Fillable Workbook To Accompany BCCNP Learning Module On RN Scope (British Columbia College of Nurses & Midwives)

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Workbook To Accompany BCCNP Learning Module On RN Scope (British Columbia College of Nurses & Midwives)

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bccnm.ca
Understanding the
Scope
BCCNM LEARNING MODULE — WORKBOOK
Of Registered Nurses Practice
page 2
Introduction
This workbook offers activities that allow you to apply ideas presented in the on-line Learning
Module. It is organized in two sections.
• Part 1 includes Workbook Activities that are related to various topic areas. As you work through
themodule,youwillbedirectedtocompleteaspecicWorkbookActivity.Thissectionalso
includespagesforyoutorecordyourreectivethoughtsandinsightsrelatedtoyourexploration
in this module.
Some of these activities include case scenarios with associated questions. These provide an
opportunityforyoutoapplytheinformationthathasbeenofferedinthemoduleinthecontext
ofthispractice-basedscenario.Whenyouhavecompletedtheseactivities,youmaywishto
compare your responses with those provided in the “Workbook Activities: Case Perspectives”
located in Part 3.
• Part 2: This section of the workbook provides an opportunity for you to create a plan for your
continued professional growth with the Registered Nurses Scope of Practice Standards. A
sample Professional Development Plan is provided to help you in this process.
• Part 3 presents sample responsestoWorkbookactivitieswithcasescenarios.Theseresponses
provide the perspectives of the course writer and others on the case scenario.
page 3
pa rt 1
Workbook Activities
page 4
WorkbookActivity#1
Now that we have reviewed how nursing practice is described in the regulation please take a moment to think
aboutyourownpracticeandtheactivitiesyouconducteachday.Whichactivitiesconstitutemostofyour
practice?Whicharerestricted?Whichonesarenot?Dosomerequireanorder?Itmaybehelpfultothinkof
a typical work day, evening or night and write out your daily activities, then you may want to highlight those
thatarerestrictedandcirclethosethatrequireanorder?YoumayndithelpfultoreviewSection6and7of
theRegulation(linkbelow)andpotentiallysection8and9ifyouareeitheracertiedregisterednurseora
nurse practitioner.
Nurses (Registered) and Nurse Practitioner’s Regulation (BC Laws)
htt
p://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/284_2008
1
page 5
WorkbookActivity#2
2
Charlies’s Story
Ather1600checkinCharliecantellthatMr.Holt’s,aclientwithtype1
diabetes,conditionhaschanged.Assheaskshimhowhefeels,Charlie
notes he is more lethargic, appears sleepy and seems to have trouble
focusingonCharlie`squestions.ShenoticesthatMr.Holtseemstobe
fallingasleepassheistalkingtohim.WhenCharlieattemptstowake
him up with a gentle touch , he opens his eyes but seems to have trouble
keeping them open. “I feel so tired, I can barely keep my eyes open”.
CharlieknowsMr.Holtwasadmittedovernightwithgeneralweakness
after a fall at home. She remembers, when reviewing his history, that he is
diabetic and self-administers insulin at home.
Charliebeginsherassessmentbyadministeringabloodglucosetestwhich
showsabloodglucoselevelof3.2.Charliealsotakeshisvitalsigns.Hispulseis110/minandregular,BP
140/60,and02Satsare99%onroomair.
Basedonherassessment,CharliedrawsaconclusionaboutMr.Holtsstatus.Shediagnoseshiscondition
ashypoglycemiarelatedtodecreasedbloodsugarlevel.Charlieknowsshecanimprovehiscondition
temporarily by giving him some orange juice that is kept by his bedside and by then following the decision
support tool (DST) for hypoglycemia provided by her employer.
Indecidingtotreat,Charlieconsiderstherisks,benetsandpossibleoutcomes.Inherjudgment,the
outcomeisreasonablypredictableandthebenetsoutweighrisks.Shehastheknowledge,skilland
judgment to follow her organizational decision support tool and protocol for treating hypoglycemia,
including managing any intended and unintended outcomes.
ExplaininghernextstepstoMr.Holt,shehelpshimdrinkhisglassoforangejuice.Reassuringhim,she
watchesforandchangesinhiscondition.Withinafewminutes,Mr.Holthasvisiblyimproved.Heappears
more awake and states that he is feeling hungry.
CharliepagesMr.Holt‘sphysicianusingtheintercomsystemintheclient’sroom.Whenthephysician
arrives,Charlieconsultswiththetreatingphysicianandreceivesorders.Sheupdatesthecareteamand
documents her ongoing assessment, diagnosis, treatment, and communication with the physician.
page 6
ReectingonCharlie’sStory
Considerthefollowingquestionsandjotdownyourthoughtsinthespaceprovided.Youmaywishtocompare
your answers with the discussion in Part #3, Case PerspectiveslocatedattheendofthisWorkbook.
