LICENSED PRACTICAL NURSES

Scope of Practice
Standards, Limits, Conditions

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Vancouver, BC V6C 1S4 Toll-free: 1.866.880.7101
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Last Updated: February 2023

SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Revision Log
Revision Date Revisions Made

Sept. 1, 2020 Published by BCCNM (new college)

Oct. 26, 2020 New Acting within Autonomous Scope of Practice

and Acting with a Client-Specific Order standards

November 5, 2020 Minor revisions

December 7, 2020 Minor revision to clarify that no order is required to

perform throat swabs for COVID-19 testing
purposes

April 6, 2021 Changes to bring MAiD standards, limits and

conditions in line with changes to the Criminal
Code

August 23, 2021 Updated links throughout

September 15, 2021 Added clarification that LPNs administer IV

medications after successfully completing
additional education

June 30, 2022 Updated MAiD standards, limits, and conditions

related to returning unused substances to
pharmacy; removed COVID-19 temporary
exemption
Updated restricted activities that require an order
for nasopharyngeal swabs; removed COVID-19
temporary exemption

June 30, 2022 Added new limits and conditions for the provision
of medical aesthetics

November 24, 2022 Removed limits and conditions related to

participating in allergy challenge testing or
desensitization treatments and performing ankle-
brachial index (ABI) testing and ear irrigation for
cerumen removal

February 14, 2023 Minor language updates related to Mental Health

and Substance Use

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Table of Contents
Introduction .......................................................................................................................................4
What is an LPN?................................................................................................................................................................................ 4
Controls on Nursing Practice – a Shared Responsibility .................................................................................................5

Nurses (Licensed Practical) Regulation ......................................................................................... 6

What You Need to Know ...............................................................................................................................................................6
Regulatory Framework ..................................................................................................................................................................6

Nursing Diagnosis ............................................................................................................................. 7

Standards, Limits & Conditions ....................................................................................................... 8
Employer Assessment of Existing LPN Competence ......................................................................................................................................... 8

Scope of Practice Standards for Licensed Practical Nurses ......................................................................................... 8

Autonomous Scope of Practice and Client-specific Orders............................................................................................................................ 8

Standards for Acting within Autonomous Scope of Practice ........................................................................................................................ 9
Limits & Conditions: Restricted Activities that Do Not Require an Order ............................................................................................. 13
Standards for Acting with Client-Specific Orders ................................................................................................................................................ 17
Limits & Conditions: Restricted Activities that Require an Order .............................................................................................................. 21
Limits & Conditions: Non-Restricted Activities .................................................................................................................................................... 27
Limits & Conditions: Other Practice Settings ........................................................................................................................................................ 29
Restricted Activities Outside the Scope of Practice of LPNs ...................................................................................................................... 33

Medical Assistance in Dying ...................................................................................................................................................... 34

Glossary ...........................................................................................................................................39
More Information ........................................................................................................................... 43

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Introduction
The foundation of practical nursing is expressed through:

The scope of practice as defined in the Nurses (Licensed Practical) Regulation

Standards, limits and conditions set by the British Columbia College of Nurses and Midwives
(BCCNM)

Entry Level Competencies for Licensed Practical Nurses

This document outlines the standards, limits and conditions BCCNM sets for licensed practical nurse
(LPN) practice in British Columbia (BC). The standards, limits and conditions cannot be looked at by
themselves, but must be reviewed as part of a bigger picture. To provide safe, competent and ethical
care, LPNs need to carefully consider what activities they are permitted to perform within their
autonomous scope of practice (without an order) and which activities require a client-specific order
(with an order) before performing them.

WHAT IS AN LPN?

An LPN is a nurse who studies from the same body of nursing knowledge as registered nurses and
registered psychiatric nurses. Their practice is based on a foundational knowledge, critical thinking,
critical inquiry and clinical judgment.

LPNs graduate from a BCCNM-recognized practical nursing education program based on a standardized
curriculum. Other BCCNM requirements that LPNs must meet to obtain registration include passing the
Canadian Practical Nurse Registration Examination, providing evidence of English Language proficiency,
competence, good character, a criminal record check and fitness to practise nursing.

LPNs care for clients at all life stages. They provide health care services for the:

a) promotion, maintenance and restoration of health, with a focus on clients with stable or
predictable states of health

b) prevention, treatment and palliation of illness and injury, with a focus on stable or
predictable disorders and conditions, primarily by:

o assessing health status,

o planning, implementing and evaluating interventions and
o coordinating health services 1.

Through a combination of further education and experience, LPNs are able to care for clients who
have more complex care needs. They work collaboratively with clients, families, groups, communities
and other members of the health care team to support safe, competent and ethical care. LPNs work
in hospitals, residential care facilities, home and community care, clinics, schools,
occupational/industrial health, correctional facilities, complex care and palliative care.

1 Nurses (Licensed Practical) Regulation

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CONTROLS ON NURSING PRACTICE – A SHARED RESPONSIBILITY

Government, BCCNM, employers and LPNs work together to ensure the public receives safe,
competent and ethical care through specific controls on LPN practice.

Figure 1: Controls on Practice

Beginning at the base of the pyramid, and moving upward, each control narrows LPN practice.

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Nurses (Licensed Practical) Regulation

In December 2015, the BC government signed into law a revised Nurses (Licensed Practical)
Regulation. BCCNM has established standards, limits and conditions to complement the Regulation.

WHAT YOU NEED TO KNOW

• You can stay up to date by reading and checking BCCNM’s website and newsletters

• Contact BCCNM if you are an LPN who is carrying out activities that are not included in this
document

REGULATORY FRAMEWORK

The 2015 Regulation sets out a new regulatory framework for LPNs in BC. Several fundamental
changes impact the way LPNs practise in BC.

LPNs can carry out orders from nine different health professionals:

• Dentists

• Medical doctors

• Midwives

• Naturopaths

• Nurse practitioners

• Pharmacists

• Podiatrists

• Registered nurses

• Registered psychiatric nurses

LPNs are only allowed to act on a client-specific order from an authorized health professional
who is registered to practise in British Columbia, except where the client has been transferred
from Alberta, Yukon or the Northwest Territories for emergency treatment in British Columbia. In
addition, an order for an LPN to cast a fracture of a bone may only ever be given by a physician
or nurse practitioner who is registered in British Columbia.

LPNs have a degree of autonomous practice, which they never had in the past:

• LPNs make a nursing diagnosis of a condition before determining an appropriate

plan of care

• LPNs are authorized to treat respiratory distress in a known asthmatic, anaphylaxis

and hypoglycemia

LPNs are authorized to carry out restricted activities and need to know which restricted
activities require an order and which restricted activities do not.

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Nursing Diagnosis
In the 2015 Regulation, LPNs are authorized to make a nursing diagnosis without an order. If the LPN
is determining the appropriate care for a client, the LPN must first make a nursing diagnosis of a
condition as the cause of the client’s signs or symptoms.

All LPNs perform assessment as part of the nursing process; however, autonomously making a
nursing diagnosis about the cause of a client’s condition and autonomously determining what
nursing interventions will improve or resolve the client’s condition will be new for some LPNs.

Figure 2: The nursing process

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Standards, Limits & Conditions

BCCNM standards, limits, and conditions for LPN practice complement the Regulation and further
define the LPN scope of practice set out in the Regulation. Limits and conditions build on entry-level
LPN competencies. BCCNM sets limits and conditions to describe restrictions on activities that are
part of the LPN scope of practice. Some limits and conditions include the term “only”. Others say
“LPNs do not….” The intent is to clarify limits on LPN practice.

