5 Tips for Understanding the Scope of Practice Standards
Scope of practice standards establishes the standards, limits and conditions for Registered Psychiatric Nurses’ (RPNs) practice. These scope of practice standards link to other standards, policies and bylaws of CRPNBC and all legislation relevant to psychiatric nursing practice.
The Autonomous Scope of Practice and Client-specific Orders Standards are now in effect.
These standards outline the requirements for RPNs when they are providing client care in the following ways:
- Acting within autonomous scope of practice
- Acting with client-specific orders
- Giving client-specific orders
We’ve made some language changes and introduced the concept of giving client-specific orders. We’ve put together an overview to help you understand the changes to the scope standards and to consider how they will apply in your practice. It’s important to read the Scope of Practice Standards: Autonomous Scope of Practice and Client-Specific Orders in full.
+1. Review the changes to the standards
Standards for Acting within Autonomous Scope of Practice
What’s the same?
You’ll be familiar with the standard Acting within Autonomous Scope of Practice We’ve updated the language to reflect that psychiatric nursing has an autonomous scope of practice. This scope standard outlines the requirements when you carry out activities that are not restricted and section 6 restricted activities within autonomous scope of practice and your individual competence.
Examples of acting within autonomous scope of practice
- Assessing a resident in a group home, you diagnose uncomplicated pain related to arthritis and administer acetaminophen.
- Diagnosing anaphylaxis in a client post-immunization and treating with epinephrine according to your organization’s DST.
- Suspecting urinary retention in a client, you carry out a bladder scan. Confirming the diagnosis, you treat it with an in-and-out catheterization.
Learn more about diagnosing and treating conditions.
Standards for Acting with Client-specific Orders
What’s the same?
You’ll also be familiar with the standard Acting with Client-specific Orders. This scope standard sets out the requirements for acting on a client-specific order from a listed health professional for a section 7 restricted activity. Listed health professionals now include dentists, midwives, naturopaths, pharmacists, physicians, podiatrists, certified practice registered nurses and nurse practitioners.
In your current practice, you may already follow direction for client-specific care from other health professionals for activities within your autonomous scope and individual competence.
Acting with client specific-orders defines and formalizes this process and clarifies accountability when you act on a client-specific order from a non-listed health professional for an activity that is not restricted or within section 6 of the regulation.
You’ll need to obtain a client-specific order for an activity within RPN autonomous scope of practice when:
- You do not have the competence to diagnose the condition or assess the client and determine appropriate treatment.
- Organizational supports are insufficient to allow you to meet CRPNBC’s regulatory requirements.
Non-listed health professionals are regulated professionals not listed within the RPN Regulation. They have specialized competence (within their own autonomous scope) that allows them to assess clients and recommend care appropriate for the client’s condition. This includes physiotherapists, dietitians, occupational therapists, wound care nurse-clinicians, RPNs, registered nurses and psychologists.
Examples of acting with client-specific from non-listed health professionals
- Mobilizing a fresh post-operative client with complex mobility issues acting on a client-specific order from a physiotherapist.
- Altering a client’s enteral feed, acting on a client-specific order from a dietitian.
- Preventing further contracture by applying a splint to your client’s hand, acting on a client-specific order from an occupational therapist.
- Following a client-specific order from a psychologist, you follow the behaviour modification plan which is documented in the clients chart.
Standards for Giving Client-specific Orders
In your practice, you may already give direction for client-specific care. We’ve introduced the concept of Giving Client-specific Orders This scope standard sets out the requirements when giving a client-specific order for an activity within autonomous scope of practice. When giving a client-specific order, you also need to meet the requirements of Acting within Autonomous Scope of Practice
Examples of giving client-specific orders
- Assessing a client, you diagnosis suicidal ideation and give a client-specific order for constant observation for suicide risk.
- To assess for suspected urinary retention in a client, you give a client-specific order for a bladder scan.
- Diagnosing dry eyes in a client, you give a client-specific order for artificial tears.
+2. Be familiar with these key concepts
Autonomous scope of practice
For RPNs, “autonomous scope of practice” includes the restricted activities listed in section 6 of the RPN Regulation, and the provision of other care or services that do not involve restricted activities, except for any activities, care or services that are excluded from autonomous scope of practice under CRPNBC standards, limits, conditions and other controls on practice.
An “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.
The client-specific 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, etc.).
- Include a unique identifier such as a written signature or an electronically generated identifier.
Diagnosing a condition
The RPN Regulation sets out the type of diagnosis RPNs can make. Specifically, RPNs can make a nursing diagnosis that identifies a condition, not a disease or disorder, as the cause of a client’s signs or symptoms.
This nursing diagnosis is a clinical judgment about the cause of a client’s mental or physical condition. It is made to determine whether the condition can be improved or resolved by the RPN intervening appropriately to achieve a result for which the RPN is accountable.
Listed health professional
A “listed health professional” is a health professional who is regulated, and authorized by the RPN Regulation to give orders for the performance of activities listed in section 7. Listed health professionals are dentists, midwives, naturopaths, physicians, podiatrists, pharmacists, certified practice registered nurses and nurse practitioners.
Non-listed health professional
A “non-listed health professional” is a regulated health professional that is not listed within the RPN Regulation. Non-listed health professionals have specialized competence within their profession’s autonomous scope of practice and within their own individual competence that allows them to assess a client and to design or recommend care appropriate for the client’s condition.
Examples of non-listed health professionals include physiotherapists, dietitians, and occupational therapists, wound care nurse-clinicians, RPNs, registered nurses (who are not certified practice registered nurses or nurse practitioners) and psychologists. Some examples of orders given by non-listed health professionals include orders for enteral feeds, mobilization plans, group therapy approaches or wound management.
“Restricted activities” are higher risk clinical activities that must not be performed by any person in the course of providing health services, except members of a regulated profession that has been granted specific legislative authority to do so, based on their education and competencies.
+3. Learn more about RPN scope of practice
RPN scope of practice
The scope of practice for RPNs in British Columbia is set out in the Nurses (Registered Psychiatric) Regulation under the Health Professions Act. Additional scope of practice information is included in CRPNBC’s Bylaws, Standards of Scope of Practice for Registered Psychiatric Nurses: Standards, Limits and Conditions.
How practice is described in the regulation
RPN practice includes activities that are not restricted and restricted activities (section 6) that RPNs can carry out within their autonomous scope of practice and restricted activities (section 7) that require a client-specific order from a listed health professional. RPNs move from novice to expert without having to obtain any additional regulatory approval from CRPNBC.
CRPNBC determines which activities are considered the practice of psychiatric nursing.
+4. Understand the controls on nursing practice
There are four levels of controls on RPNs’ practice:
- The Health Professions Act and Nurses (Registered Psychiatric) Regulation, which sets out the scope of practice in fairly broad strokes.
- CRPNBC standards, limits and conditions, which complement and further define and limit the scope of practice set out in the RPN Regulation.
- Employer/organizational policies, which may restrict RPNs’ practice in a particular agency or unit.
- An individual RPN’s competence to carry out a particular activity.
While the new and revised scope standards are in effect, your practice will not change until your organization puts policies and supports in place.
5. Consider your practice context
Consider your practice setting, interdisciplinary team and organizational supports.
- What conditions do I diagnose and treat or prevent?
- What organizational supports and resources are in place to support me?
- Do I currently act on direction from non-listed health professionals?
- In what situations would I obtain a client-specific order from a non-listed health professional?
- Do I currently give direction for client-specific care to other health care providers/professionals?
- In what situations might I give a client specific order?
Be aware that although these are in effect, your practice will not change until your organization puts policies and supports in place.