1. Whatisthedifferencebetweendiagnosingadiseaseanddiagnosingacondition?
2. Whichhealthprofessionalgroup(s)areauthorizedtodiagnoseadisease?
3. Whatconditionsmightyoudiagnoseandtreatinyourpractice?
4. WhendiagnosingandtreatingaconditionwhichScopeStandardswouldyoufollow?
5. Whoholdsthesoleaccountabilityandresponsibilitywhendiagnosingandtreatingacondition?
2
page 7
WorkbookActivity#3
Tara’s Story
Tara,aresidentialcarenurse,iscaringforMr.Junga87yearoldmanwho
has been her client for the last few months. As Tara conducts her morning
vital signs and talks to her clients, she notices that Mr. Jung appears
uncomfortable. Upon assessing him, Tara gathers enough information to
diagnose bladder retention.
Mr.Jungexplainsthathehasnotvoidedinthelast12hours,hislower
abdomenisdistendedandhestatesthatheisinpain.Toconrmher
assessment and diagnosis of urinary retention, Tara conducts a bladder
scan.Mr.Jung’sbladderisveryfull,thescanrevealsaurineretention
greater that 500 mls.
AsTarahasdealtwithurinaryretentionmanytimesbefore,sheknowsexactlywhattodotohelpMr.Jungfeel
better. After assessing the client, coming to a nursing diagnosis of a condition of urinary retention Tara has
determinedtheneedforaninandoutcatheterization.Tara’splaceofworkhasaDecisionSupportToolfor
urinary retention which Tara reviews prior to carrying out the activity. She charts the outcome and assesses
Mr. Jung once again post catheterization.
3
page 8
ReectingonTara’sStory
Usingthe“ActingwithinAutonomousScope”ReectiveTool,(linkbelow)considerthefollowingquestions
and jot down your thoughts in the space provided. You may wish to compare your answers with the discussion
in Part #3, Case Perspectives locatedattheendofthisWorkbook.
1. InTara’scase,whoisresponsibleandaccountablefortheactivityTarachosetocarryout?
2. Whatotheraction(s)shouldTaratakeinthiscase?
3. Tara’sorganizationhasaDecisionSupportToolinplaceforurinaryretention.WhatwouldTaraneedtodoif
this was not the case?
4. WhatimportantcomponentoftheActingwithinAutonomousScopestandardsisnotincludedinthe
description of this case?
5. If you were Tara, what would be your clinical decision making process? Describe, in detail, what you would do.
3
Acting Within Autonomous Scope of Practice Reflective Tool
https://www.bccnm.ca/Documents/learning/modules/ASOPthinkingtool.pdf
page 9
WorkbookActivity#4
Sergei’s Story
Sergei,aregisterednurse,worksonamedical/surgicalunit.Hisclient
Mrs.Whiteis67yearsoldandhasrecentlyundergonehipreplacement
surgery.ItisnowtimeforMrs.WhitetostartwalkingsoSergeicontacts
the Physio Therapist for an assessment and mobility plan.
The Physio Therapist conducts the assessment and provides a client-
specicorderthatfocusesonMrs.White’scurrentabilitytomoveand
strengtheningandtherapeuticexercisestorestoreherwalkingability.
Usingthe“ActingwithClient-SpecicOrders”ReectiveTool,(linkbelow)considerthefollowingquestions
and jot down your thoughts in the space provided. You may wish to compare your answers with the discussion
in Part #3, Case PerspectiveslocatedattheendofthisWorkbook.
1. Beforeactingonthisclientspecicorder,whatmustSergeiensure?
2. Whatshouldtheclientspecicorderinclude(theactualwrittendocument)?
4
Acting With Client Specific Orders Thinking Tool
https://www.bccnm.ca/Documents/learning/modules/ACSOthinkingtool.pdf
BCCN
M Acting with Client-specific Orders Web Page:
https://www.bccnm.ca/RN/ScopePractice/part2/acting_orders/Pages/Default.aspx
un
derstanding the scope of registered nurses practice workbook
page 10
WorkbookActivity#5
Steve and Julie’s Story
Steve,anexperienceRN,worksonamedical/surgicalunit.Heiscaring
forMrs.Chana60yroldwomenwithType1diabeteswhocameinwith
alargediabeticfootulcer.SteverealizesthatMrs.Chanwouldbenet
fromsomewounddebridementandspecicwoundcare.Knowing
thatdeterminingthespecicsfortheseactivitiesisbeyondhisown
competence level, Steve calls on Julie a wound clinician to assess his client.
