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Volume 51, No. 20

B.C. Reg. 284/2008

The British Columbia Gazette,

Part II

October 21, 2008

B.C. Reg. 284/2008 , deposited October 15, 2008, pursuant to the HEALTH PROFESSIONS ACT [Section 12 (2)]. Ministerial Order M244/2008, dated October 10, 2008.

I, George Abbott, Minister of Health Services, order that effective October 17, 2008, the attached Nurses (Registered) and Nurse Practitioners Regulation is made.

— G. ABBOTT, Minister of Health Services.

NURSES (REGISTERED) AND

NURSE PRACTITIONERS REGULATION

Contents

Definitions

College name

Reserved titles

Scope of practice

Patient relations program

Restricted activities

Restricted activities for services under an order

Restricted activities for certified practices

Restricted activities for nurse practitioners

Transitional (certified practices)

Definitions

1 In this regulation:

"Act" means the Health Professions Act ;

"compound" means

(

a) in sections 6 (1) (

k) and 7 (1) (f), to mix a drug with one or more other ingredients, and

(

b) in

section 7 (1) (g), to mix 2 or more ingredients of a therapeutic diet;

"design" means to select the appropriate ingredients for a therapeutic diet;

"dispense"

(

a) in the definition of "prescribe", has the same meaning as in

section 1 of the Pharmacists, Pharmacy Operations and Drug Scheduling Act , and

(

b) if paragraph (

a) does not apply, has the same meaning as in

section 1 of that Act,

(

i) excluding "sell" as defined in

section 1 of that Act, and

(ii) including receipt of payment on behalf of a registrant's employer for a drug dispensed or administered by the registrant, if the registrant's employer lawfully requires payment for that drug from a person in respect of the individual for or to whom it is dispensed or administered;

"health professional" means

(

a) a person who is authorized under an enactment to practice dentistry, medicine, midwifery or podiatry in British Columbia, or

(

b) a nurse practitioner;

"nurse practitioner" means a registrant who is authorized under the bylaws to practise nursing as a nurse practitioner;

"nursing" means the health profession in which a person provides the following services:

(

a) health care for the promotion, maintenance and restoration of health, and

(

b) prevention, treatment and palliation of illness and injury, primarily by

(

i) assessment of health status,

(ii) planning and implementation of interventions, and

(iii) coordination of health services;

"nursing diagnosis" means a clinical judgment of an individual's mental or physical condition to determine whether the condition can be ameliorated or resolved by appropriate interventions of the registrant to achieve outcomes for which the registrant is accountable;

"order" means an instruction or authorization given by any method by a health professional for a registrant to provide or perform a service that includes the performance or provision of an activity described in

section 7 (1) to or for a named individual, if the health professional has assessed that individual, and includes

(

a) an instruction or authorization regarding the time or times at which the service is to be initiated by a registrant, and

(

b) this instruction or authorization if it incorporates by reference, in whole or in part and with any changes the health professional considers necessary or appropriate, a guideline, protocol or other recorded description of a course of action or decision-making process to be used by a registrant in providing or performing the service to or for a specified class of individuals;

"pharmacist" has the same meaning as in

section 1 of the Pharmacists, Pharmacy Operations and Drug Scheduling Act ;

"prescribe" means to authorize a pharmacist to dispense a specified drug in a specified amount for use by a named individual;

"substance" includes air or water.

College name

2 The name "College of Registered Nurses of British Columbia" is the name of the college established under

section 15 (1) of the Act for nursing.

Reserved titles

(1) The following titles are reserved for exclusive use by registrants:

(

a) nurse;

(

b) registered nurse;

(

c) licensed graduate nurse.

(2) The titles "nurse practitioner" and "registered nurse practitioner" are reserved for exclusive use by nurse practitioners.

(3) All nurse practitioners may be known by the title "registered nurse".

(4) This

section does not prevent a person from using the title "nurse" in a manner authorized by another regulation under

section 12 of the Act.

Scope of practice

4 A registrant may practise nursing.

Patient relations program

5 The college is designated for the purposes of

section 16 (2) (

f) of the Act.