BCCNM uses three regulatory mechanisms to establish limits and conditions on LPN practice:

Additional education

Formal post-basic education

Other supports

Employer Assessment of Existing LPN Competence

Employers provide organizational supports and systems necessary for LPNs to meet BCCNM’s
Standards of Practice.

An employer may assess and validate an LPN’s competence to carry out an activity as a way to
ensure safe care, while avoiding any service interruption.

If an LPN is already carrying out activities that require additional education or formal post-basic
education, employers may assess the LPN’s existing competence to identify any gaps and decide
what supports are needed to close those gaps. Employers may choose to develop their own
additional education (see BCCNM’s Additional Education Resource); however, for activities that
require formal post-basic education, it may be more appropriate for the LPN to seek support from an
institution that offers the education needed to acquire the necessary competencies.

SCOPE OF PRACTICE STANDARDS FOR LICENSED PRACTICAL NURSES

Autonomous Scope of Practice and Client-specific Orders

Scope of Practice Standards establish the standards, limits, and conditions for licensed practical
nurses’ practice. These scope of practice standards link to other standards, policies, and bylaws of
BCCNM and all legislation relevant to licensed practical nursing practice.

For the purposes of these scope of practice standards, the “LPN Regulation” refers to the Nurses
(Licensed Practical) Regulation which applies to licensed practical nurses in British Columbia.

Organizations establish processes, supports, and resources such as policies, procedures and decision
support tools to ensure that licensed practical nurses meet the standards of practice set out by
BCCNM.

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Introduction

These scope of practice standards outline the requirements for registered nurses providing client
care in the following ways:

• Acting within autonomous scope of practice

• Acting with client-specific orders

Licensed practical nurses may provide care to clients by:

• acting within autonomous scope of practice when carrying out:

o non-restricted activities, and

o restricted activities within section 6 (restricted activities that do not require an

order) of the Nurses (Licensed Practical) Regulation.

• acting on a client-specific order from a listed health professional for a restricted activity
included in section 7 (restricted activities that require an order) of the Nurses (Licensed
Practical) Regulation.

• acting on a client-specific order from a non-listed health professional for an activity that is
within the licensed practical nurse’s autonomous scope of practice and the licensed practical
nurse’s individual competence

Standards for Acting within Autonomous Scope of Practice

Introduction

Scope of practice refers to the activities that licensed practical nurses are educated and authorized to
perform. Acting within autonomous scope of practice refers to licensed practical nurses:

• assuming accountability and responsibility for making decisions about client care, and

• performing activities that they are educated, competent, and allowed to perform without a
client-specific order.

To ensure they are providing safe care, licensed practical nurses need to know when they are
allowed to act within autonomous scope of practice and when they require a client-specific order
before performing an activity.

The Nurses (Licensed Practical) Regulation allows licensed practical nurses to make a nursing
diagnosis that identifies a condition – not a disease or disorder – as the cause of a client’s signs or
symptoms. Licensed practice nurses diagnose and determine a plan of care for a variety of
conditions that can be improved, resolved, or prevented with nursing activities. Other conditions may
be stabilized or improved by licensed practical nurses but require the involvement of another health
professional to diagnose and treat the underlying disease or disorder.

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The Nurses (Licensed Practical) Regulation lists restricted activities that are allowed to be
performed by licensed practical nurses. Restricted activities are clinical activities that pose a
significant risk of harm to the public. These include restricted activities that ‘do not require an order’
(Section 6 of the Regulation) and restricted activities that ‘require an order’ (Section 7 of the
Regulation). Some restricted activities are listed under section 6 and also under section 7 of the
Regulation. The BCCNM Scope of Practice for Licensed Practical Nurses – Standards Limits
Conditions provides additional details about Section 6 and Section 7 restricted activities.

Before acting within autonomous scope of practice, licensed practical nurses need to consider all
four controls on practice to ensure they are allowed to perform the activity: 1) The Nurses (Licensed
Practical) Regulation; 2) BCCNM standards of practice including standards, limits, and conditions; 3)
organizational/employer policies, processes, and restrictions; and 4) the nurse’s individual
competence.

Autonomous scope of practice includes:

• The performance of restricted activities that are listed in section 6 of the Nurses (Licensed
Practical) Regulation, unless the activity is prohibited by any BCCNM standard, limit, or
condition. These restricted activities do not require an order from a health professional who
is listed 2 in the Regulation.

• The provision of other care or services that are not restricted activities, unless the care or
services are excluded from autonomous scope of practice by any BCCNM standard, limit, or
condition.

Autonomous scope of practice does not include:

• The performance of restricted activities that are listed in section 7 of the Nurses (Licensed
Practical) Regulation (to the extent the care provided is not within the activities listed in
section 6 of the Regulation). These are restricted activities that require an order from a
health professional who is listed in the Regulation.

• The provision of other care or services, including restricted or non-restricted activities, that
are prohibited or otherwise excluded from autonomous scope of practice by:

o any BCCNM standard, limit, or condition, or

o organizational/employer policies, processes, or restrictions.

• The provision of a service that is prohibited by other legislation (see Legislation Relevant to
Nurses’ Practice).

2 Listed health professionals include physicians, nurse practitioners, registered nurses (with or without certified practice), registered
psychiatric nurses, dentists, midwives, naturopaths, podiatrists, and pharmacists.

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Principles

Licensed practical nurses are accountable and responsible when they make a decision that
the client’s condition 3 would benefit from an activity and act within autonomous scope of
practice to perform the activity.

Licensed practical nurses acting within autonomous scope of practice ensure that the
activity they will perform is:

a. Within the scope of practice for LPNs acting without a client-specific order as set
out in the Nurses (Licensed Practical) Regulation,

b. Consistent with BCCNM’s standards of practice including standards, limits, and

conditions,

c. Consistent with organizational/employer policies, processes, restrictions, and

d. Within the nurse’s individual competence.

Licensed practical nurses acting within autonomous scope of practice ensure they have the
competence to:

a. Make decisions about whether the client would benefit from the activity, having
considered:

i. the known risks and benefits to the client,

ii. the predictability of outcomes of performing the activity, and

iii. other relevant factors specific to the client or situation,

b. Carry out the activity safely and ethically, and

c. Safely manage the intended and unintended outcomes of performing the activity.

Licensed practical nurses acting within autonomous scope of practice identify the effect of
their own values, beliefs, and experiences in decision-making, recognize potential conflicts,
and take action for the needs of the client to be met.

Licensed practical nurses acting within autonomous scope of practice use current evidence
to support their decision-making and the activity to be performed.

Licensed practical nurses acting within autonomous scope of practice follow a clinical
decision-making process when they:

a. Assess the client’s health status,

3 Based on their assessment of the client, licensed practical nurses make a clinical judgement (a nursing diagnosis) of a condition as the
cause of the client’s signs and symptoms.

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b. Make a nursing diagnosis 4 of a client condition that can be prevented, improved,

ameliorated, or resolved through nursing activities,

c. Determine a plan of care,

d. Determine an activity to be performed,

e. Implement an activity to prevent, treat, or palliate an illness or injury and/or

improve, ameliorate, or resolve a condition,

f. Change or cancel a client-specific order for activities within the nurse’s autonomous
scope of practice,

g. Manage the intended and unintended consequences of carrying out the activity,

h. Manage and evaluate the outcomes of the activity.

Licensed practical nurses acting within autonomous scope of practice communicate and
collaborate with the client (or their substitute decision-maker) about nursing diagnoses,
decisions, actions, and outcomes to support the client to be an active participant in making
informed decisions about the care to meet the client’s needs.

Licensed practical nurses acting within autonomous scope of practice communicate and
collaborate with the health care team about nursing diagnoses, decisions, actions, and
outcomes.

