Practical nurse scope of practice: three questions before you say yes
Authorized, allowed by policy, and competent: the three questions that decide if an activity is in a practical nurse's scope.
- An order answers only part of the first question.
- An employer can limit your scope and can never add to it.
- When one answer is “no”, say so and get help.
An activity is yours to do when three answers are “yes”: the law and your regulator authorize it, your employer's policy allows it on this unit, and you are competent to do it for this client. A written order answers only part of the first question. This guide follows one practical nurse through three requests.
An order is not the whole answer
It is 08:00, and a physician stops you in the hallway and asks you to start an intravenous line on client M. The order is written, and you learned the skill at your last job, so it feels like an easy yes. Before you agree, ask three questions.
Three questions before you say yes
| Ask | Who answers it |
|---|---|
| 1. Is it authorized for a practical nurse? | The law and your regulator. An order is one part of this. |
| 2. Does policy allow it here? | Your employer, for this unit. |
| 3. Am I competent to do it for this client? | You: your knowledge, your skill and your judgment. |
The IV start: policy says no
The first answer is yes, because the order is in place. The second answer is no, because policy on this unit gives every intravenous start to the intravenous team.
An employer can limit what you do. An employer can never add to your legal scope. So you tell the physician and the charge nurse, and the team is called.
The catheter: competence says no
Now suppose the request was a urinary catheter, which is ordered and which policy allows. The third question decides it. You have only practised on a mannequin, so you say so, and you ask a competent nurse to do it while you watch and learn.
The insulin: three yeses
And suppose it was the subcutaneous insulin that you give every shift. All three answers are yes, so you give it.
Scope of practice differs between provinces and between employers. Follow your regulator's standards and your agency's policy.