If you have flu-like symptoms such as fever, chills and achiness, stay home. It may be difficult for you to work effectively and you may be contagious. Although it’s difficult knowing your absence might impact your colleagues’ work, you have a duty to protect your clients from the risk of infection. Staying home when ill is one way to do this. Washing your hands frequently and keeping your immunizations up to date are other ways to prevent infection and provide safe care to your clients.The Communicable Diseases: Preventing Nurse-to-Client Transmission Practice Standard provides more information about your responsibilities to provide safe care to clients.
While you’re not required to have a flu shot to be registered with CRNBC, 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.
The Communicable Diseases: Preventing Nurse-to-Client Transmission Practice Standard provides more information about your responsibilities to provide safe care to clients.
The BC Ministry of Health has a policy for immunizations and health care staff. Be sure to check your employer’s policies for staff immunizations and influenza control.
Yes, administering Botox and dermal fillers are within RN scope of practice. Botox is a Schedule 1 medication. Dermal fillers are either Schedule 2 medications or substances. In all cases, you'll need a client-specific order from a physician or dentist and to meet the Standards for Acting with an Order.
CRNBC has recently clarified that RNs always require an order before compounding or administering dermal fillers (Scope of Practice for RNs, p. 24)
As these procedures come with potential client risks, there are many things to consider before carrying out these activities. We recommend you review the following resources:
The College of Physicians and Surgeons of British Columbia and the College of Dental Surgeons of British Columbia have information relevant to nurses administering Botox Cosmetic and dermal fillers. Please contact email@example.com if you have any questions.
Yes, you need an order. Although many sclerosing agents are Schedule II medications, you would administer these agents to treat a disorder, such as varicose veins, only after a physician has assessed the client, diagnosed the disorder and ordered the sclerotherapy.
RNs can administer Schedule II medications without an order to treat a condition they’ve diagnosed, but we’re not aware of any conditions that RNs could treat autonomously by administering a sclerosing agent.
See the Scope of Practice for Registered Nurses for more information and guidance.
When recommending or participating in complementary and alternative health care (CAHC) practices, your primary duty continues to be providing ethical and competent care. If you are recommending any CAHC practice, you must:
Visit the complementary & alternative health care page for more information.
If a pharmacist has already dispensed your client's medications to your unit or agency, you’re responsible for taking steps to ensure proper use. This includes:
The Dispensing Medications Practice Standard provides clear direction for labelling, packaging, client education and documentation. Agency policies should reflect these requirements.
Unless the person is a client under your care, you should not dispense medications to them. The Dispensing Medications Practice Standard sets clear requirements for nurses when dispensing.
Agency policy and practice should support appropriate dispensing by nurses. If you are not able to meet the expectations set out in the practice standard, document this issue and discuss it with your manager.
Preparing medications is part of the process of medication administration. Preparation includes selecting, calculating, crushing, breaking, mixing, labelling, drawing up, popping out, etc. You should prepare medications as close as possible to the time you administer them.
Pre-pouring medications is preparing medications in advance and storing them until you or others need them. Examples of this practice include:
You should not pre-pour medications as it can blur the accountability for making sure the seven rights are met and/or increases the possibility of errors.
If you can’t administer medications immediately after preparing them, make sure they are securely stored. Follow your agency policies and use your professional judgment when deciding how far in advance to prepare your medications.
There are some situations where you may share the responsibility for preparing and administering medications. Examples include:
You’ll find more information and guidance in the Medication Administration practice standard.
Yes, pharmacists can accept verbal orders from authorized health professionals and dispense medications accordingly. You may use the dispensing label in place of the health professional’s order, provided the medication is in the original pharmacy container and your agency permits it.
Yes, RNs can dispense medications, including narcotics, to clients under their care. RNs must meet the requirements set out in the Dispensing Medications Practice Standard and follow agency policy.
Your documentation should provide a clear picture of your client's status, your actions and client's outcomes, for example:
Your client’s condition and care needs are factors in determining how much and what documentation is required. Acutely ill or high risk clients or those with complex health problems will require more comprehensive, in-depth and frequent documentation.
The requirements for documentation come from legislation, case law, Standards of Practice and agency policies. Documenting is a way to show you have applied nursing knowledge, skills and judgement and met the legal standard of care. Document according to agency policy — these policies should reflect legislative and other requirements.
Documentation practice standard provides information and direction for your documentation. The
Canadian Nurses Protective Society also has helpful resources.
Chart the care you were able to provide, including any assessments, nursing interventions and changes to the client’s plan of care. Communicate to your manager through established processes - that you were unable to follow specific protocols and outline the circumstances that prevented you from doing so. Complete a patient safety learning event report or equivalent if directed by your agency policy.
