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Overview

CRNBC-certified practices are activities that registered nurses can carry out only after they have successfully completed a certification program approved by CRNBC and have been granted the corresponding certified practice designation by CRNBC. Certified practices are outlined in Section 8 of the Nurses (Registered) and Nurse Practitioners Regulation and set out within the CRNBC-approved decision support tools.

Certified practices are carried out autonomously and the registered nurse is solely accountable for the diagnosis and treatment of the client. Certification allows registered nurses to:

  • Diagnose some diseases and disorders (as set out in decision support tools)
  • Carry out some restricted activities autonomously (as set out in decision support tools) that would otherwise require an order, e.g., administering, compounding or dispensing Schedule I medications
History

Certified practices arose from a concern about the scope of practice of registered nurses identified by the Health Professions Council in its 2001 report Safe Choices: A New Model for Regulation Health Professions in British Columbia. The Health Professions Council agreed that registered nurses carried out some activities that were not captured in the report, but it expressed concern about the lack of provincial consistency in the educational preparation of registered nurses for these activities. It also stated that the regulatory body needed to take a more active role in regulating these practices.

Today

The Nurses (Registered) and Nurse Practitioners Regulation mandates CRNBC to directly oversee certified practices. CRNBC Bylaws set out the duties and membership of a CRNBC Certified Practices Approval Committee. The Bylaws also establish:

  • Certified practice categories
  • Requirements for initial certification and maintenance of certification
  • Authorized titles for those on a certified practice register
Assumptions

CRNBC formulated the following assumptions to provide a foundation for policy development related to certified practice:

  • CRNBC-certified practices are learned by registered nurses after their initial registration and, therefore, current entry-level competencies for registered nurses are considered foundational to all the certified practices.
  • Wherever possible, CRNBC-certified practices should be grouped into a cluster of similar activities and be considered part of an existing focus of nursing practice, such as remote practice nursing.
  • Section 8 of the Regulation formalizes and standardizes existing registered nurse practices that, in the past, were carried out using mechanisms such as indirect and/or standing orders, delegation or employer-based competency review.
  • Registered nurses carrying out CRNBC-certified practices are not authorized to carry out the restricted activity of prescribing. Instead, they administer, compound and dispense Schedule I medications without an order. Any Schedule I medications that are administered or dispensed by registered nurses are provided by their employer. Therefore, registered nurses carrying out
    CRNBC-certified practices must be employed or on contract to an employer.

Categories of CRNBC-Certified Practices

After consulting with registered nurses, CRNBC identified three certified practice categories:

1. Reproductive Health

Registered nurses who complete CRNBC certification in reproductive health:

  • Diagnose and treat sexually transmitted infections
  • Provide contraceptive management

2. Remote Practice

Remote nursing practice frequently (but not necessarily) occurs in communities where there is no resident physician or nurse practitioner, but where physicians or nurse practitioners visit the community periodically and are available to provide consultation to the registered nurse.

Registered nurses who complete CRNBC certification in remote nursing practice:

  • Diagnose and treat minor acute illness as set out in established decision support tools (including administering, compounding or dispensing Schedule I medications without an order)
  • Carry out all activities included in reproductive health certification

3. RN ​First Call

RN First Call frequently (but not necessarily) occurs in small acute care hospitals, diagnostic and treatment centres and other settings where there is physician or nurse practitioner service available in the community.

Registered nurses who complete CRNBC certification in RN First Call:

  • Diagnose and treat minor acute illness (including administering, compounding or dispensing Schedule I medications without an order) as set out in decision support tools.
Key Elements of Implementing Certified Practices

1. Identifying and grouping CRNBC-certified practices

CRNBC is responsible for identifying and grouping certified practices and sending that information to government in a bylaw. Bylaws are subject to government approval.
The three CRNBC-certified practice categories identified to date are Reproductive Health, Remote Nursing Practice and RN First Call. Registered nurses or employers who identify additional areas of nursing practice that may require CRNBC certification should contact CRNBC.

2. Program approval

The authority for approving the certification program rests with CRNBC as set out in the Regulation. The approval criteria are developed by CRNBC. The process is similar to the process used by CRNBC for recognizing programs related to entry-to-practice for registered nurses and nurse practitioners.

The Certified Practices Approval Committee is a standing committee under the CRNBC Bylaws. The Committee is responsible for ensuring that the approval criteria are met, rather than for scrutinizing program content. In making its decision, the committee reviews four aspects of a program to determine if the approval criteria have been met:

A.

Competencies

For the initial three certified practice categories, CRNBC approved competencies that had already been developed, based on a set of board-approved criteria. These criteria include an expectation that there is broad stakeholder involvement in the development of the competencies.

The competencies list the diseases and disorders that nurses who are certified in a particular category are able to diagnose and treat.

For new certified practices, CRNBC will assemble an expert panel to develop the competencies.

CRNBC is responsible for periodically reviewing all the required competencies.

​​B.

Decision Support Tools

Decision support tools for each CRNBC-certified practice are developed by an expert group or an organization recognized for its expertise. Decision support tools set out the activities that are included in the certified practice.

CRNBC approves the decision support tools as part of the approval process and establishes the criteria related to those decision support tools. For example, the criteria state that the decision support tools must be evidence-informed and follow a standardized format, and that their development must involve key stakeholders. Criteria outline when the decision support tools must be reviewed by CRNBC.

C.

Course Development and Delivery

An education course is developed and provided by an expert organization or by an educational institution in consultation/collaboration with an expert organization or a panel of experts.

CRNBC approves the course based on criteria, such as ensuring that the course prepares registered nurses to meet the related competencies and to practise within the parameters set out in the related decision support tools.

The timeline for review of courses is included in board policies and started with a three-year approval cycle. Criteria exist to trigger earlier review if required.

D.

Exit Evaluation

All courses are required to have a mechanism for evaluating competence at the time the student exits the course. The comprehensiveness of the required evaluation is set out in criteria. For example, CRNBC may require both a written test and a process of clinical evaluation for a specific certified practice. Criteria are also set by CRNBC related to the identification of examination writers and invigilation of examinations.

3. Designation on a certified practice register

All registered nurses who successfully complete an approved certified practice course are entered on the register for the appropriate certified practice category. Registered nurses are required to apply for designation once they have successfully completed an approved course. The Board has determined that there is no fee at this time for designation on a certified practice register.

 

CP_education ​

Changes to the regulation

Where certified practice is no longer required

Government changes to the Nurses (Registered) and Nurse Practitioners Regulation affect the activities related to communicable diseases, emergency cardiac care and managing labour. These three activities do not require CRNBC certification. Instead, CRNBC sets limits and conditions on these activities. In nearly all cases, registered nurses carrying out these activities are required to meet the competencies established by a provincial agency such as the British Columbia Centre for Disease Control or the British Columbia Perinatal Health Program and follow a decision support tool developed by that same provincial authority.

Communicable Diseases

  • Manage communicable disease outbreaks and treat contacts of a communicable disease
  • Administer or manage travel immunizations
  • Administer tuberculin skin tests and order X-rays for tuberculosis screening
  • Emergency Cardiac Care
  • Give specified cardiac drugs
  • Perform defibrillation.

Note: Endotracheal intubation will require College-approved delegation.

Managing Labour

  • Manage labour in an institutional setting if the primary care provider is absent
  • Manage and deal with emergency delivery (although delivery is not included within registered nurses' scope of practice)

Footnote

1

CRNBC-certified practice education does not prepare registered nurses to be primary care providers. A certified practice nurse seeks direction or orders from a physician or nurse practitioner when the care required is beyond the scope of certified practice or the competence of the individual registered nurse.

   
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