Licensed practical nurses acting within autonomous scope of practice communicate and
collaborate with the health care professional who gave the order (or their delegate), the
client, and other members of the health care team when changing or cancelling a client-
specific order for activities that are within the nurse’s autonomous scope of practice and
individual competence.

Licensed practical nurses acting within autonomous scope of practice consult with, or refer
clients to, other health care professionals when:

a. The needs of the client exceed their scope of practice or individual competence,

b. Required by organizational/employer policies or processes, or

c. Client care would benefit from the expertise of other health care professionals.

Before performing an activity within autonomous scope of practice, licensed practical nurses
consider available resources and human and system factors that may impact their ability to
safely perform the activity and to manage intended and unintended outcomes of the
activity.

4 Nursing diagnosis: 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 nurse to achieve outcomes for which the nurse is accountable: Nurses
(Licensed Practical) Regulation.

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Limits & Conditions: Restricted Activities that Do Not Require an Order

While LPNs are solely responsible and accountable for their own practice, they have a greater
responsibility when acting within autonomous scope of practice (performing an activity without an
order from an authorized health professional). LPNs follow BCCNM’s Standards for Acting within
Autonomous Scope of Practice.

LPNs may choose to seek advice from other health professionals even when an activity, such as
making a nursing diagnosis or performing wound care, is within the Autonomous Scope of Practice
of LPNs.

Restricted Activities without Orders BCCNM Limits and Conditions

Make a nursing diagnosis None

identifying a condition as the
cause of the signs and
symptoms of an individual

For the purpose of wound care LPNs provide wound care if a wound care treatment plan
other than the suturing of skin is in place.
lacerations, perform a
LPNs probe, irrigate, pack or dress a tunneled wound:
procedure on tissue below the
dermis or below the surface of a a) After successfully completing additional
mucous membrane education

b) By following decision support tools

LPNs do not carry out any form of sharps debridement

including conservative sharps wound debridement
(CSWD).

Administer, by inhalation, LPNs administer oxygen:

oxygen or humidified air
a) After successfully completing additional
education

b) By following decision support tools

Administer purified protein LPNs administer purified protein derivative (PPD), read the
derivative by injection, for the results and refer the client to an appropriate health
purpose of tuberculosis professional when they:
screening
a) Possess the competencies for tuberculosis (TB)
screening established by BC Centre for Disease
Control (BCCDC)

b) Follow BCCDC decision support tools

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Restricted Activities without Orders BCCNM Limits and Conditions

For the purpose of assessment, None

put an instrument, or a device
or finger

a. into the external ear canal

up to the ear drum, or

b. beyond the anal verge

For the purpose of assessment LPNs carry out digital stimulation or rectal disimpaction:
or ameliorating or resolving a
a) After successfully completing additional
condition, put an instrument or
education
a device or finger beyond the
anal verge b) By following decision support tools

For the purpose of providing None

personal hygiene care, put an
instrument or a device, hand or
finger beyond the labia majora
up to the cervix

Put a wearable hearing None

instrument, or part of or an
accessory for it, into the
external ear canal, up to the
eardrum

For the purpose of assessment, LPNs assess the integrity of the eardrum after
put into the external ear canal, successfully completing additional education.
up to the eardrum, air that is
Also see Restricted Activities with Orders #9 and #16
under pressure no greater than
the pressure created by the use
of an otoscope

Apply ultrasound for the None.

purpose of

a. bladder volume
measurement; or

b. blood flow monitoring

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Restricted Activities without Orders BCCNM Limits and Conditions

Apply electricity using an LPNs use automated external defibrillators (AEDs) after
automatic external defibrillator, successfully completing a cardiopulmonary resuscitation
for the purpose of defibrillation (CPR) course for health professionals that includes the
in the course of emergency use of AEDs.
cardiac care

Apply electricity for the purpose LPNs apply transcutaneous electrical nerve stimulation
of providing transcutaneous (TENS) after successfully completing additional
electrical nerve stimulation education.

In respect of a drug specified in LPNs diagnose and treat anaphylaxis:

Schedule I or II of the Drug
a) After successfully completing additional
Schedules Regulation,
education
compound, dispense or
administer the drug by any b) By following decision support tools
method for the purpose of
LPNs only administer Epinephrine to treat anaphylaxis.
treating anaphylaxis

In respect of a drug specified in LPNs treat respiratory distress in a known asthmatic:

Schedule I or II of the Drug
a) In a team approach
Schedules Regulation,
compound, dispense or b) With an order from an authorized health
administer the drug by any professional
method for the purpose of
treating respiratory distress in a
known asthmatic

In respect of a drug specified in LPNs who make a nursing diagnosis and treat
Schedule I or II of the Drug hypoglycemia follow decision support tools
Schedules Regulation
LPNs only administer Glucagon to treat hypoglycemia.
compound, dispense or
administer the drug by any
method for the purpose of
treating hypoglycemia

In respect of a drug specified in LPNs who autonomously compound or administer

Schedule I or II of the Drug immunoprophylactic agents, in a team approach, for the
Schedules Regulation purpose of preventing disease:
compound, dispense or
a) Administer immunoprophylactic agents to clients
administer the drug by any
four years of age and older who have stable or
method for the purpose of
predictable states of health
preventing disease using
immunoprophylactic agents

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Restricted Activities without Orders BCCNM Limits and Conditions

b) Successfully complete the additional education

established by the BC Centre for Disease Control.

c) Follow the decision support tools established by

the BC Centre for Disease Control.

LPNs do not autonomously compound, dispense or

administer immunoprophylactic agents for the purpose of
preventing disease in travelers.

In respect of a drug specified in LPNs compound, dispense or administer Schedule II

Schedule II of the Drug drugs to treat a disease or disorder with an order from an
Schedules Regulation authorized health professional.
compound, dispense or
See limits and conditions for Medical Aesthetics.
administer the drug orally,
intranasally or by intramuscular
or subcutaneous injection

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Standards for Acting with Client-Specific Orders

Introduction

For public safety, licensed practical nurses need to know which activities they are allowed to perform
within their autonomous scope of practice and which activities require a client-specific order before
they are allowed to perform them. Licensed practice nurses also need to know which health
professionals are authorized to give a client-specific order that they are allowed to act with.

A client-specific order is an instruction or authorization given by a regulated health professional for

a nurse to provide care for a specific client, whether or not the care or service includes a restricted
activity or a non-restricted activity. A consultation, referral or professional recommendation is not an
order.

The client-specific order must:

• be documented in the client’s permanent record by the regulated health professional giving
the client-specific order,

• include all the information needed for the ordered activity to be carried out safely (e.g., time,
frequency, dosage), and

• include a written/electronic signature.

The Nurses (Licensed Practical) Regulation lists restricted activities that are allowed to be performed
by licensed practical nurses. Restricted activities are clinical activities that pose a significant risk of
harm to the public. These include restricted activities that ‘do not require an order’ (Section 6 of the
Regulation) and restricted activities that ‘require an order’ (Section 7 of the Regulation). Some
restricted activities are listed under section 6 and also under section 7 of the Regulation. The BCCNM
Scope of Practice for Licensed Practical Nurses – Standards Limits Conditions provides additional
details about Section 6 and Section 7 restricted activities.

Licensed practical nurses need to consider all four controls on practice to determine whether they
require a client-specific order before performing an activity:

• The Nurses (Licensed Practical) Regulation

• BCCNM standards of practice

• Organizational/employer policies, processes, and restrictions

• The nurse’s individual competence.

