What is a Registered Nurse?

A Registered Nurse (RN) is a health profession that applies specialized and evidence-based knowledge of nursing theory and health and human sciences, skills, and judgment in providing professional services to another person, including: 

• The promotion, maintenance, and restoration of health 
• The prevention, treatment, and palliation of illness and injury, primarily by: Assessing health status 
  • Planning, implementing, and evaluating interventions 
  • Coordinating health services 
• The research, education, management or administrative activities incidental to performing the services referred to above 

Registered nurses are innovative, evidence-informed, and knowledgeable. The RN is responsible for the coordination of care and determines the most appropriate care provider to meet the needs of the client. RNs possess the knowledge, skills, and critical thinking to assume a leadership role in the care of all clients and to improve client outcomes by applying a population health approach. All Registered Nurses are leaders regardless of their role or job title. RNs are respected for being leaders in all domains of nursing, whether they are in a formal leadership role or not. Leadership qualities are demonstrated in a variety of ways, including advocating for clients, sharing knowledge, promoting quality practice, and establishing professional relationships. 

What guides the practice of registered nursing? 

• Regulated Health Professions Act (RHPA) 
• Registered Nurses and Registered Psychiatric Nurses Regulations 
• Standards of Nursing Practice for Registered Nurses 
• Code of Ethical Conduct 
• PEICNM policies, bylaws, practice directives, and other documents 
• Employer policies, guidelines, and procedures 
• Other provincial and federal legislation 

Domains of Practice 

Registered nursing includes four distinct domains. 

1. Clinical Practice: The RN is responsible for the coordination of care and determines the most appropriate care provider to meet the needs of the client. 
2. Administration: The RN directs and influences the work of others in a defined environment to enhance the shared vision of an organization or institution. 
3. Education: The RN works within an academic setting and clinical practice settings. In the academic setting, they may assess, plan, deliver, and evaluate curriculum to prepare graduates to meet the needs of the health care system. The RN would provide evidence-based instruction that is clinically relevant and promotes scholarly practice. In the clinical practice setting, the RN enables professional development and continuing competence through employer-based programming. 
4. Research: The RN in a researcher role validates and refines existing knowledge and generates new knowledge that contributes to and influences all domains of nursing. 

Reserved Activities 

A reserved activity is a clinical activity that can only be performed by specific regulated health professionals as there is a significant risk of harm to the public. The RHPA decides which professional can perform each reserved activity, which means that other regulated health professionals may also be assigned the same reserved activities. This means that collaborative practice is imperative. 

The Code of Ethical Conduct and Standards of Nursing Practice also underpin the practice and the performance of reserved activities. As well, practice directives expand on concepts in the regulations and outline specific practice expectations for the performance of reserved activities. 

Reserved Activities for RNs 

An RN may only perform a reserved activity if: 

• the reserved activity is listed in the Registered Nurses and Registered Psychiatric Nurses regulations, which are discussed below. 
• they meet the conditions outlined in Section 13(2) of the regulations. 
• the reserved activity is within the individual RN’s scope of competence. An individual RN’s scope cannot exceed the RN profession’s legislated scope of practice. Each individual RN must be qualified and competent with their own scope of practice. 
• they follow employer’s policies. Employer policies provide further direction on an RN’s practice. An employer may place limits on RNs and their practice. An employer’s policies must be consistent with the RHPA, regulations, bylaws, standards, code of ethical conduct and practice directives. 

The following are reserved activities for RNs: 

1. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane or on the surface of the cornea. 
2. Setting or casting a fracture of a bone or a dislocation of a joint. 
3. Administering a substance by injection, transfusion, inhalation, mechanical ventilation, irrigation or enteral or parenteral instillation. 
4. Administering a drug or vaccine by any means. 
5. Putting an instrument, hand or finger  
   • beyond the external ear canal,
   • beyond the point in the nasal passages where they normally narrow, 
   • beyond the pharynx or larynx, 
   • beyond the opening of the urethra, 
   • beyond the labia majora, 
   • beyond the anal verge, or 
   • into an artificial opening into the body 
6. Applying sound energy or electrical energy, other than ionizing radiation. 
7. Applying electrical energy in the form of ionizing radiation to conduct an X-ray for the purpose of dental screening, diagnosis, or treatment. 
8. Performing allergy challenge testing by any method. 
9. Managing labour in an institutional setting where the primary health care provider is not present. 

Activities that are not reserved 

A profession’s scope of practice is not solely encompassed by reserved activities. The full extent of a nurse’s scope of practice cannot be described by reserved activities alone. The Standards of Practice would include examples of nursing practice that do not fall under a reserved activity. Some examples are: 

• Assessing the health status of a client 
• Planning and evaluating client care 
• Critical thinking 
• Supporting activities of daily living 
• Communicating with clients and families 
• Collaborating with the health care team 
• Developing professional and therapeutic relationships 
• Documenting 
• Maintaining client safety 
• Mentoring students and new graduates 
• Ensuring infection control