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Understanding Your Scope of Practice
Nurses and nurse employers: A new provincial order authorizes health care professionals, including nurses, to provide patient care services outside their regular scope of practice. It also enables hospitals to engage regulated health professionals from out of province.
As a nurse, how do I determine if a procedure or activity is within my scope of practice?
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 relevant legislation, such as the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA). Both acts focus on the nursing scope of practice statement and the authority of nurses to perform a series of controlled acts.
The scope of practice statement for nurses in Ontario states:
“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”
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 Long-Term Care Homes Act governs nurses working in long-term care facilities.
It is your accountability for understanding the legislative requirements and determining if the procedure or activity lies within your scope of practice.
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 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 encouraged to consult with your employer and broader health care team to determine if your practice setting supports the performance of the procedure. This includes reviewing and understanding relevant organizational policies. 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 ?
- Are the necessary resources available to support you before, during and after the procedure or activity?
- Will resources continue to be available when performing future procedures or activities?
A nurse’s individual scope of practice is unique and specific to each nurse. A variety of factors can influence individual scope, including the context of the nurse’s practice setting, competence, knowledge, skill and judgment. Prior to performing any procedure or activity, nurses are accountable for reflecting on their individual scope and considering whether they have the adequate knowledge, skill, and judgment to perform the activity or procedure safely and competently.
Nurses can expand their individual scope by engaging in several different learning activities, such as taking courses, obtaining certifications or developing new skills. Nurses also are accountable for continuing their competence and addressing gaps they may have in their practice, so they 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?
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.