A licensed practical nurse may act with a client-specific order given by a ‘listed health professional’
or a ‘non-listed health professional’:

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• A listed health professional 5 is a health professional listed in the Nurses (Licensed Practical)
Regulation as authorized to give an order for a restricted activity to be performed by a
licensed practical nurse. Only these health professionals are authorized to give orders for
activities listed in section 7 (‘restricted activities that require an order’) of the Regulation 6
that allow the licensed practical nurse to perform that activity. Listed health professionals
are physicians, nurse practitioners, registered nurses (with or without certified practice),
registered psychiatric nurses, dentists, midwives, naturopaths, podiatrists, and pharmacists.

• A non-listed health professional is a health professional who is NOT listed in the Nurses
(Licensed Practical) Regulation. A non-listed health professional is not authorized to give
orders for restricted activities in section 7 of the Regulation.6 However, depending on
organizational/employer policies and processes, they may give orders for activities that are
within the licensed practical nurse’s autonomous scope of practice. Non-listed health
professionals have specialized competence within their profession’s scope of practice and
individual competence that allows them to assess a client and to design or recommend care
to meet the client’s needs. An example of a non-listed health professional is a dietitian.

Principles

Licensed practical nurses require a client-specific order from a listed health professional to
perform any restricted activity listed in section 7 (restricted activities that require an order)
of the Nurses (Licensed Practical) Regulation (to the extent the care provided is not within
the activities or related limits and conditions listed in section 6 of the Nurses (Licensed
Practical) Regulation).

Licensed practical nurses acting with a client-specific order ensure the ordered activity is:

a. within the scope of practice as set out in the Nurses (Licensed Practical) Regulation,

b. consistent with standards, limits and conditions established by BCCNM,

c. consistent with organizational/employer policies, processes, and restrictions, and

d. within their individual competence.

Licensed practical nurses acting with a client-specific order ensure that they have the
competence to:

a. perform the activity safely and ethically,

b. manage the intended outcomes of the activity, and

c. recognize unintended outcomes of the activity and implement a plan for dealing
with these unintended outcomes.

5 A listed health professional must be registered to practise in British Columbia, except where the client has been transferred from
Alberta, Yukon or the Northwest Territories for emergency treatment in British Columbia. In addition, an order for a licensed practical
nurse to cast a fracture of a bone may only ever be given by a physician or nurse practitioner who registered in British Columbia.
6 To the extent the activity is not within the activities or related limits and conditions listed in section 6 of the Regulation.

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Licensed practical nurses acting with a client-specific order ensure that the order:

a. is client-specific,

b. is clear and complete,

c. is documented, legible, dated and signed with a written/electronic signature, and

d. contains enough information for the nurse to carry it out safely.

Licensed practical nurses accept a verbal or telephone client-specific order only when there
is no reasonable 7 alternative, according to organizational/employer policies and processes,
and when doing so is in the best interest of the client. Nurses repeat the client-specific order
back to the ordering health professional to confirm its accuracy and promptly document the
order.

Licensed practical nurses conduct assessments to ensure that the client's condition
continues to warrant the activity before acting with a client-specific order.

Licensed practical nurses may not change or cancel a client-specific order given by a listed
health professional when the activity is outside of the nurse’s autonomous scope of practice
or the nurse’s individual competence.

Licensed practical nurses communicate and collaborate with the health professional (or their
delegate) who gave the client-specific order, follow organizational/employer policies and
processes, take action as needed, and document in the client record, when:

a. the ordered activity may no longer be appropriate because the client’s condition,
needs or wishes have changed (e.g.to ‘hold’ the order),

b. they are not able to carry out a client-specific order,

c. the client-specific order does not appear to consider a client’s individual

characteristics, values/beliefs, and preferences,

d. the client-specific order does not appear to reflect current evidence or be in the
best interest of the client,

e. they change or cancel a client-specific order for activities that are within their
autonomous scope of practice, or

f. the safeguards and resources are not available to manage the outcomes of
performing the activity, including reasonably foreseeable unintended outcomes.

Licensed practical nurses follow the standards for Acting within Autonomous Scope of
Practice when they change or cancel a client-specific order that is within their autonomous
scope of practice and individual competence.

7 “Reasonable” refers to the common understanding that registrants of BCCNM would have as to what is appropriate in the situation.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Licensed practical nurses are responsible and accountable for any changes or cancellations
they make to a client-specific order that is within their autonomous scope of practice and
individual competence.

Licensed practical nurses obtain a client-specific order to perform an activity or provide care
or a service that is within their autonomous scope of practice when:

a. It is required by organizational/employer policies, processes, or restrictions,

b. there are insufficient organizational/employer supports, processes and resources in

place (such as decision support tools or clinical practice documents) to enable the
nurse to meet BCCNM standards, limits, or conditions related to the activity, care or
service, or

c. the nurse does not have the individual competence to make a nursing diagnosis or
carry out an assessment to determine whether the client would benefit from the
activity, care or service, but is competent to carry out the activity .

Licensed practical nurses ONLY act with a client-specific order from a non-listed health
professional when:

a. the activity is within the nurse’s autonomous scope of practice,

b. the nurse is able to meet BCCNM standards, limits, or conditions related to the
activity,

c. the activity is within the nurse's individual competence, and

d. organizational/employer policies, and processes exist that:

i. clarify the accountability and responsibility of the nurse and the non-listed
health professional, and

ii. outline the requirements for the non-listed health professional to complete
an assessment and to ensure that the ordered activity is in the best interest
of the client.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Limits & Conditions: Restricted Activities that Require an Order

LPNs require a client-specific order from an authorized health professional to carry out certain
restricted activities. The health professional giving the order must be authorized to perform the
restricted activity without an order (that is, within their autonomous scope of practice), and the
restricted activity must be within the LPN scope of practice and permitted by employer policy.
When acting with an order, LPNs follow BCCNM’s Standards for Acting with Client-Specific Orders.

Restricted Activities with BCCNM Limits and Conditions

Orders

Perform a procedure on Peritoneal Dialysis

tissue below the dermis
LPNs carry out peritoneal dialysis:
or below the surface of
a mucous membrane a) For clients with stable or predictable states of health

b) After successfully completing additional education

Phlebotomy

LPNs perform phlebotomy:

a) To collect blood samples from clients 14 years of age and

older

b) After successfully completing additional education

c) By following decision support tools

d) By using a peripheral evacuated system

Wound Care

LPNs apply compression therapy,

provide negative pressure wound therapy (vacuum assisted

closure (VAC), or carry out maggot debridement therapy:

a) If a wound care treatment plan is in place

b) After successfully completing additional education

c) By following decision support tools

LPNs do not carry out any form of sharps debridement including

conservative sharps wound debridement (CSWD).

Cast a fracture of a LPNs apply casts for a fracture of a bone:

bone
a) With a client-specific order from a medical practitioner or
nurse practitioner registered in BC*

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Restricted Activities with BCCNM Limits and Conditions

Orders

b) After successfully completing additional education

**Licensed practical nurses may only act on a client-specific order

to cast a fracture of a bone given by a medical practitioner or nurse
practitioner who is registered in British Columbia as per the Nurses
(Licensed Practical) Regulation section 7(3).

Administer a substance See limits and conditions for Medical Aesthetics.

by injection

Administer a substance LPNs do not:

by inhalation
a) Administer nitrous oxide

b) Monitor clients taking nitrous oxide

c) Administer inhaled substances for purposes of

anaesthesia or procedural (conscious) sedation

LPNs work in a team nursing approach to provide care and

monitor clients under:

a) General anesthesia

b) Procedural sedation

Administer a substance LPNs care for clients requiring mechanical ventilation:

by mechanical
a) With stable or predictable states of health
ventilation
b) After successfully completing additional education

LPNs provide care to clients who use continuous positive airway

pressure (CPAP) or bi-level positive airway pressure (BPAP) after
successfully completing additional education.

Administer a substance LPNs do not irrigate ostomies.

by irrigation
LPNs irrigate only those percutaneous tubes they are permitted to
irrigate at entry-level.

