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Applying the standards for acting with client-specific orders

Part 2: Scope of practice standards

Applying the standards for acting with client-specific orders

  • Under the Health Professions Act and the RN Regulation some restricted activities are listed under both section 6 and also under section 7.  For example, "put an instrument or device..." and "perform a procedure below the dermis" are located in section 6 and section 7.
    • The CRNBC Scope of Practice for Registered Nurses provides additional detail about restricted activities including information about why an activity might be included in section 7 instead of section 6. 
    • If you hold a certified practice designation, the CRNBC Scope of Practice for Registered Nurses provides further information about the limits and conditions specific to section 8 certified practice activities.
    • Examples of activities under both section 6 and section 7 include:
      • "put an instrument or a device, hand or finger..."
        • Giving an enema or catheterizing a client with urinary retention is an example of when “putting an instrument or a device, hand or finger” could be a section 6 activity within autonomous scope (depending on the controls on practice)
        • Putting an instrument into a surgical site is an example of when “putting an instrument or a device, hand or finger” is a section 7 activity and requires an order from a listed health professional
      • "perform a procedure below the dermis"
        • Wound care is an example of when "performing a procedure below the dermis" could be a section 6 activity within autonomous scope (depending on the controls on practice)
        • Performing peritoneal dialysis is an example of when "performing a procedure below the dermis" is an activity under section 7 and requires an order from a listed health professional
    • Administering schedule 1 medications is an example of when you might be acting under section 6, section 7 or section 8 depending on the controls on practice and your professional designation (e.g. certified practice)
  • If you have questions about an order or the order does not contain the required information for you to carry it out safely, seek further clarification from the person who gave the order or from others on the health care team or your team leader.
  • If you have reason to believe that the ordered activity may be outside of the scope of practice or individual competence of the health professional who gave the order (for example, a podiatrist ordering a medication to treat congestive heart failure), it is important that you follow-up and clarify before acting on the order.
  • When determining whether an order has enough information for you to act on it, consider elements such as:
    • the duration if there are time limits to the ordered activity (e.g. for 7 days)
    • the frequency of care – how often the care needs to take place
    • the conditions that need to exist to carry out the order (e.g. client condition, lab result)
  • Except in an emergency, such as a cardiac arrest, avoid verbal orders when you are working in the same location of care as the health professional giving the order.
  • In some cases the best option for the client is for an order to be given by telehealth. In this case, increase client safety by following organizational policy, procedures and restrictions, and the Telehealth practice standard.

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