Restricted activities

(1) A registrant in the course of practising nursing may

(

a) make a nursing diagnosis identifying a condition as the cause of the signs or symptoms of the individual,

(

b) for the purpose of wound care, perform a procedure on tissue below the dermis or below the surface of a mucous membrane,

(

c) for the purposes of collecting a blood sample or donation, perform venipuncture,

(

d) for the purposes of establishing intravenous access, maintaining patency or managing hypovolemia,

(

i) perform venipuncture, or

(ii) administer a solution by instillation through a parenteral method,

(

e) administer

(

i) oxygen or humidified air by inhalation, or

(ii) nutrition by instillation through an enteral method,

(

f) for the purposes of assessing an individual or ameliorating or resolving a condition identified through the making of a nursing diagnosis, administer a solution

(

i) by irrigation, or

(ii) by instillation through an enteral method,

(

g) for the purposes of assessing an individual or ameliorating or resolving a condition identified through the making of a nursing diagnosis, put an instrument or a device, hand or finger

(

i) into the external ear canal, up to the eardrum,

(ii) beyond the point in the nasal passages where they normally narrow,

(iii) beyond the pharynx,

(iv) beyond the opening of the urethra,

(

v) beyond the labia majora,

(vi) beyond the anal verge, or

(vii) into an artificial opening into the body,

(

h) for the purposes of assessing an individual or ameliorating or resolving a condition identified through the making of a nursing diagnosis, put into the external ear canal, up to the eardrum,

(

i) air that is under pressure created by the use of an otoscope, or

(ii) water that is under pressure created by the use of an ear bulb syringe,

(

i) apply ultrasound for the purposes of bladder volume measurement, blood flow monitoring or fetal heart monitoring,

(

j) apply electricity using an automatic external defibrillator,

(

k) compound, dispense or administer by any method a drug specified in

Schedule II of the Drug Schedules Regulation, B.C. Reg. 9/98, or

(

l) dispense or administer the following drugs specified in

Schedule I of the Drug Schedules Regulation, B.C. Reg. 9/98:

(

i) epinephrine, for the purpose of treating anaphylaxis;

(ii) dextrose in concentrated solutions for parenteral nutrition, for the purpose of treating hypoglycemia.

(2) Section 7 (2) does not apply to the provision or performance by a registrant of a service that includes the provision or performance of an activity described in subsection (1).

Restricted activities for services under an order

(1) A registrant in the course of practising nursing may

(

a) perform a procedure on tissue below the dermis, below the surface of a mucous membrane or in or below the surface of the cornea,

(

b) administer a substance, other than a drug that is specified in a

Schedule of the Drug Schedules Regulation, B.C. Reg. 9/98,

(

i) by injection,

(ii) by inhalation,

(iii) by mechanical ventilation,

(iv) by irrigation, or

(

v) by instillation through an enteral or parenteral method,

(

c) put an instrument or a device, hand or finger

(

i) into the external ear canal, up to the eardrum,

(ii) beyond the point in the nasal passages where they normally narrow,

(iii) beyond the pharynx,

(iv) beyond the opening of the urethra,

(

v) beyond the labia majora,

(vi) beyond the anal verge, or

(vii) into an artificial opening into the body,

(

d) put into the external ear canal, up to the ear drum, a substance that is under pressure,

(

e) apply electricity for the purposes of

(

i) cardioversion, including defibrillation,

(ii) adjusting a pacemaker,

(iii) adjusting or setting implanted cardiac devices, or

(iv) electro-cauterization,

(

f) compound, dispense or administer by any method a drug specified in

Schedule I or IA of the Drug Schedules Regulation, B.C. Reg. 9/98,

(

g) design or compound a therapeutic diet if nutrition is administered through an enteral method,

(

h) conduct allergy challenge testing or allergy desensitizing treatment that involves injection, scratch tests or inhalation,

(

i) conduct allergy challenge testing by any method if the individual being tested has had a previous anaphylactic reaction, or

(

j) conduct a cardiac stress test for the purposes of diagnosis and treatment planning.