Administer a substance LPNs:

by enteral or parenteral
a) Change IV bags infusing via peripheral access (not central
instillation
venous access)

b) Monitor clients receiving blood or blood products in a

team nursing approach

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Restricted Activities with BCCNM Limits and Conditions

Orders

c) Provide care to clients receiving parenteral nutrition in a

team nursing approach

LPNs do not:

a) Start transfusions of blood or blood products

b) Start or monitor parenteral nutrition

c) Administer radiopaque dyes via parenteral instillation

d) Access central venous access devices or central venous

lines

Also see hemodialysis for exceptions

For the purpose of LPNs start IVs:

establishing
a) After successfully completing additional education
intravenous access,
maintaining patency or b) Using a short peripheral device
managing hypovolemia
LPNs:
a. perform
venipuncture, or a) Administer parenteral solutions to clients with stable or
predictable states of health
b. administer a
solution by b) Change IV bags infusing via peripheral access (not central
parenteral venous access)
instillation
Also see hemodialysis for exceptions

Put an instrument or a LPNs do not insert a curette or other instrument into the external
device, hand or finger ear canal to remove:
into the external ear
a) Foreign objects
canal, up to the
eardrum b) Earwax

Put an instrument or a LPNs suction the nasal passages beyond the point where they
device, hand or finger normally narrow after successfully completing additional
beyond the point in the education.
nasal passages where
LPNs do not:
they normally narrow
a) Insert nasogastric (NG) tubes

b) Insert orogastric (OG) tubes

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Restricted Activities with BCCNM Limits and Conditions

Orders

c) Carry out nasopharyngeal washes

Put an instrument or a LPNs do not insert laryngeal mask airways (LMAs).

device, hand or finger
Also see Restricted Activities with Orders #15
beyond the pharynx

Put an instrument or a LPNs insert coude tip catheters after successfully completing
device, hand or finger additional education.
beyond the opening of
the urethra

Put an instrument or a LPNs remove vaginal packing after successfully completing

device, hand or finger additional education.
beyond the labia
LPNs insert or remove pessaries after successfully completing
majora
additional education.

LPNs do not:

a) Insert vaginal packing

b) Carry out pelvic or vaginal examinations

c) Perform cervical cancer screening

d) Insert an instrument, substance or medication into or

beyond the cervix.

Put an instrument or a LPNs insert tubes into the rectum:

device, hand or finger
a) After successfully completing additional education
beyond the anal verge
b) By following decision support tools

LPNs do not insert or advance scopes for rectal/bowel

examinations.

Put an instrument or a LPNs provide tracheostomy care to clients:

device, hand or finger
a) With well-established tracheostomies
into an artificial
opening into the body b) After successfully completing additional education

LPNs carry out digital examination of colostomies for clients:

a) With well-established stomas

b) After successfully completing additional education

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Restricted Activities with BCCNM Limits and Conditions

Orders

LPNs insert suprapubic catheters and gastrostomy tubes for

clients:

a) With well-established stomas

b) After successfully completing additional education

Put into the ear canal, None

up to the eardrum, a
substance that is under
pressure

Apply ultrasound for LPNs do not carry out:

diagnostic or imaging
a) Fetal heart monitoring using an intermittent Doppler, or
purposes, except that
any related activities including palpation and auscultation
ultrasound may be
of the fetal heart
applied to a fetus only
for the purpose of fetal Also see antenatal care
heart monitoring

In respect of a drug The LPN Regulation (Section 7) permits LPNs to compound,

specified in Schedule I, dispense, and administer medications listed in Schedule I, IA or II of
IA or II of the Drug the provincial drug schedules with a client-specific order from an
Schedules Regulation, authorized (listed) health professional.
compound, dispense or
LPNs change IV bags containing potassium chloride (KCL) infusing
administer the drug
via peripheral access (not central venous access), when the IV bag
has been compounded commercially or by a pharmacy.

LPNs administer IV medications after successfully completing

additional education.

LPNs do not administer:

a) IV push medications

b) IV medications through a central venous access device

c) Intrathecal medications

d) Intra-osseous medications

e) Medications into epidural spaces

f) Medications into perineural spaces

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Restricted Activities with BCCNM Limits and Conditions

Orders

g) Inhaled substances or medications for purposes of

anaesthesia or procedural sedation

LPNs work in a team nursing approach to provide care and

monitor clients under:

a) General anesthesia

b) Intrathecal anesthesia

c) Epidural anesthesia

d) Procedural sedation

Also see:

• Medical Aesthetics

• Hemodialysis for exceptions

• Restricted Activities without Orders #16 and #17

If nutrition is None
administered by enteral
instillation, compound
or dispense a
therapeutic diet

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Limits & Conditions: Non-Restricted Activities

The following activities are part of LPN scope of practice and are not restricted; however, they may
carry a significant degree of risk if they are not performed safely. When acting within autonomous
scope of practice (‘without an order’), LPNs follow BCCNM’s Standards for Acting within Autonomous
Scope of Practice. When acting with an order, LPNs follow BCCNM’s Standards for Acting with
Client-specific Orders.

Non-Restricted Activities BCCNM Limits and Conditions

Applying a restraint LPNs apply restraints when an order from an authorized health
professional is in place.

Taking an LPNs take electrocardiograms (ECGs):

electrocardiogram
a) After successfully completing additional education

b) When a health care professional authorized to read the ECG

is immediately available

LPNs are not responsible for reading or interpreting ECG results.

Caring for a client on LPNs work in a team nursing approach to provide care for clients on
telemetry telemetry:

a) With stable or predictable states of health

b) After successfully completing additional education

LPNs are not responsible for monitoring or interpreting telemetry

readings.

Changing a chest LPNs change chest tube dressings:

tube dressing
a) For clients with stable or predictable states of health

b) After successfully completing additional education

c) By following decision support tools

Changing a dressing LPNs do not change dressings on central venous access devices or
on a central venous central venous lines.
line
Also see hemodialysis for exceptions

Measuring a visible LPNs measure a visible central venous line on clients with stable or
central venous line predictable states of health.

Also see hemodialysis for exceptions

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Non-Restricted Activities BCCNM Limits and Conditions

Performing Human LPNs perform Human Immunodeficiency Virus (HIV) point of care
Immunodeficiency testing (POCT):
Virus Point of Care
a) After successfully completing additional education
Testing
b) By following established organizational processes and
procedures for HIV POCT

c) When an authorized health professional is available for

consultation and referral

Performing skin and LPNs who make a nursing diagnosis and treat reddened skin, skin
wound care above tears and wounds above the dermis, without an order, follow
the dermis decision support tools.

Preparing and giving LPNs compound, dispense and administer naloxone without an
an unscheduled drug order, when used to treat an opioid overdose emergency.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Limits & Conditions: Other Practice Settings

BCCNM has developed limits and conditions for specific practice settings that are less common for
LPNs. To work in these settings, LPNs need additional education or formal post-basic education.

Practice Setting BCCNM Limits and Conditions

Ambulatory LPNs working in ambulatory care clinics or offices where surgical procedures
Care are performed:

a) Require a unit orientation that is consistent with LPN entry-level

competencies

b) Assist with surgical procedures:

• After successfully completing additional education

• When an authorized health professional is immediately

available

LPNs do not administer:

a) IV push medications

b) IV medications through a central venous access device, or a central

venous line

c) Intrathecal medications

d) Intra-osseous medications

e) Medications into epidural spaces

f) Medications into perineural spaces

g) Inhaled substances or medications for purposes of anaesthesia or

procedural (conscious) sedation

LPNs work in a team nursing approach to provide care and monitor clients
under:

a) General anesthesia

b) Intrathecal anesthesia

c) Epidural anesthesia

d) Procedural sedation

LPNs work in a team nursing approach to care for clients recovering from
epidural anesthesia after successfully completing additional education.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Practice Setting BCCNM Limits and Conditions

Antenatal LPNs working in antenatal clinics require a unit orientation consistent with
Care LPN entry-level competencies.

