Carrying out immunization¹ related activities requires competencies beyond that of routine medication activities. Nurses performing immunization-related activities must be competent (possess the required knowledge, skills, and judgment) to safely do so.

Nurses also comply with federal and provincial regulations, B.C. College of Nurses and Midwives' (BCCNM) standards of practice, and workplace policies when performing immunization-related activities. Individual competencies may impact whether a nurse can dispense, compound, or administer immunizations in their practice.

When educating clients or the public about immunizations nurses:

• Use current evidence-based information
• Identify the effect of their own values, beliefs, and experiences about immunizations
• Recognize potential conflicts and take action to meet client needs

Scope of practice — standards, limits & conditions​​

What you need to know

Immunization-related activities are a restricted activity within the RN autonomous scope of practice ('do not require an order') under the Nurse (Registered) and Nurse Practitioners Regulation. BCCNM requires RNs who autonomously compound, dispense or administer immunizations to:

1. Have the competencies set by the B.C. Centre for Disease Control (BCCDC) and to follow their decision support tools where indicated;
2. Follow BCCNM limits and conditions, and apply relevant standards of practice; and
3. Follow workplace policies.

Nurses providing immunizations are accountable and responsible for assessing their immunization competencies regularly and undertaking additional education as needed to maintain their competence.

Review the following standards:

• Medication practice standard
• RN Scope of practice standard
  
• Acting within autonomous scope of practice standard
• Acting with client-specific orders standard 
• Giving client-specific orders standard

Achieving immunization competencies

Please visit the BCCDC website for required competencies and training information. Immunization competencies may be achieved through a workplace's additional education requirements or by completing BCCDC's immunization competency course.  Some immunizations require you to complete BCCDC's immunization competency course before compounding, dispensing or administering them.

Please note that BCCNM does not train, educate or provide education materials for nurses related to giving immunizations. Nurses must meet the competencies set by BCCDC (the standard for assessment of immunization competencies). This is often achieved by completing the BCCDC Immunization course. Check with your workplace to confirm requirements.

Restricted activities that do not require an order: Immunizations

FAQs

For personal reasons, I don't want to/or can't have a particular vaccination. Will I lose my license if I refuse?

While you're not required to have vaccinations to be registered with BCCNM, you are responsible for protecting your clients from the risk of infection. Nurses have a professional, ethical and legal duty to provide clients with safe care. Review the B.C. Ministry of Health's and your workplace policies about immunizations and influenza control.

The Communicable Diseases: Preventing Nurse-to-Client Transmission practice standard provides more information about your responsibilities to provide safe care to clients.

I work at a facility and have been told by my manager that the physician wants all clients in the facility to have flu vaccines. Do I need a client-specific order for each client, or can the physician just give one order that applies to all clients?

Physicians need to give a client-specific order for each client that is to be immunized. Orders cannot be applied to a group or a population of clients. However, nurses can give immunizations autonomously to clients  if they have the competencies and follow BCCNM standards, limits and conditions.

Can I administer a flu immunization within my autonomous scope of practice (i.e. 'do not require an order')?

Yes, if you meet the conditions in your Scope of Practice standard, possess the competencies set by the B.C. Centre for Disease Control (BCCDC), follow BCCDC decision support tools, and adhere to workplace policies.

Within their autonomous scope of practice, RNs can compound, dispense, or administer immunizations for the purpose of preventing disease if they have the competencies set by BCCDC and follow BCCDC decision support tools.

See BCCNM Scope of Practice for Registered Nurses:

• Acting within autonomous scope of practice
• Acting with client specific orders

General immunizations

Who can give a client-specific order for immunizations?

Health care professionals who are authorized to give a client-specific order is laid out in your  nursing regulation. Not all nursing designations have the same list of authorized prescribers. Review  Nurses (Registered) and Nurse Practitioners Regulation to see who is authorized to give client-specific orders.

Only RNs who meet the requirements in the Giving a Client-specific Order practice standard can autonomously give client-specific orders for immunizations. If the nurse cannot fully meet the standard, they must get a client-specific order from another authorized health professional.

For example, a public health nurse (RN) with the immunization competencies can give a client-specific order to another RN, an LPN, or an RPN to administer a vaccine to a client they have assessed. The nurse who is administering the vaccine must follow the Medication practice standard and be competent to give an injection. Nurses who are acting on a client-specific order to immunize and meet BCCNM standards, do not need to meet all of the competencies established by BCCDC before administering the immunization.

Nurses giving client specific orders for immunizations must follow:

• Scope of practice standard Giving Client-specific Orders
• Consent practice standard
• Medication practice standard
• Documentation practice standard
• Workplace policies

Does an LPN need supervision to give an immunization?

Administering an immunization is within the autonomous scope of practice for LPNs. They do not need to be supervised. However, LPNs who administer immunizations work within a team-based approach and access support as needed.  Working within a team-based approach means that when client care includes activities fall outside the LPN scope of practice or the individual LPN's competencies, they seek out other members of the health care team to jointly review and determine how the client's care needs will be met.

I have a client who needs an immunization and I do not meet the BCCDC immunization competencies. Can I give this immunization autonomously or do I need a client-specific order?

You cannot give this immunization within your autonomous scope of practice as you do not meet the BCCNM conditions/limits for this activity. You will need to get a client-specific order from an authorized prescriber before administering it.

You do not need to meet the BCCDC immunization competencies when acting on a client-specific order, however, you would need to ensure you have the competence to give an injection and administer medication. Nurses must get a client-specific order to administer an immunization if they do not meet the standards, limits and conditions set out in their Scope of Practice standards. 

Review your scope of practice standard to see what the requirements needed to administer immunizations within your autonomous scope of practice.

Resources

• BCCDC
• Immunization refresher/renewal course
• Immunize BC
  

Additional Resources

• Acting on a client specific order thinking tool
• Acting within autonomous scope of practice thinking tool
• BCCNM Bylaws
• Consent practice standard
• Documentation practice standard
  
• Legislation Relevant to Nurses' Practice
• Medication practice standard
• Self-employment

BC Centre for Disease Control

• BCCDC's basic immunization course
  

• BCCDC decision support tools ​
  

Footnotes​​​​​