Scope of Practice Flashcards

According to the CNO Scope of Practice standard, which of the following is the primary basis for a nurse's authority to practice?

Answer: Provincial legislation, including the Nursing Act, 1991 and the Regulated Health Professions Act, 1991.

The CNO's Scope of Practice standard states that a nurse's authority to perform activities is defined in legislation, specifically the Nursing Act, 1991 and the Regulated Health Professions Act, 1991 (RHPA). While employer policies, orders, and individual competence are crucial factors in decision-making, the legal authority to practice originates from provincial law.

A Registered Practical Nurse (RPN) working in a community clinic is asked by a physician to administer a substance by injection, a controlled act. The RPN has not performed this specific type of injection before. What is the most appropriate initial action for the RPN to take?

Answer: Reflect on their individual competence and inform the physician they lack the knowledge, skill, and judgment to perform the act safely.

The CNO's Scope of Practice standard requires nurses to consider three key concepts: authority, context, and competence. While the RPN has the authority to perform the controlled act with an order, they are accountable for ensuring they have the individual competence (knowledge, skill, and judgment) to do so safely. The most appropriate action is to recognize their limitations and communicate this to the ordering provider.

Which of the following statements about an employer's role in a nurse's scope of practice is correct?

Answer: Employers can limit a nurse's scope of practice but cannot expand it beyond what legislation permits.

According to the CNO, employers can establish policies that may restrict or limit what a nurse can do in a specific practice setting. However, they cannot authorize a nurse to perform activities that fall outside the legislated scope of nursing practice. A nurse's primary accountability is to meet CNO standards, even if they conflict with employer policies.

A Registered Nurse (RN) delegates the task of performing a simple dressing change, which is below the dermis, to an Unregulated Care Provider (UCP) for a stable client. Who is ultimately accountable for the decision to delegate this controlled act?

Answer: The RN who delegated the task.

The CNO's Scope of Practice standard clarifies that when a nurse delegates a controlled act, they are responsible for the decision to delegate. This includes ensuring that the delegatee is competent to perform the act safely. While the UCP is responsible for performing the task properly, the delegating nurse retains accountability for the delegation decision itself.

An RN in a public hospital independently decides to insert a finger beyond the anal verge to assess for fecal impaction, which is a controlled act. In this setting, the nurse requires which of the following to perform this act?

Answer: A direct order from a physician or Nurse Practitioner.

While RNs and RPNs can initiate certain controlled acts in some settings, the Public Hospitals Act restricts this authority. In a hospital, an order from an authorized provider (like a physician or NP) is required for a nurse to perform most controlled acts, including putting a finger beyond the anal verge.

To determine if performing a specific activity is within their scope of practice, a nurse must consider three essential components. These are:

Answer: Authority, Context, and Competence.

The CNO's Scope of Practice standard is structured around three key concepts that a nurse must consider before performing any activity: Authority (do I have the legal right?), Context (is it appropriate in this setting?), and Competence (do I have the knowledge, skill, and judgment?).