Scope of practice refers to the range of activities that a health-care professional is both educated and authorized to perform. The boundaries of a health-care professional’s scope of practice are outlined in legislation and their profession’s practice directions and/or standards of practice as well as the Code of Ethics. These boundaries evolve over time to meet the ever-changing needs of populations and the health-care system. Enhancing your understanding of scope of practice in Manitoba is important to provide safe, competent, and ethical care.
The Practice of Registered Nursing General Regulation defines registered nurse scope of practice. Through the course of applying registered nursing skill, knowledge, and judgment you may perform reserved acts. Reserved acts are clinical activities that present a significant risk of harm to the public when not performed competently.
In essence, the Regulated Health Professions Act (RHPA) sets out what clinical activities are reserved acts and the regulations specify which of these reserved acts are within the RN profession’s scope of practice. Authorization mechanisms are a way in which RNs obtain the authority to perform a reserved act. Authorization mechanisms include orders, clinical decision tools, practice directions, and additional education.
Here are some examples of different types of authorization mechanisms currently in place.
Example One: Reserved Acts
Reserved Act 1- Diagnosis
Making a diagnosis is authorized to all registered nurses of all registrant classes. As a registered nurse, you may only make a diagnosis that is appropriate to your practice. Assessment and diagnostic skills are important aspects of diagnosis. This reserved act is completed only when you communicate the diagnosis to the individual client (or their personal representative) within the context of a professional nurse-client relationship. However, when you do not have the necessary clinical knowledge, diagnostic information and/or professional relationship to communicate the diagnosis, you cannot make that diagnosis.
Reserved Act 2- Ordering or Receiving Screening or Diagnostic Tests
Ordering or receiving reports of screening or diagnostic tests may be performed by registered nurses within the RN registrant class in an approved practice setting if:
- the clinical decision tool is in place at the approved practice setting; or
- a collaborative relationship exists with a health-care professional legally permitted and competent to order and receive the tests.
A clinical decision tool is a document that guides the assessment, diagnosis, or treatment of a client-specific clinical problem. A clinical decision tool may include medication administration if the medication is for a client with an urgent/emergent presentation where access to the appropriate authorized prescriber is not available or timely. Please review the College document “What is a Clinical Decision Tool” to better understand the requirements and limitations of a clinical decision tool.
Example Two: Orders
A current Public Health Order provides authority to Public Health Nurses to manage patients with certain Sexually Transmitted and Bloodborne Infections. This authority is provided by the Chief Public Health Officer and is in effect until May 31, 2023. The authority is provided to Public Health Nurses as described in the College document Public Health Nurse (PHN) Authorization to Treat Chlamydia, Gonorrhea and Syphilis
Example Three: Practice Direction
Rural, Remote and Underserved Population Access to Medication
RNs and RN(NP)s support clients in a variety of practice settings including those in rural, remote and underserved areas.
Clients in rural, remote, and underserviced areas are at risk for potentially harmful delays in care because of barriers to timely access to services.
When clients are provided medications by staff in a rural or remote practice setting, for example, we recognize the importance of safeguards and protocols that need to be followed. Collaborative teamwork is essential to ensuring safe, timely and responsive care to underserved populations.
Please refer to the Practice Direction: Rural, Remote and Underserved Population Access to Medication to better understand the requirements and limitations.
Example Four: Notation to Prescriber
Registered Nurse Authorized Prescriber (RN(AP))
The Authorized Prescriber role enables Registered Nurses to bring a distinct impact on access and quality care within three practice areas in Manitoba: sexual and reproductive health, diabetes management, and travel health. This innovation allows for RN(AP)s to independently prescribe within their current positions for Manitobans within a collaborative work environment.
The AP notation is an additional authority that was provided for in The Regulated Health Professions Act in May 2018 with a goal to transition RNs functioning in an AP role to have this notation by May 2023. Registered Psychiatric Nurses are not bound to this end date.
If you are interested in achieving your Authorized Prescriber notation:
- Review CRNM Authorized Prescriber resources.
- Work with your Leadership team to confirm the need for the role and available support.
Options may include:
- Prescriber Continuing Competence Assessment
- Course Work through Athabasca University or Red River College Polytechnic
- Clinical Practicum Coordinated through Red River College Polytechnic
Both the registrant and the registrant’s employer/leadership team are in the best position to determine what mechanism is the most appropriate in the practice setting to support high-quality, safe and ethical care.
RN(AP) Resource Page: https://www.crnm.mb.ca/rns-nps/practice-support/rnap-resources/
Diabetes Health Stream Update
Red River College Polytechnic is developing the learning module which, once complete, will go to CRNM Council for approval. Watch for updates on our website for more details in the RN(AP) Resource section
Individual scope of practice is comprised of the skill, knowledge, and judgement that you have obtained within the legislated scope of practice of the profession.
Throughout your career, you will need to continually maintain, enhance, and attain skill, knowledge, and judgment within the legislated scope of practice to meet client needs. The annual continuing competency program can help you maintain, enhance, and attain competence.
There are five main areas of responsibility related to scope of practice:
- Ensuring you are legally authorized
- Ensuring you are competent
- Client safety
- Collaborative practice
When faced with changing practice environments, advances in technology and emerging issues, you can apply scope of practice concepts and the five areas of responsibility to determine actions to take to ensure your practice is authorized, competent, safe, appropriate, and collaborative.
Please feel welcome to contact a member of the College Quality Practice Team if you have additional questions.