Julie, a wound care clinician, who is also an RN, conducts an
assessmentandwounddebridementwithMrs.Chanandthenwritesup
aclient-specicorderoutliningthewoundcarenecessarytocareforher
footulcer.ThisclientspecicorderistobecarriedoutdailybytheRN
on shift.
Usingthe“GivingClient-SpecicOrders”ReectiveTool,(linkbelow)considerthefollowingquestionsand
jot down your thoughts in the space provided. You may wish to compare your answers with the discussion in
Part #3, Case PerspectiveslocatedattheendofthisWorkbook.
1. Wheremustthisorderbewritten,whatimportantrequirementsmustthisordermeet?
2. Whoisaccountableandresponsibleforthisclientspecicorder?
3. Asidefromregulatoryrequirements(suchasBCCNM`sstandardslimitsandconditions),whatother
requirements must Julie and the RN on shift acting on the order follow?
5
Giving Client Specific Orders Thinking Tool
https://www.bccnm.ca/Documents/learning/modules/GCSOthinkingtool.pdf
BCCNM Scope of Practice Standards Web Page
https://www.bccnm.ca/RN/ScopePractice/Pages/Default.aspx
page 11
NotesfromReectionPoints
page 12
AfrmationsandInsights
page 13
pa rt 2
Growth Planning
page 14
WorkbookActivity#6
6
My Plan for Professional Development/Growth
Goals
1.
2.
3.
Action Plan
People or places that I can investigate for learning strategies to help me meet my goals for growth and
ongoing development are:
1.
2.
3.
page 15
My Plan for Professional Development/Growth
Strategy Resources I need to
implement this strategy
Target completion date Other thoughts
6
Reminder: Add your completed action plan to your Quality Assurance Portfolio/My Professional Plan.
page 16
WorkbookActivity#6
6
Goals
1. To increase my understanding of what it means for me to be a self-
regulating professional.
2.
3.
Action Plan
People or places that I can investigate for learning strategies to help me meet my goals for growth and
ongoing development are:
1. Review Learning Resources section of this module
2. Assess Organizational policies related to activities defined within Autonomous Scope of Practice
3.
My Plan for Professional Development/Growth: An Example
Review BCCNM resources related to Autonomous Scope of Practice
page 17
My Plan for Professional Development/Growth: An Example
Strategy Resources I need to
implement this strategy
Target completion date Other thoughts
6
Reminder: Add your completed action plan to your Quality Assurance PD Plan/My Professional Plan.
1. Review
documents
identied
in Learning
Resources section
of module
2. Have
discussion with
unit Educator
related to
Autonomous Scope
of Practice
Activities and
relevant policies
& guidelines
1. None – just
download the
documents from
the Learning
resources
section!
2. Can do this
casually and/
or in scheduled
meeting time as
needed.
1. Within the
next week
2. Within the
next month
page 18
pa rt 3
Workbook Activities
and Case Perspectives
page 19
ReectingonCharlie’sStory
1. What is the difference between diagnosing a disease and diagnosing a condition?
Conditionsalwayshaveassociatedsignsandsymptoms.Aconditionmayresultfromaknowndiseaseor
disorderoritstreatment.Forexample,aregisterednursemaydiagnosehypoglycemiainaclientwithdiabetes,
urinary retention in a post-operative client or angina in a client with a history of coronary artery disease.
Otherconditions,suchashypoxiaorpostpartumhemorrhage,mayresultfromamedicalproblemsuchas
an undiagnosed disease or disorder. In these situations, a registered nurse may diagnose and stabilize the
condition until a physician or nurse practitioner diagnoses the underlying disease or disorder.
2. Which health professional group(s) are authorized to diagnose a disease?
InB.C.,diagnosing(adisease,disorderorcondition)isarestrictedactivitygrantedtosomeregulatedhealth
professionals. For instance, physicians and nurse practitioners are authorized to diagnose diseases, disorders
andconditions;andcertiedpracticeregisterednursesareauthorizedtodiagnoseaverylimitednumberof
diseasesanddisorders.Registerednurses(otherthancertiedpracticenurses)havetheauthoritytodiagnose
conditions only.
Under the Nurses (Registered) and Nurse Practitioner Regulation, you can make a nursing diagnosis that
identiesaconditionasthecauseofaclient’ssignsorsymptoms.Anursingdiagnosisisaclinicaljudgment
aboutyourclient’sphysicalormentalcondition.Itinvolvesdrawingaconclusionaboutwhat’scausingthe
signsorsymptomsyou’verecognized.