LPNs provide antenatal care:

a) To healthy women with an uncomplicated pregnancy

b) In a team approach with medical practitioners, midwives, registered

nurses and/or nurse practitioners

Also see Restricted Activities with Orders #17

Emergency LPNs working in emergency rooms require a unit orientation that is

Room consistent with LPN entry-level competencies.

LPNs do not triage clients in emergency rooms (ERs).

LPNs work in a team nursing approach to provide care for clients with stable
or predictable states of health

Also see Non-Restricted Activities #2 and #3

Hemodialysis LPNs working in hemodialysis settings carry out hemodialysis:

a) For clients with stable or predictable states of health

b) After successfully completing post-basic education through an in-

house program offered by a health authority affiliated with BC Renal

c) By following decision support tools established by a health

authority affiliated with BC Renal

d) When a registered nurse is immediately available

e) Using an arteriovenous (AV) fistula or AV graft

LPNs working in hemodialysis settings manage, access and maintain central

venous lines and central venous access devices used specifically for
hemodialysis by:

a) Changing dressings on central venous access lines specific to

dialysis access only

b) Measuring visible central venous access lines specific to dialysis

access only

c) Carrying out dialysis through a central venous access line specific to

dialysis access only

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Practice Setting BCCNM Limits and Conditions

LPNs working in hemodialysis settings administer solutions, substances and

Schedule I, IA, II and III drugs by any route, including intravenous and IV push,
as part of routine hemodialysis procedures.

LPNs working in hemodialysis settings do not administer:

a) Intrathecal medications

b) Intra-osseous medications

c) Medications into epidural spaces

d) Medications into perineural spaces

e) Inhaled substances or medications for purposes of anaesthesia or

procedural (conscious) sedation

LPNs working in hemodialysis settings monitor clients receiving blood or

blood products in a team nursing approach.

LPNs working in hemodialysis settings do not start transfusions of blood or

blood products.

Medical LPNs successfully complete additional education 9 before providing medical

Aesthetics 8 aesthetic procedures.

LPNs administering injectable drugs or substances or implantable devices for

medical aesthetic purposes only do so:

a) with a client-specific order from a health professional 10, and

b) when the ordering health professional, or another health

professional who has assumed responsibility for the care of the
client, is present within the facility when the procedure is being
performed and immediately available for consultation.

8
“Medical aesthetics” refers to elective non-surgical outpatient clinical procedures that include the performance of a restricted activity
(activities listed in sections 6 and 7 of the Nurses (Licensed Practical) Regulation) and are primarily intended to alter or restore a
person’s appearance.
9
“Additional education” is structured education (e.g., a workshop, course or program of study) designed so that LPNs can attain the
competencies required to carry out a specific activity as part of LPN practice. Additional education builds on the entry-level
competencies of LPNs, identifies the competencies expected of LPNs, includes both theory and application to practice and includes an
objective, external evaluation of LPNs’ competencies.
10
“Health professional” has the same meaning as in the Nurses (Licensed Practical) Regulation.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Practice Setting BCCNM Limits and Conditions

Mental Health LPNs working in settings where substance use or a mental health disorder is
and the primary diagnosis require an orientation that is consistent with LPN
Substance entry-level competencies.
Use
LPNs work in a team nursing approach to provide care for clients whose
primary diagnosis is substance use or a mental health disorder after
successfully completing additional education.

Perioperative LPNs work in a scrub or circulating role in the operating room (OR):

a) After successfully completing formal post-basic education

b) When a registered nurse is immediately available

LPNs do not administer:

a) IV push medications

b) IV medications through a central venous access device, or a central

venous line

c) Intrathecal medications

d) Intra-osseous medications

e) Medications into epidural spaces

f) Medications into perineural spaces

g) Inhaled substances or medications for purposes of anaesthesia or

procedural () sedation

LPNs working in a perioperative setting work in a team nursing approach to

provide care and monitor clients under:

a) General anesthesia

b) Intrathecal anesthesia

c) Epidural anesthesia

d) Procedural sedation

Postpartum LPNs working in postpartum settings require a unit orientation consistent

Care with LPN entry-level competencies that includes:

a) Infant resuscitation as part of a cardiopulmonary resuscitation (CPR)

course for health professionals

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Practice Setting BCCNM Limits and Conditions

b) The Neonatal Resuscitation Program (NRP) modules 1-4 and 9

c) Newborn and maternal assessment, including breastfeeding,

consistent with the Perinatal Services British Columbia (PSBC)
Newborn Clinical Pathway and the Postpartum Clinical Pathway

LPNs provide care for mothers and newborns:

a) With stable or predictable states of health

b) When a registered nurse, nurse practitioner, midwife and/or medical

practitioner is immediately available

LPNs take heel pricks after successfully completing additional education.

Restricted Activities Outside the Scope of Practice of LPNs

LPNs only provide care within BCCNM’s scope of practice. However, there are two exceptions:

in life-threatening emergencies

where a formal delegation process is in place

In life-threatening emergencies, LPNs are ethically obligated to provide the best care they can, given
the circumstances and their individual competence. Employers and nurses should not rely on the
emergency exemption when an activity is considered an expectation of practice in a particular
setting. The emergency exemption is meant to deal with situations involving imminent risk of death
or serious harm that arise unexpectedly and require urgent action.

The following activities are considered to be outside the LPN scope of practice and LPNs do not
carry them out.

LPNs do not:

Apply electricity to destroy tissue or affect the heart or nervous system (exception:
automated external defibrillators)

Apply laser that cuts or destroys tissue

Administer allergy challenge testing or desensitization treatments

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

MEDICAL ASSISTANCE IN DYING

Introduction

The Criminal Code allows a person, under limited circumstances, to request and receive a substance
intended to end their life (sections 241.1 – 241.4).

Only two forms of medical assistance in dying (MAiD) are permitted under the Criminal Code:

• the administering by a medical practitioner or nurse practitioner of a substance to a person

at their request that causes their death

• the prescribing or providing by a medical practitioner or a nurse practitioner of a substance

to a person at their request, for their self-administration that in doing so cause their own
death

The role of licensed practical nurses (LPNs) may include:

• providing information

• acting as an independent witness, as described in the Criminal Code

• acting as a proxy, for a mentally capable client who is physically unable to sign a request for
medical assistance in dying

• acting as a witness in a virtual assessment

• aiding a medical practitioner or nurse practitioner in the provision of medical assistance in

dying

Licensed practical nurses cannot prescribe, compound, prepare, dispense or administer any
substance intended for the purpose of medical assistance in dying. Licensed practical nurses can
record information for reference use by the assessor-prescriber 11 as needed, but the assessor-
prescriber is responsible for documenting the substance they administer or provide in the client’s
record and medication administration record.

Licensed practical nurses approached about aiding in the provision of medical assistance in dying
should speak with their employer for further information about their role in MAiD. Employers may
also further limit the role of nurses in MAiD.

The purposeful and intended outcome of medical assistance in dying is to assist a person explicitly
requesting assistance in dying to end their life in a respectful, culturally appropriate, safe, ethical,
legal and competent manner. Palliative care is care that improves the day-to-day quality of life for a
person experiencing a life-limiting illness.

11 A nurse practitioner or medical practitioner who is responsible for completing both an eligibility assessment and providing medical
assistance in dying.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Licensed practical nurses have important roles in providing high quality client-centered end of life
care. These activities include: advocating for clients, providing information, participating in decision-
making, caring for and supporting clients and their families and collaborating with members of the
health care team to ensure that clients have their care and information needs met.

The Criminal Code requires that any person requesting medical assistance in dying is informed of the
means that are available to relieve their suffering, including palliative care. More specifically, when
the client’s natural death is not reasonably foreseeable, the Criminal Code requires that this must
include information, where appropriate, about counselling services, mental health and disability
support services, and community services, as well as palliative care, and that the client must be
offered the opportunity to consult with professionals who provide those services or that care. This
ensures that the person requesting medical assistance in dying is able to make a fully informed
decision about their health care options for end of life care and palliation.

Directing, counselling or recommending a client to end their life remains an offence under the
Criminal Code. However, health professionals are permitted to provide information about medical
assistance in dying.

Witnessing and Signing MAiD Requests, Acting as a Proxy, and Witnessing Virtual
Assessments

Independent Witness for MAiD Requests 12

The Criminal Code requires that a client’s request for MAiD must be made in writing, in the presence
of an independent witness who must sign the request.

The role of the independent witness is to provide confirmation of the client’s signing and dating of
their request for MAiD, and that the client understands what they are signing.

An independent witness must be at least 18 years of age and must understand what it means to
request MAiD.

An independent witness can be a paid professional personal or health care worker, other than a
nurse practitioner or medical practitioner who completes a required eligibility assessment for the
client.

To be considered independent means that the witness cannot:

• know or believe that they are a beneficiary under the client’s will, or that they will benefit in
any other way from the client’s death

• be an owner or operator of a health care facility where the client lives or is receiving care

• be a caregiver for the client, unless that is their primary occupation for which they are paid

12 Health Canada. (2021, March 18). Medical assistance in dying. https://www.canada.ca/en/health-canada/services/medical-assistance-

dying.html

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Acting as a proxy

The Criminal Code also allows another person to sign a client’s request MAiD as their proxy, if the
client has the mental capacity to make a free and informed decision with respect to their health but
is physically unable to sign and date the request. The proxy must sign the request in the client’s
presence, on the client’s behalf, and under the client’s express direction.

To be eligible to act as a proxy, a person must:

• be at least 18 years of age

• understand what it means to request MAiD

• not know or believe that they are a beneficiary under the client’s will, or that they will benefit
in any other way from the client’s death

Acting as a Witness to a Virtual Assessment

The medical assistance in dying standards for nurse practitioners and medical practitioners also
require the physical attendance of a regulated health professional at a virtual assessment of
eligibility, to act as a witness to the assessment. Licensed practical nurses can act in this role, even if
they are providing care to the patient.

Licensed practical nurses should seek clarification from their employer before acting in the formal
role of an independent witness, acting as a proxy for signing any forms related to medical assistance
in dying, or acting as a witness to a virtual assessment.

Conscientious Objection

An LPN may have beliefs and values that differ from those of a client. Nothing in the Criminal Code
compels LPNs to aid in the provision of medical assistance in dying. The Duty to Provide Care
practice standard addresses conscientious objection. This practice standard requires LPNs with a
conscientious objection to take all reasonable steps to ensure that the quality and continuity of care
for clients seeking or receiving medical assistance in dying are not compromised.

The Duty to Provide Care practice standard also requires LPNs with a conscientious objection to
notify their organization well before the client is to receive medical assistance in dying. If medical
assistance in dying is unexpectedly proposed or requested and no arrangement is in place for
alternative providers, that practice standard further requires LPNs to inform those most directly
involved of their conscientious objection, and to ensure a safe transfer of care to an alternate
provider that is continuous, respectful and addresses the unique needs of a client.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Standards, Limits and Conditions

Standards

Licensed practical nurses ensure that a client has access to the information that the client
requires to understand all of their options and to make informed decisions about medical
assistance in dying and other end-of-life options such as palliative care.

Licensed practical nurses assess the cultural and spiritual needs and wishes of the person
seeking medical assistance in dying and explore ways the person’s needs could be met
within the context of the care delivery.

Licensed practical nurses work with their organizations and other members of the health
care team to ensure that the person requesting or receiving medical assistance receives high
quality, coordinated and uninterrupted continuity of care and, if needed, safe transfer of the
client’s care to another health care provider.

Licensed practical nurses who participate in medical assistance in dying, follow legal,
legislative, regulatory and organizational requirements for aiding in the provision of medical
assistance in dying.

Licensed practical nurses may return unused substances intended for the purpose of
providing medical assistance in dying to the pharmacy, when asked by the assessor-
prescriber. When asked to carry out such a request, licensed practical nurses ensure the
drugs are stored securely until transported and are returned to the pharmacy within 72
hours of the MAiD procedure, and they sign any forms normally signed by the assessor-
prescriber to note the return of the substances.

Limits and Conditions

Licensed practical nurses only aid in the provision of medical assistance in dying and do not
act as an assessor or assessor-prescriber 13 or provide medical assistance in dying to a person
(i.e., they do not prescribe, compound, prepare, dispense or administer any substances
specifically intended for the purpose of providing medical assistance in dying, nor document
the provision of medical assistance in dying).

Licensed practical nurses do not receive substances specifically intended for the purpose of
providing medical assistance in dying from a pharmacist.

Licensed practical nurses do not direct or counsel clients to end their lives.

13 Assessor: A nurse practitioner or medical practitioner who is responsible for completing an assessment of the client’s eligibility for
medical assistance in dying.
Assessor-Prescriber: A nurse practitioner or medical practitioner who is responsible for completing both an eligibility assessment and
providing medical assistance in dying by prescribing and (when applicable) administering the substance to be used in MAiD. This role
may be referred to by other regulatory colleges as the “prescribing nurse practitioner”.

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Licensed practical nurses participate in activities related to medical assistance in dying only
as permitted under the Criminal Code and other legislation, regulations, regulatory college
standards, and provincial and organizational policy and procedures.

Licensed practical nurses do not act as an independent witness if they:

a. provide health care services or personal care to the client, unless they are a paid
personal or health care worker who provides those services as their primary
occupation.

b. own or operate any facility where the client requesting medical assistance in dying
resides or is receiving treatment

c. know or believe that they are a beneficiary under the client’s will, or that they will
otherwise receive any financial or other material benefit as a result of the client’s
death

Licensed practical nurses do not act as a proxy for signing any forms related to medical
assistance in dying if they know or believe that they are a beneficiary under the will of the
client making the request, or that they will receive, in any other way, any financial or other
material benefit resulting from the client’s death.

Licensed practical nurses who aid in the provision of medical assistance in dying successfully
complete additional education.

Licensed practical nurses who aid in the provision of medical assistance in dying follow the
BC provincial decision support tool, in accordance with employer policy.

Licensed practical nurses do not aid in the provision of medical assistance in dying for a
family member.

Licensed practical nurses do not pronounce death related to medical assistance in dying.

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Glossary
Accountability: The obligation to answer for the professional, ethical and legal responsibilities of
one’s activities and actions.

Additional education: Structured education (e.g., a workshop, course or program of study) designed
so that LPNs can attain the competencies required to carry out a specific activity as part of LPN
practice. Additional education builds on the entry-level competencies of LPNs, identifies the
competencies expected of LPNs, includes both theory and application to practice and includes an
objective, external evaluation of LPNs’ competencies.

Appropriate action: Getting more information from the client, consulting with a colleague or
manager or questioning the health professional who gave the order.

Assessment: A process of observation and evaluation of the physical or mental status of an

individual. Assessment may involve observing symptoms, but does not include identifying a
condition as the cause of these symptoms.

