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Understanding Scope of Practice and Your Nursing Accountabilities
As a nurse, how do I determine if I can perform a procedure? Or if an activity is within my scope of practice?
The Nursing Act, 1991 defines the nursing scope of practice as:
"The practice of nursing is the promotion of health and the assessment of, the provision of care for and the treatment of health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function."
To determine whether you can perform an activity, you must consider and answer ‘Yes’ to the following questions related to authority, context and competence:
Nurses are accountable to comply with the regulations under the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA). These Acts give nurses the legal authority to perform a range of activities including controlled acts.
Depending on your practice setting, you also may be accountable to other legislation. For instance, the Public Hospitals Act governs nurses working in hospitals and the Fixing Long-Term Care Act, 2021 governs nurses working in long-term care facilities.
It is your accountability to understand the legislative requirements and determine if you have the authority to perform an activity in your practice setting.
Below are guiding questions to help you reflect on and assess if you have the authority:
- Does the activity align with the nursing scope of practice statement?
- Is the activity a controlled act authorized to nursing?
- Do you have the appropriate authorizing mechanisms (for example, direct orders, directives, or delegation) in place to support the performance of the activity?
- Have you considered other legislation that is relevant to your practice (federal legislation, provincial legislation)?
Employers are responsible for determining the roles and responsibilities of their staff, including determining whether nurses can perform specific activities in the practice setting.
You are accountable to determine if your workplace policies support the performance of an activity in the practice setting. This includes reviewing and understanding relevant policies, the availability of resources and consulting with your employer and broader health care team.
If your practice setting does not support the performance of an activity, you can advocate for and assist in the development of policies and procedures in the interest of client safety.
Here are some guiding questions to reflect on:
- Is the activity within your documented role description?
- Do organizational policies support your performance of the r activity?
- Are there resources to support you before, during and after the activity?
Each nurse may require different amounts of training, support and resources to reach the level of competence required to safely perform a particular activity.
You are accountable for reflecting on your practice and considering whether you have the competence, which is the knowledge, skill, and judgment to perform the activity safely, including managing any adverse outcomes.
You can expand your individual competence in your practice by engaging in different learning activities, such as taking courses, obtaining certifications or developing new skills. You also are accountable to participate in Quality Assurance to continue your competence and address learning needs you have in your practice, so you are able to safely provide care.
Below are some guiding questions to help you reflect on your individual practice:
- Do you have the knowledge, skill and judgment to:
a) Assess the appropriateness of performing the activity?
b) Perform the activity?
c) Manage the client before, during and after the activity?
- How will you obtain and maintain your competence?
By answering ‘yes’ to all of the above questions, you may perform the activity in accordance with the standards of practice.
The organization of this resource is adapted from the College of Licensed Practical Nurses of Alberta, LPN Practice Decision-Making Tool, 2019.
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By answering ‘yes’ to all of these questions, you may perform the procedure or activity in accordance with the standards of practice.
The organization of this resource is adapted from the College of Licensed Practical Nurses of Alberta, LPN Practice Decision-Making Tool, 2019.
