August 2021

Ask these four questions before performing any procedure or activity

Over the past few months, we’ve heard from many of you that emergency orders, the dynamic nature of the pandemic and an increase in redeployment across practice settings have led to questions about what procedures and activities you’re currently allowed to perform.

We hear you — and our Practice Quality team has an answer.

Although there are many factors that will influence your decision, the formula for making that decision is simple. For any situation, to determine whether you can perform a particular procedure or activity, ask yourself the following four questions. If you can answer “yes” to all of them, then it’s appropriate for you to perform it.

1. Do I have the authority?

Your legislated scope of practice comes from the Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991. However, your practice can be impacted by other factors, such as federal and provincial legislation, and your workplace policies.

It's important to note that what nurses can do can in different practice settings can vary as some legislation is specific to certain settings. For example, an RN working in a hospital will have a different authority than an RN working in the community.

Your practice can also be impacted by emergency orders, such as those the government has implemented throughout the COVID-19 pandemic. While emergency orders are in effect, they may override the existing legislation that normally governs your practice. Work with your employer to determine whether specific emergency orders apply to your practice setting. You can find a list of the emergency orders currently in effect that may affect your nursing practice here.

In addition to emergency orders, certain exemptions to legislation may also affect your practice. For example, the Ministry of Health has created an exemption in the Regulated Health Professions Act, 1991 to allow RNs and RPNs to administer the COVID-19 vaccine without an order.

It is your accountability to be aware of your legislated scope of practice and other legislation or policies that might impact your practice. You can do this by staying informed about your employer’s policies, and reading The Standard and other information CNO sends you.

2. Does my employer/practice setting support it?

Your employer is responsible for determining your roles and responsibilities. This includes establishing whether you can perform certain activities and procedures in your practice setting.

We encourage you to review and understand your workplace’s policies. As well, consult with your employer and broader health care team to make sure your practice setting supports performing a procedure. If your practice setting does not support performing a procedure or activity, you can advocate for and assist in developing policies and procedures that prioritize patient safety.

3. Do I have the knowledge, skill and judgment?

Just because you can do something doesn’t mean you should. Before performing any procedure or activity, consider whether you have the knowledge, skill and judgment to perform the activity or procedure safely and competently, as well as to manage any potential outcomes.

If you feel that you don’t, then don’t perform the procedure or activity. Instead, identify your learning gaps and talk to your employer and health care team about them. Seek out any training or education opportunities (including peer mentoring) to ensure you can provide safe patient care. If necessary, transfer care to a more appropriate health care provider.

4. Is it in the best interest of the patient?

Assess the patient, their wishes, goals of care and care needs. Your patient may have unique needs or specific care goals, and it’s a nurse’s role to be the patient’s advocate. The Code of Conduct says that nurses treat patients as individuals and work together to promote patient well-being.

Since no two patients, practice settings, employers, or individual nurses’ knowledge, skill and judgment will be exactly alike, it’s important to ask and apply these questions each time. Understanding them, and why each is important, will enable you to provide the safest possible care for your patients.

Learn more about nursing scope of practice by reading Understanding Your Scope of Practice. If you have questions, contact Practice Support.
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