Nurse Role

RN – Reproductive Health (Contraceptive Management) Certified

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    Care Activities this role could do

    • RN – Reproductive Health (Contraceptive Management) Certified: Can autonomously educate, assess patient preference, and determine the best hormonal contraceptive for patients. They can dispense and/or administer combined hormonal contraception and progestin-only hormonal contraception. They are also able to prescribe if they have taken the prescribing course and are supported by their employer.

      They can implant and remove implanted progestin-only hormonal contraception (POHC) if they have completed an implant-specific, hands-on recommended training or equivalent program prior to autonomous insertion or removal of a contraceptive implant.

      RN – Reproductive Health (Contraceptive Management) Certified Nurses cannot insert IUDs regardless of if a patient specific order is given and they have additional training such as the IUD/LARC course.

    • 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).

    • RN- Reproductive Health (Sexually Transmitted Infections) Certified: Can autonomously medically diagnose and treat most STIs as outlined by BCCDCs Decision Support Tools. This includes compounding, dispensing, and administering pharmacological treatments. They are also able to prescribe if they have taken the prescribing course and are supported by their employer.

      If a clinic is interested in dispensing, STI medications can be ordered directly from BCCDC. This requires clinics to maintain ability to manage medication inventory. If clinic does not want to maintain medications on-site, the primary care provider or the Reproductive Health (Sexually Transmitted Infections) Certified Nurse can write a prescription to provide the patient.

      RNs: RNs cannot diagnose or treat most STIs but do a wide range of care activities related to Sexually Transmitted Infections including assessment and testing. 

      To understand differences in care activities that can provided by certified and non-certified practice, we recommend reviewing the BCCDC document on BCCDC Communicable Diseases: Certified Practice vs. Non-certified Practice: What is the difference?. 

      Additional Links:
      BCCDC Information on the Certified and Non-Certified Practice for STIs
      Communicable Diseases Control Manual – STIs
      NNPBC Decision Support Tools for Certified Practice RNs
      PHSA Competencies for Pelvic Exams
      BCCDC Non-Certified Practice Decision Support Tool for Pelvic Exam

    • 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 LPNs.  LPNs 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

    • RN: RNs can carry out wound care autonomously BELOW the dermis, without an order, including cleansing, irrigating, probing, debriding, packing, dressing, and suturing if they  have successfully complete additional education in wound management.

      With this additional education, RNs can provide a client specific order for, or carry out, conservative sharp wound debridement, negative pressure wound therapy, maggot therapy or compression therapy.  They can also diagnose conditions associated with wounds below the dermis or surface of the mucous membrane.

      Suturing limited to uncomplicated skin lacerations and must follow the Decision Support Tool.

      LPN: LPNs are limited to wound care ABOVE the dermis. LPNs can provide wound care for more extensive wounds but must be following a wound care treatment plan, have additional education, and follow Decision Support Tools. With these supports in place LPNs can provide wound care to a tunneled wound including probing, irrigating, packing, or dressing.

      LPNs DO NOT carry out any form of sharps debridement.

      Additional Links:
      BCCNM: LPN Restricted activities that do not require an order
      BCCNM: RN Restricted activities that do not require an order – Wound Care

    • RNs can undertake primary care triage. However, while triage is part of the basic competency for all RNs this can be highly dependent on clinical experience. If triage is important to have as a skill, be sure to clearly articulate this in the job description and ask potential nurses about their experience and individual competency with triage.

      LPNs are not able to undertake triage activities.

      Additional Links:
      Understanding Nursing Scope of Practice

    • 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

    • Immunizations are a restricted activity for 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.

      Immunization competencies may be achieved through extra education and employer support or by completing BCCDC’s immunization competency course. Some immunizations require you to complete BCCDC’s immunization competency course before compounding, dispensing or administering them.

      Additional Links:
      BCCNM Immunization Scope Information
      BCCDC Immunization Competencies
      BCCDC Immunization Additional Education
      BCCDC Immunization Decision Support Tools (DSTs)
      RN 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

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

      RNs: Can autonomously administer routine and travel vaccines to all ages provided they:

      Additional Links:
      BCCNM Immunization Scope Information
      BCCDC Immunization Competencies
      BCCDC Immunization Additional Education
      Canadian Immunization Guide
      Canadian Communicable Disease Reports
      RN Limits and Conditions on Immunizations

    Nursing Scope of Practice

    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.