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Standards for acting with client-specific orders

Part 2: Scope of practice standards

Standards for Acting with Client-specific Orders

1.

Nurses require an order from a listed health professional to perform any restricted activity listed in section 7 of the RN Regulation (to the extent the care provided is not within the activities listed in section 6, or, as noted for certified practice registered nurses, in section 81)

2.

Nurses acting on client-specific orders ensure the ordered activity is:

  • within their scope of practice as set out in the RN Regulation,
  • consistent with any standards, limits and conditions established by CRNBC,
  • consistent with organizational policy, procedures, and restrictions.

3.

Nurses acting on a client-specific order ensure that they have the competence to:

  • carry out the activity safely and ethically,
  • manage the intended outcomes of the activity,
  • recognize unintended outcomes of the activity and implement the plan for dealing with these unintended outcomes.

4.

Nurses obtain an order to perform an activity or provide care or service that is within their autonomous scope of practice when:

  • there are insufficient organizational supports, processes and resources in place (such as decision support tools or clinical practice documents) to enable the nurse to meet CRNBC’s regulatory requirements
  • the nurse does not have the individual competence to make a nursing diagnosis or carry out an assessment to determine whether the client would benefit from the activity, care or service, but is competent to carry out the procedure (e.g. complex wound care)

5.

Nurses only act on a client-specific order from a non-listed health professional when:

  • the activity is within autonomous scope of practice
  • the activity is within the nurse's individual competence
  • organizational supports, processes and resources, including policies and procedures, exist that:
    • clarify the accountability and responsibility of the nurse and the non-listed health professional
    • outline the requirements for the non-listed health professional to complete an assessment and to ensure that the ordered activity is in the best interest of the client

If an organization does not have supports, processes and resources related to client-specific orders by non-listed health professionals, nurses follow the scope of practice standards for acting within autonomous scope of practice.

6.

Nurses acting on an order ensure that the order:

  • is client-specific
  • is clear and complete
  • is documented, legible, dated and signed with a unique identifier such as a written signature or an electronically generated identifier
  • contains enough information for the nurse to carry it out safely.

7.

Nurses accept verbal or telephone orders only when there is no reasonable2 alternative, and when doing so is in the best interest of the client. Nurses repeat the order back to the ordering health professional to confirm that it is accurate. Nurses promptly document any verbal or telephone orders.

8.

Nurses carry out appropriate assessments to ensure that the client's condition continues to warrant the activity before acting with a client-specific order.

9.

Nurses follow organizational policy, procedures and restrictions, and take appropriate action, including communicating and collaborating with the health professional who gave the order, or their delegate, and the health care team when:

  • they are not able to carry out a client-specific order (e.g. hold an order)
  • the order does not seem to be evidence-based
  • the order does not appear to consider a client’s individual characteristics or wishes
  • the ordered activity may no longer be appropriate because the client’s condition, needs or wishes have changed
  • they change or cancel a client-specific order for activities that are within their autonomous scope of practice
  • the safeguards and resources are not available to manage the outcomes of performing the activity including possible unintended outcomes that are reasonably foreseeable

10.

Nurses follow the standards for Acting within Autonomous Scope of Practice and/or Giving Client-specific Orders when they change or cancel a client-specific order and are responsible and solely accountable for any changes that they make.

11.

Nurses may not change or cancel a client-specific order given by a listed health professional when the activity is outside of autonomous scope of practice or the nurse’s individual competence.

12.

Nurses follow legal and ethical obligations regarding client consent.

Applying the standards for acting with client-specific orders

Footnotes

1 Certified practice registered nurses do not require an order for a restricted activity listed in section 8 of the RN Regulation that is within the autonomous scope of the nurse’s certified practice designation and the nurse’s individual competence.
2 Reasonable refers to the common understanding that registrants of the nursing profession would have as to what is appropriate in the situation.
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