Autonomous Scope of Practice and Client-specific Orders (Acting with Client-specific Orders and Giving Client-specific Orders)

In December 2015, government approved changes to the Nurses (Registered Psychiatric) Regulation. CRPNBC has been working since then to incorporate these changes in our standards of practice.

What are the changes?

The changes to RPN scope of practice include one new and two revised scope of practice standards. We’ve made some language changes and introduced a new concept—giving client-specific orders.

How can I learn more?

Download the PDF

Review the three scope standards:

CRPNBC’s role

Remember: your employer may put additional requirements into place.

Scope of Practice Standards establish the standards, limits and conditions for Registered Psychiatric Nurses’ practice. These scope of practice standards link to other standards, policies and by-laws of CRPNBC  and all legislation relevant to nursing practice.

For the purposes of these scope of practice standards, the “RPN Regulation” refers to the Nurses (Registered Psychiatric) Regulation which applies to Registered Psychiatric Nurses in British Columbia.

Organizations establish processes, supports and resources such as policies, procedures and decision support tools to ensure that RPNs meet the standards of practice set out by CRPNBC.

INTRODUCTION

These scope of practice standards outline the requirements for RPNs when they are providing client care in the following ways:

  • Acting within autonomous scope of practice.
  • Acting on client-specific orders.
  • Giving client-specific orders.

Depending on the controls on practice, including the RPN Regulation, autonomous scope of practice, organizational policies and restrictions, and the RPN’s individual competence, RPNs may provide care to clients by:

  • Acting within autonomous scope of practice and the RPN’s individual competence when carrying out
    • non-restricted activities, and
    • restricted activities within Section 6 of the RPN Regulation.
  • Acting on a client-specific order from a listed health professional for a restricted activity that is within Section 7 of the RPN Regulation (to the extent the care provided is not within  autonomous scope of practice under section 6).
  • Acting on a client-specific order from another regulated health professional for an activity that is within autonomous scope of practice and the RPN’s individual competence.
  • Giving a client-specific order for an activity within autonomous scope of practice and the RPN’s individual competence.

What is a client-specific order?

A “client-specific order” is any instruction or authorization given by a regulated health professional to provide care for a specific client, whether or not the care or service includes any restricted activity.

Client-specific orders can include instructions that set out the usual care for a particular client group or client problem and are made client-specific by the ordering regulated health professional.

The order must:

  • Be documented in the client’s permanent record by the regulated health professional.
  • Include all the information needed for the ordered activity to be carried out safely (e.g. time, frequency, dosage).
  • Include a unique identifier such as a written signature or an electronically generated identifier.

Once given, orders may be transcribed in other documents such as a client care plan.

What is not a client-specific order?

  • An instruction that is recorded in any type of communication tool, for example a kardex, that is not signed or recorded in the client’s permanent record, is NOT an order.
  • A consultation, referral or recommendation is NOT an order.

Related Standards of Practice

  • Scope of Practice Standards, Limits and Conditions for Registered Psychiatric Nurses.
  • Consent Practice Standard.
  • Documentation Practice Standard.
  • Privacy and Confidentiality Practice Standard.

Other CRPNBC Resources

For more information on this or any other practice issue, contact CRPNBC’s Practice Consultant by email at [email protected] or call 604.931.5200 or 1.800.565.2505.

© Copyright College of Registered Psychiatric Nurses of British Columbia 2017
 

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