Nurse Role

Licensed Practical Nurse (LPN)

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    Additional Care Activities this role could do

    Care Activities this role could do

    • RNs and LPNs can coordinate care.  This may include coordination with other healthcare teams, (e.g. home care, long-term care), coordinating transfers to hospital, or coordinating on follow-up care after discharge from hospital.

    • Casting is a restricted activity for both RNs and LPNs. Both RNs and LPNs, can apply a cast for a fracture of a bone, with he following conditions:

      • Require a client specific order from a physician or nurse practitioner registered in BC.
      • Must successfully complete additional education. For questions about additional education, please contact BCCNM.

      Additional Links:

    • RNs: Can assess and provide education to patients living with chronic illness. This includes unstable or unpredictable chronic illness with general and patient specific care plans, including educating, assessing, and monitoring health status for people living with diabetes, chronic obstructive pulmonary disease (COPD) or heart failure and other chronic illnesses. 

      This also includes medication administering, dispensing, and compounding medications when acting with a client-specific order from an authorized health professional or acting autonomously within their scope of practice when an order is not required.

      LPNs: LPNs can support chronic care case management and are generally limited to providing care for stable or predictable patients.  They can provide care for more complex patients, with experience and additional education.

      Additional Links:
      Nursing Practice Standards – Medication

    • Both LPNs and RNs can design and deliver educational sessions.   For example, a Nurse could facilitate an established patient educational workshop such as “Craving Change” or an Intro to Diabetes course that includes an established agenda of learning outcomes, slide deck with speaking notes, and patient handouts.

      Nurses can also create educational workshops on new topics that are within their areas or scope and competency.

    • RNs & LPNs: Can create and run group visits including:

      • Determining the learning outcomes for the group visit.
      • Researching current evidence-based practices and anticipating participant questions.
      • Building a workshop to educate patients on aspects of prevention/screening, assessment, diagnosis criteria, treatment options including both pharmacological and pharmacological modalities, and ongoing monitoring/management.
      • Providing mock demonstrations and practice/learning with equipment (e.g. learning how to self-inject insulin).
    • RNs: RNs can autonomously provide ear syringing with an ear bulb syringe for the purposes of ear wax removal. If using an Elephant ear syringing method or a similar method with greater water pressure than an ear bulb syringe, an order is required.

      LPNs: Ear syringing is a restricted activity for LPNsLPNs can, with a client specific order, provide ear syringing. If using an Elephant ear syringing method or a similar method with greater water pressure than an ear bulb syringe, an order is required.

      LPNs do not insert a curette or other instrument into the external ear canal.

      This is not an entry-level practice. Employers will need to provide education.

      Additional Links:

      BCCNM RN Limits and Conditions: Putting items into body openings
      BCCNM RN Limits and Conditions: Putting substances into ears

    • LPNs and RNs can assess and provide routine follow-up visits to patients living with chronic illness. The nurse can assess and provide education to patients living with diabetes, chronic obstructive pulmonary disease (COPD) or heart failure and other chronic illnesses when their condition is stable or predictable.

      During the assessment, if the assessment reveals the disease process has changed, the nurse will collaborate and communicate with the clinic team to refer to the physician or nurse practitioner for additional assessment, treatment, and follow up.

    • Immunizations are a restricted activity for both LPNs and RNs that has specific limits and conditions.

      RNs:  RNs can autonomously administer routine vaccines to patients of all ages provided they follow BCCDC Decision Support Tools possess the competencies outlined by the BCCDC, and follow work-place policies..

      LPNs: LPNs are able to undertake immunizations but must be working in a team-based approach. LPNs can compound and administer routine vaccinations but are limited to people 4 years and older who have stable or predictable states of health. LPNs are limited to COVID-19, BCCDC identified immunoprophylactics, influenza, pneumococcal immunizations. They are required to complete BCCDC additional education and follow BCCDC Decision Support Tools

      Additional Links:
      BCCDC Immunization Competencies
      BCCDC Immunization Additional Education
      BCCDC Immunization Decision Support Tools (DSTs)
      LPN Immunization Decision Tree
      RN Limits and Conditions on Immunizations
      LPN Limits and Conditions on Immunizations

    • Both RNs and LPNs can autonomously provide wound care. LPNs are limited to wound care ABOVE the dermis, following a wound care treatment plan, and they must have additional education and follow Decision Support Tools (DSTs).

      Additional Links:
      RN Scope of Practice, Wound Care
      LPN Restricted activities that do not require an order

    Controls on Nursing Practice

    There are 4 levels of control on practice for nurses.  Controls at level 3 and 4 are important to consider when hiring a nurse into primary care. 

    Organizations and employers (YOU!) are responsible for providing support, training, clinical policies specific to your clinic, and workflow processes to support nurses in practice. Employers/Clinics can also place employer or organization level controls on practice for nurses but you cannot expand the nursing scope of practice beyond what provincial legislation allows. 

    Additionally, each Individual nurse will have their own competency.  Each nurse is legally and professionally responsible for their own autonomous nursing practice. Nurses are responsible for assessing their individual competency. Although a care activity may be set out by BCCNM as part of a scope of practice, an individual nurse may determine that they do not have a competency or have been unable to maintain a competency.

    Nurses are responsible for communicating their scope and limits to their employer and actively working with their employer to maintain competency in areas of mutually identified relevance. Nurses and employers work together to identify opportunities for developing competencies to meet the needs of patients. Clinic leaders and colleagues must respect individual nursing competency.  If an individual nurse says “no”, a clinic employer or fellow clinician colleague can’t say “yes”.

    Controls on Practice-BCCNM-Nurse Compass-Team-Based Care BC

    From Controls on Nursing Practice, by British Columbia College of Nurses and Midwives. Reprinted with permission.