Practical Nursing Scope of Practice

Scope of practice is a decision boundary, not a list of procedures a practical nurse may perform in every situation. Three questions must be separated: - Scope: Does legislation and the nurse’s registration permit this type of activity? - Competence: Does this nurse have the knowledge, technical skill, and judgment to perform it safely? - Authorization: Is there an order, directive, delegation, or other recognized mechanism permitting the act for this client and setting? A fourth factor is context. The practice setting, employer policy, client acuity, available resources, and conditions on the registration certificate can narrow what is appropriate at that moment. An assignment from another nurse or a prescriber cannot expand legal scope, and a nurse’s previous experience cannot replace a required authorizing mechanism. This distinction prevents two opposite errors. A practical nurse may be legally authorized to perform an act but still need to decline because the nurse is not competent or the client’s condition exceeds the nurse’s capability. Conversely, a nurse may be technically capable of a procedure but unable to perform it because the provincial rules,...