3. What conditions might you diagnose and treat in your practice?
SeelinkonBCCNMWebSite:
https://www.bccnm.ca/RN/learning/scope/diagnosing/Pages/Default.aspx
4. When diagnosing and treating a condition which Scope Standards would you follow?
The Regulation also authorizes you to carry out certain restricted activities without an order to assess for or
treataconditionyou’vediagnosed.Forexample,youmayinsertaurinarycatheter,suctionatracheostomy,
irrigateanostomy,oradministeroxygenoradministerIVuids.Thestandardsforactingwithinautonomous
scopeofpracticesetoutexpectationsfornursescarryingoutactivitiesautonomously.
5. Who holds the sole accountability and responsibility when diagnosing and treating a condition?
Whenyoudiagnoseanddecidetotreatacondition,youaresolelyaccountableforthediagnosis,appropriate
treatment,andyourclient’soutcomes.Decidingtocarryoutanactivitywithinautonomousscopeofpractice
requires a greater level of knowledge, skill and judgment than carrying out the same activity with a client-
specicorderfromanotherhealthprofessional.
2
page 20
ReectingonTara’sStory
1. In Tara’s case, who is responsible and accountable for the activity Tara chose to carry out?
Only Tara.
2. What other action(s) should Tara take in this case?
CommunicatewithotherhealthcareprofessionalsinvolvedinMr.Jung’scaretoensurecontinuityofcareand
increase best client outcome.
3. Tara’s organization has a Decision Support Tool in place for urinary retention. What would Tara need to
do if this was not the case?
Communicateandcollaboratewithhealthcareteam,ensurethatherorganizationsupportsherprocessand
decisions/actions of acting within autonomous scope and knows her role, responsibility and applications of the
standards when acting within autonomous scope.
4. What important component of the Acting within Autonomous Scope standards is not included in the
description of this case?
Obtaining consent from client.
5. If you were Tara, what would be your clinical decision making process? Describe, in detail,
what you would do.
Assess, talk to client, diagnose condition, ensure you know your responsibility, your role, think of potential
outcomes, use evidence, obtain consent….
Link on BCCNM Web Site:
https://www.bccnm.ca/RN/ScopePractice/part2/autonomous/Pages/Default.aspx
Acting Within Autonomous Scope of Practice Reflective Tool
https://www.bccnm.ca/Documents/learning/ASOP_thinking_tool.pdf
3
page 21
ReectingonSergei’sStory
1. Beforeactingonthisclientspecificorder,whatmustSergeiensure?
• Theorderedactivityiswithinhisscopeofpractice(asoutlinedintheRNRegulation)
• ThatheisactinginaccordancewithanyBCCNMstandards,limitsandconditions.
• Thatheisactinginaccordancewithhisorganizationalpoliciesandprocedures.
• Sergeimustbesurehehasthecompetencetocarryoutthisactivitysafelyandethically.
2. Whatshouldtheclientspecificorderinclude(theactualwrittendocument)?
• Beclientspecific
• Clearandcomplete
• Documented,legible,datedandsignedwithauniqueidentifiersuchasawrittensignatureofan
electronicallygeneratedidentifier.
• ContainenoughinformationforSergeitocarryoutthisactivitysafely
BCCNM Acting with Client-specific Orders Web Page:
https://www.bccnm.ca/RN/ScopePractice/part2/acting_orders/Pages/Default.aspx
Acting With Client Specific Orders Thinking Tool
h
ttps://www.bccnm.ca/Documents/learning/modules/ACSOthinkingtool.pdf
4
page 22
ReectingonSteveandJulie’sStories
1. Where must this order be written, what important requirements must this order meet?
• Client’spermanentrecordandmustbesignedorbeaccompaniedbyauniqueidentifier.
• Becompleteandclear
• Haveenoughinformationfortheshiftnursetocarryouttheactivitysafely
• Documentedandlegible
2. Whoisaccountableandresponsibleforthisclientspecificorder?
• Julie,theRNwhogivestheorder
3. Aside from regulatory requirements (such as BCCNM`s standards limits and conditions), what
other requirements must Julie and the RN on shift acting on the order follow?
• OrganizationalPoliciesandProcedures
• SinceJulieisaNon-Listedhealthcareprovider,anyRNsonshiftmustensuretheyhaveindividual
competence to carry out this activity and follow Acting with Autonomous Scope Standards.
Giving Client Specific Orders Thinking Tool
https://www.bccnm.ca/Documents/learning/modules/GCSOthinkingtool.pdf
BCCNM Scope of Practice Standards Web Page:
https://www.bccnm.ca/RN/ScopePractice/Pages/Default.aspx
5
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Workbook To Accompany BCCNP Learning Module On RN Scope (British Columbia College of Nurses & Midwives)

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Completed 27 February 2021

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