Refer to the Documentation practice standard for more information and guidance.
CRNBC does not require you to co-sign students’ documentation. Nursing students are responsible and accountable for documenting the care they personally provide to clients.
In some situations, it may be necessary for an RN (such as a preceptor or faculty) to document their own assessment, interventions and evaluations. For example, if a client developed an acute or complex problem, the RN may need to document her/his assessment and response to the problem, in addition to the student’s documentation. Use your professional judgment to determine if additional documentation is necessary.
Employers may set additional requirements related to documentation and working with students. Ask a clinical educator or manager for your unit whether there is such a policy. Regulatory Supervision of Nursing Student Activities provides direction additional for nurses working with students.
Thank you to the College of Registered Nurses of Manitoba for permission to adapt their content.
Generally, if you consult with another health care provider (HCP) and receive direction and/or orders for your client’s care, you should document this. While other HCPs are responsible for documenting any orders or care they provide to a client, your documentation should accurately reflect the care you provide to a client, including when you’ve consulted with another health care provider, including their name and title. When documenting, include:
For example, if you seek clarification from a physiotherapist about mobilizing a client, record the reason for seeking clarification, name and title of the physiotherapist providing the clarification, action you took as the RN, and expected outcome. Update the plan of care as appropriate.
The Documentation practice standard provides more direction and information for your documentation.
Thank you to the College of Registered Nurses of Nova Scotia for permission to adapt their content.
CRNBC Standards (Scope of Practice, Medication Administration, and Documentation) don’t specifically address texting or email. Patient safety and best practices should be considered before engaging in this practice. Employer systems should be secure so that client information sent using technology cannot be changed in transit, is kept confidential and can be validated.
Review and follow relevant health authority/employer policy when using electronic devices to communicate client information. You’ll want to make sure:
Pronouncement of death is the opinion or determination that, based on a physical assessment, life has ceased. Although there are presently no laws in B.C. governing who can pronounce death, your employer may have policies and procedures related to this.
Certification of death refers to the completion of the death certificate identifying the cause of death. Currently, only physicians, nurse practitioners and coroners can complete and sign death certificates. Registered nurses cannot.
You can find more information on completing death certificates in the BC Government’s Handbook for Physicians, Nurse Practitioners and Coroners.
No, carrying out pelvic exams and Pap smears is within the scope for practice for all RNs.
If you’re carrying out these activities, you’ll need to meet the Standards for Acting without An Order (p. 13). This includes making sure you have the necessary competencies and follow the DSTs established by the Provincial Health Services Authority (PHSA) (p. 21).
Not necessarily. These activities are within the scope of practice for all RNs. However, if your role includes autonomously diagnosing and/or treating specific diseases and disorders with Schedule 1 (prescription level) medications, you’ll need to be CRNBC-certified.
The emergency exemption generally does not apply in this situation.
The Health Professions Act's emergency exemption is meant to deal with situations that:
The emergency exemption does not cover activities that are an expectation of a nurse’s role, including activities that would be expected to arise from time to time in the ordinary course of your employment. Neither you nor your employer should rely on the emergency exemption to allow you to carry out activities considered an expectation of practice in your setting.
You’ll find more information and guidance about scope of practice in the Scope of Practice for RNs: Standards, Limits and Conditions.
No, incision and drainage is outside the scope of practice of CRNBC-certified nurses. Nurse practitioners are the only nurses who may perform this intervention.
Check Certified Practice and Scope of Practice for NPs for more information and guidance on scope.
These situations are usually beyond an individual nurse’s control and often require a systems level approach for resolution.
In these types of situations, you could:
When you give advice over the phone you are accountable for the care you provide. By answering the phone you initiate a nurse-client relationship and a duty to provide care. When offering telephone advice you must have the competence to assess the health needs of callers and provide appropriate advice, including referring to other services. You must also follow agency policy.
Your ability to assess a situation over the phone may be influenced by:
Recognize when providing advice over the phone is not appropriate.
Your agency policies should outline the required competencies, the type of advice you may give and documentation processes. They should also include guidelines for informing clients about when and how to seek further care.
Your agency policies should outline the required competencies, the type of advice you may give and documentation processes. They should also include guidelines for informing clients about when and how to seek further care. The
Telehealth, Boundaries in the Nurse-Client Relationship, Consent and Documentation practice standards will provide further information and guidance about your responsibilities when providing advice over the phone.
For further information on the Standards of Practice or professional practice matters, contact us: