Answer
A procedure or activity is within a nurse’s scope of practice only when all of the following conditions are met:

The procedure or activity falls within your legislative scope
The procedure or activity is supported by your employer or practice setting
You have the knowledge, skill and judgment to perform the procedure or activity

If you can answer “yes” to all three of those criteria, then the procedure or activity is within your nursing scope of practice. If you cannot answer yes to all three questions, do not perform the procedure or activity. Consult with your broader health care team about next steps.

How do I determine if something is within my legislative scope?
The Nursing Act, 1991 and the Regulated Health Professions Act, 1991 determine how the nursing profession is regulated in Ontario. Both acts focus on the nursing scope of practice statement and the authority of nurses to perform a series of controlled acts.

Depending on your practice setting, you may also be accountable to other legislation. For instance, the Public Hospitals Act, 1990 governs nurses working in hospitals and the Long-Term Care Homes Act, 2007 governs nurses working in long-term care facilities. It is your accountability to understand the legislative requirements that impact your practice.

Reflect on your legislative scope of practice by considering:

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 my class of registration?
Are there appropriate authorizing mechanisms (direct orders, directives, delegation, or initiation) in place to support me performing the procedure or activity?
What legislation may be relevant to my practice (federal legislation, provincial legislation)?
What is my understanding of how this legislation impacts my practice?

How do I determine if the procedure or activity is supported by my employer or practice setting?
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. We encourage you 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.

Reflect on your employer scope by considering:

Is the procedure or activity within my documented role description?
Do organizational policies support me performing the procedure?
Are the necessary resources available to support me before, during and after the procedure or activity?
Will resources continue to be available when performing future procedures or activities?

How do I determine if I have the knowledge, skill and judgment?
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.

Reflect on your individual scope by considering:

Am I the most appropriate care provider?
Do I have the knowledge, skill and judgment to:
- Assess the appropriateness of performing the procedure?
- Perform the procedure?
- Manage the patient before, during and after the procedure?
How will I obtain and maintain my competence?

Have a question? Check out Ask Practice, where you'll find answers to frequently asked questions about nursing scope of practice and other practice issues. You can also write to us. Our Practice Support team can help you understand your nursing accountabilities.

February 2020 Standard Quiz