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Understanding Your Scope of Practice
As a nurse, how do I determine if a procedure or activity is within my scope of practice?
"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."1
To determine if a procedure or activity is within your scope of practice, you must consider and answer ‘Yes’ to the following questions:
Nurses are accountable to practice under the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA). Both acts focus on the nursing scope of practice and the authority of nurses to perform procedures and 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 for understanding the legislative requirements and determining if you have the authority to perform the procedure or activity.
Below are guiding questions to help you reflect on the legislative scope of practice:
- Does the procedure or activity align with the nursing scope of practice statement?
- Is the procedure or activity a controlled act authorized to nursing and to your class of registration?
- Are there appropriate authorizing mechanisms (direct orders, directives, delegation, or initiation) in place to support the performance of the procedure or activity?
- What other legislation may be relevant to your practice (federal legislation, provincial legislation)?
- What is your understanding of how this legislation impacts your practice?
- Code of Conduct
- RHPA: Scope of Practice, Controlled Acts Model
- Legislation and Regulation: An Introduction to the Nursing Act, 1991
- Authorizing Mechanisms
Employers are responsible for determining the roles and responsibilities of their employees, including determining whether nurses can perform certain activities and procedures in the practice setting. You are accountable to determine if your practice setting supports the performance of a procedure or activity. This includes reviewing and understanding relevant organizational policies and consulting with your employer and broader health care team. If your practice setting does not support the performance of a procedure or activity, you can advocate for and assist in the development of policies and procedures in the interest of patient safety.
Below are some guiding questions to help you reflect on the employer scope:
- Is the procedure or activity within your documented role description?
- Do organizational policies support your performance of the procedure or activity?
- Are there resources to support you before, during and after the procedure or activity?
A nurse’s individual scope of practice is unique and specific to each nurse. A variety of factors can influence your individual scope, including the context of the practice setting, competence, knowledge, skill and judgment. Prior to performing any procedure or activity, you are accountable to reflect on your practice and consider whether you have the knowledge, skill, and judgment to perform the activity or procedure safely and competently.
You can expand your individual 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 scope:
Are you the most appropriate care provider?
- Do you have the knowledge, skill and judgment to:
a) Assess the appropriateness of performing the procedure?
b) Perform the procedure?
c) Manage the patient before, during and after the procedure?
- How will you obtain and maintain your competence?
- Code of Conduct
- Decisions About Procedures and Authority
- Ask Practice FAQ on Continuing Competence
- CNO Quality Assurance resources
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.