(2) The following limits or conditions apply to the provision or performance by a registrant of a service that includes the provision or performance of an activity described in subsection (1):

(

a) the registrant must not provide or perform the service except for the purpose of complying with an order;

(

b) before the provision or performance of the service,

(

i) the health professional who gives the order must be authorized under an enactment to provide or perform the service, and

(ii) the registrant must be authorized under the Act, the regulations and the bylaws to provide or perform the service.

Restricted activities for certified practices

(1) A registrant in the course of practising nursing may

(

a) provide or perform an activity described in

section 7(1), except compound, dispense or administer a drug specified in

Schedule IA of the Drug Schedules Regulation, B.C. Reg. 9/98,

(

b) make a diagnosis identifying a disease, disorder or condition as the cause of the signs or symptoms of the individual,

(

c) manage normal labour in an institutional setting if the primary maternal care provider is absent or unavailable, or

(

d) give an order to apply X-ray for diagnostic or imaging purposes, except X-ray for computerized axial tomography.

(2) Section 7 (2) does not apply to the provision or performance by a registrant of a service that includes the provision or performance of an activity described in subsection (1) (a), if the registrant is certified in respect of that service as described in subsection (3).

(3) It is a limit or condition on the provision or performance by a registrant of a service that includes the provision or performance of an activity described in subsection (1) that, before providing or performing the service, the registrant has successfully completed a certification program established or approved by or under the bylaws to ensure that registrants are qualified and competent to provide or perform that service in the practice setting in which it is to be provided or performed by the registrant.

Restricted activities for nurse practitioners

(1) A nurse practitioner in the course of practising nursing may

(

a) provide or perform an activity described in

section 7 (1), except compound, dispense or administer a drug specified in

Schedule IA of the Drug Schedules Regulation, B.C. Reg. 9/98,

(

b) provide or perform an activity described in

section 8 (1) (

b) to (d),

(

c) set or cast a closed simple fracture of a bone, or reduce a dislocation of a joint,

(

d) apply X-ray for diagnostic or imaging purposes, except X-ray for computerized axial tomography,

(

e) give an order to apply one or more of the following forms of energy:

(

i) ultrasound for diagnostic or imaging purposes, including any application of ultrasound to a fetus;

(ii) X-ray for computerized axial tomography, or

(

f) prescribe or give an order to compound, dispense or administer by any method a drug that is specified in

Schedule I or II of the Drug Schedules Regulation, B.C. Reg. 9/98.

(2) Section 7 (2) or 8 (3) does not apply to the provision or performance by a nurse practitioner of a service that includes the provision or performance of an activity described in subsection (1) (

a) or (b).

(3) It is a limit or condition on the provision or performance by a nurse practitioner of a service that includes the provision or performance of an activity described in subsection (1) that the nurse practitioner provide or perform the service in accordance with all standards, limits and conditions for the practice of nursing by nurse practitioners in relation to that service established by the board on the recommendation of a committee that

(

a) is established under

section 19 (1) (

t) of the Act, and

(

b) has the duty and power to develop and recommend standards, limits or conditions for the practice of nursing by nurse practitioners.

(4) It is a limit or condition on the provision or performance by a registrant of a service that includes the provision or performance of an activity described in subsection (1) (

c) to (

f) that the registrant be a nurse practitioner.

Transitional (certified practices)

(1) Despite sections 7 and 8, a registrant in the course of practising nursing who has not successfully completed a certification program described in

section 8 (3) may provide or perform an activity described in

section 8 (1) if

(

a) the registrant is an employee,

(

b) it is a condition of the registrant's employment that the registrant be authorized by the college to practise nursing,

(

c) the activity is provided or performed in the course of fulfilling the registrant's employment duties, and

(

d) the registrant's employer

(

i) requires, on the date this regulation comes into force, the activity to be provided or performed by a registrant in the course of fulfilling a registrant's employment duties, or

(ii) has declared to the minister, on or before the date that is 30 days after the date this regulation comes into force, an intention to require the activity be provided or performed by a registrant in the course of fulfilling the registrant's employment duties.

(2) This

section is repealed on October 31, 2009.

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