Authorized health professional: A health professional who is regulated, and authorized by the
Nurses (Licensed Practical) Regulation to give client-specific orders for the performance of activities
listed in section 7. Authorized health professionals are dentists, midwives, naturopaths, physicians,
podiatrists, pharmacists, registered nurses, registered psychiatric nurses, and nurse practitioners. An
authorized health professional must be registered to practise in British Columbia, except where the
client has been transferred from Alberta, Yukon or the Northwest Territories for emergency
treatment in British Columbia. In addition, an order for a licensed practical nurse to cast a fracture of a
bone may only ever be given by a physician or nurse practitioner who is registered in British
Columbia.

Available: The LPN has access to an authorized health professional who is:

a) physically present at the point of care,

b) not physically present at the point of care, but available within the same location, or

c) not physically present at the point of care, but available by phone or other electronic means.

Botulinum Toxin Type A products: Includes Botox Cosmetic ®, Xeomin ® and Dysport ®. Botulinum
Toxin Type A products are considered Schedule I drugs and require a prescription for sale. They are
provided to the public by a pharmacist following the diagnosis and professional intervention of a
practitioner.

BCCNM condition: The circumstances under which LPNs may carry out an activity.

BCCNM limit: In the context of LPN scope of practice, what LPNs are limited to doing or what they
are not permitted to do.

Clinical judgment: Processes that rely on critical thinking and an analysis of evidence to reflect the
complex, intuitive and conscious thinking strategies that guide nursing decisions.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Competence: The integration and application of the professional attributes required to perform in a
given role, situation or practice setting.

Competencies: The knowledge, skills, attitudes and judgment required to provide safe and ethical
care.

Compound: To mix a drug with one or more other ingredients for the purposes of dispensing or
administering the drug, or to mix two or more ingredients of a therapeutic diet for the purpose of
dispensing or administering the therapeutic diet.

Condition: A condition (e.g., hypoglycemia) may result from a known disease (e.g., diabetes) or
disorder (e.g., inability to metabolize glucose) or its treatment.

Conservative sharp wound debridement (CSWD): The removal of loose, soft, necrotic tissue at the
interface between non-viable and viable tissue using instruments (e.g., scalpel, scissors, curette) to
create a clean wound bed.

Critical inquiry: A process of purposeful thinking and reflective reasoning whereby practitioners
examine ideas, assumptions, principles, conclusions, beliefs and actions in the context of nursing
practice.

Critical thinking: An active and purposeful problem-solving process that requires LPNs to advance
beyond the performance of skills and interventions to provide the best possible care, based on
evidence-informed practice (identifying and prioritizing risks and problems, clarifying and challenging
assumptions, using an organized approach to assessment, checking for accuracy and reliability of
information, weighing evidence, recognizing inconsistencies, evaluating conclusions and adapting
thinking).

Decision support tools: Evidence-based documents used by LPNs and other health care
professionals to guide their assessment, diagnosis and treatment of client-specific clinical problems.

Delegation: Delegation, under the Health Professions Act, refers to delegation of a restricted activity
by one regulated health professional to another regulated health professional. Delegation to
regulated health professionals occurs when an activity is within the scope of the delegating
professional and outside the scope of the professional receiving the delegation. Before the
delegation can occur, BCCNM and the regulatory body of the delegating professional must both
agree that the activity is appropriate for delegation to LPNs.

Dermal fillers: Some dermal fillers are considered to be substances (i.e., Juvederm, Restylane and
other hyaluronic acid, polylactic acid and calcium based dermal fillers), while others are Schedule II
drugs (i.e., hyaluronic acid and its salts – preparations in concentrations of 5% or more).

Disease: Any deviation from, or interruption of, the normal structure or function of any body part,
organ or system that is manifested by a characteristic set of symptoms and signs and whose
etiology, pathology and prognosis may be known or unknown.

Disorder: A disturbance in physical or mental health or functions, malady or dysfunction (i.e., a mild
stomach disorder).

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Emergency exemption: In situations involving imminent risk of death or serious harm that arise
unexpectedly, LPNs are ethically obligated to provide the best care they can, given the
circumstances and their individual competence. Employers and LPNs should not rely on the
emergency exemption when an activity is considered common and expected LPN practice in that
setting.

Evidence: Data derived from various sources including research, national guidelines, regulation,
policies, consensus statements, expert opinion, historical and experiential information.

Evidence-based (evidence-informed practice): The identification, evaluation and application of

evidence to guide practice decisions.

Formal post-basic education: Structured education that builds on the entry-level LPN competencies.
Formal post-basic education is delivered:

• by an educational institution that teaches a BCCNM-recognized practical nursing education

program or equivalent, or

• through a collaborative arrangement between an employer that employs LPNs in post-basic

areas and a school that teaches a BCCNM-recognized practical nursing education program
or equivalent.

Immediately available: The LPN has access to an authorized health professional who is physically
available at the point of care.

Nursing diagnosis: 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 LPN to
achieve outcomes for which the LPN is accountable.

Other supports: BCCNM uses this condition to describe other kinds of supports required to promote
safe LPN practice. For example, the condition for taking electrocardiograms reads, “LPNs only take
electrocardiograms (ECGs) when a health care professional authorized to read the ECG is
immediately available.” Decision support tools (DSTs) may also be a condition set by BCCNM.

Responsibility: The ability to respond and answer for one’s conduct and obligations, to have integrity
and be trustworthy and reliable.

Restricted activities: Higher risk clinical activities that must not be performed by any person in the
course of providing health services, except members of a regulated profession that has been granted
specific legislative authority to do so, based on their education and competencies.

Scope of practice: The activities that LPNs are educated and authorized to perform as set out in the
Nurses (Licensed Practical) Regulation and complemented by BCCNM standards, limits and
conditions.

Self-regulate: To adhere to registration, standards of practice, ethics and continuing competence

requirements, while practising within applicable legislation, regulation and other laws governing
nursing.

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SCOPE OF PRACTICE: STANDARDS, LIMITS, CONDITIONS FOR LICENSED PRACTICAL NURSES

Standards: Expected behaviours and levels of performance against which actual behaviour and
performance can be compared.

Team approach: When the care needs of a client include activities that are outside LPN scope of
practice or the individual competencies of the LPN, the LPN seeks out other members of the health
care team to jointly review the client’s care needs and determine how the care needs will be met
between them. Where relevant, the registered nurse or registered psychiatric nurse may be the most
appropriate team member for the LPN to seek consultation and collaboration with regarding client
care needs.

Team nursing approach: When the nursing care needs of a client include activities that are outside
LPN scope of practice or the individual competencies of the LPN, the LPN seeks out the registered
nurse or registered psychiatric nurse to jointly review the client’s care needs and determine how the
care needs will be met between them.

Tracheostomy care: This includes instilling a substance into the tracheostomy to loosen respiratory
secretions, suctioning the tracheostomy, changing tracheostomy ties and changing the
tracheostomy cannula.

BC COLLEGE OF NURSES AND MIDWIVES / 42

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More Information
• Additional Education Resource

• British Columbia Centre for Disease Control

• BCCNM Practice Support

• BCCNM LPN Practice Standards

• BCCNM LPN Professional Standards

• BCCNM LPN Practice Resources

• Drug Schedules Regulation

• Entry Level Competencies for Licensed Practical Nurses

• Health Professions Act

• Legislation Relevant to Nurses' Practice

• Nursing News Newsletter

• Nurses (Licensed Practical) Regulation

• Provincial Skin and Wound Committee

Copyright © British Columbia College of Nurses and Midwives/September 2021

Effective Date: January 5, 2023

900 – 200 Granville St.

Vancouver, BC
V6C 1S4

www.bccnm.ca

Pub. No. 823

BC COLLEGE OF NURSES AND MIDWIVES / 43