for prescribing medications that has been approved by BCCNM for their certified practice designation and as set out in Table 3.
Have a BCCNM-assigned prescriber number.
Prescribe only when they have the approval or are recognized by their organization/employer²⁵ as a prescriber.
Prescribe only those medications as outlined within the decision support tools for their certified practice designation.
Have access to PharmaNet and document review of the client’s PharmaNet medication profile when prescribing controlled drugs and substances.

Table 1: RN Certified Practice Education Programs Required and Approved by BCCNM

CERTIFIED PRACTICE	CERTIFIED PRACTICE EDUCATION PROGRAM
Reproductive Health: Contraceptive Management	British Columbia Institute of Technology (BCIT): Contraceptive Management
Reproductive Health: Sexually Transmitted Infections	British Columbia Centre for Disease Control (BCCDC): Sexually Transmitted Infections Management OR British Columbia Institute of Technology (BCIT): Sexually Transmitted Infections
Remote Practice	University of Northern British Columbia (UNBC): Remote Nursing
RN First Call	University of Northern British Columbia (UNBC): RN First Call
Opioid Use Disorder	British Columbia Centre on Substance Use (BCCSU): Provincial Opioid Addiction Treatment Support Program– Registered Nurses and Registered Psychiatric Nurses

Table 2: The Diagnosis and Treatment of Diseases, Disorders, Conditions by Certified Practice RNs in Accordance with Decision Support Tools

CERTIFIED PRACTICE	Decision Support Tools	DISEASES, DISORDERS, CONDITIONS	DRUG SCHEDULES²⁸ AND THERAPEUTIC CLASSES
Reproductive Health - Contraceptive Management	Nurses and Nurse Practitioners of British Columbia (NNPBC) Certified Practice Reproductive Health- Contraceptive Management Decision Support Tools	May prescribe or dispense hormonal contraception.	Schedule I: Sex Hormones (hormonal contraception) Schedule II/III/unscheduled
Reproductive Health – Sexually Transmitted Infections	BCCDC Certified Practice Reproductive Health- Sexually Transmitted Infections Decision Support Tools	May diagnose and treat the following diseases and disorders: Chlamydia Trachomatis Neisseria Gonorrhea Mucopurulent Cervicitis Trichomoniasis Bacterial Vaginosis Urethritis Recurrent Urethritis Lower Urinary Tract Infection Genital Warts Treatment of contacts of those with sexually transmitted infections	Schedule I: Antibacterials Antivirals Antiprotozoals Antimitotics Schedule II/III or unscheduled
Remote Practice	NNPBC Certified Practice Remote Practice Decision Support Tools	May diagnose and treat the following diseases, disorders, and conditions for pediatric and adult clients unless indicated as adult only: Eye: conjunctivitis, minor corneal abrasion Ear-Nose-Throat: acute otitis media, pharyngitis, ceruminosis (adult only), dental abscess (adult only) Genitourinary: urinary tract infection Respiratory: acute bronchitis (adult only) Integumentary: abscess and furuncle (adult only), cellulitis, impetigo, bites, Pain: use of nitrous oxide/oxygen for pain management (adult only)	Schedule I: Antibacterials Antivirals Antiprotozoals Antihistamines Bronchodilators Schedule II/III or unscheduled
RN First Call	NNPBC Certified Practice RN First Call Decision Support Tools	May diagnose and treat the following diseases and disorders and conditions for pediatric and adult clients unless indicated as adult only: Eye: Conjunctivitis, minor corneal abrasion; Ear-Nose-Throat: Acute otitis media, pharyngitis, dental abscess (adult only); Urinary Tract: Lower urinary tract infection (adult only).	Schedule I: Antibacterials Antivirals Antiprotozoals Antihistamines Schedule II/III or unscheduled
Opioid Use Disorder	BCCSU Certified Practice Opioid Use Disorder Decision Support Tools	May diagnose and treat opioid use disorder	Schedule IA: Opioid Agonist Opioid Partial Agonist Schedule I: Alpha-Adrenergic Agonist Schedule II/III/unscheduled

Table 3: RN Certified Practice Prescribing Education Programs Required and Approved by BCCNM

CERTIFIED PRACTICE	CERTIFIED PRACTICE Prescribing Education
Reproductive Health: Contraceptive Management	University of Northern British Columbia: Safe Prescribing for Registered Nurses with Certified Practice
Reproductive Health: Sexually Transmitted Infections	University of Northern British Columbia: Safe Prescribing for Registered Nurses with Certified Practice
Remote Practice	University of Northern British Columbia: Safe Prescribing for Registered Nurses with Certified Practice
RN First Call	University of Northern British Columbia: Safe Prescribing for Registered Nurses with Certified Practice
Opioid Use Disorder	British Columbia Centre on Substance Use (BCCSU): Provincial Opioid Addiction Treatment Support Program–Registered Nurses and Registered Psychiatric Nurses

Footnotes

22	Certified practice registered nurses may also diagnose and treat conditions that are within the autonomous scope of general RN practice and the nurse's individual competence.
23	Additional education is structured education (e.g., a workshop, course, or program of study) designed so that registered nurses can attain the competencies required to carry out a specific activity. Additional education builds on the entry-level competencies of registered nurses; identifies the competencies expected of learners on completion of their education; includes both theory and application to practice; and includes an objective, external evaluation of learners’ competencies on completion of the education.
24	In these standards, the term "prescribing" is used to describe the issuance of a prescription for a medication to be dispensed by a pharmacist.
25	For nurses working for non-health authority agencies or organizations or who are otherwise engaged with a third-party, the “organization/employer” refers to the agency or organization with primary responsibility for the care of the client.

Resources

Certified practice

Section 8: Restricted activities for certified practice

BCCN​M Limits and Conditions for Certified Practice Registered Nurses

I. Certi​​fied practice registered nurses must:

II. Certified prac​​tice registered nurses who prescribe medications associated with their certified practice designation24 must also:

​Tab​le 1:​ RN Certified Practice Education Programs Required and Approved by BCCNM

​Table 2: The Diagnosis and Treatment of Diseases, Disorders, Conditions by Certified Practice RNs in Accordance with Decision Support Tools

Tab​le 3:​ RN Certified Practice Prescribing Education Programs Required and Approved by BCCNM