Nurse practitioners (NPs) are autonomous health professionals and are Registered Nurses who have advanced education and earned a master’s degree. They provide essential health services grounded in professional, ethical, and legal standards. NPs integrate their in-depth knowledge of advanced nursing practice, theory, health management, health promotion and disease/injury prevention, as well as other relevant biomedical and psychosocial theories to provide comprehensive health services. NPs work in collaboration with their clients and other health care providers in the provision of high-quality patient-centered care. They work with diverse client populations, in a variety of contexts and practice settings.
Nurse Practitioners have the competence to provide comprehensive health assessment, to diagnose health/illness conditions and to treat and manage acute and chronic illness within a holistic model of care. NPs order and interpret screening and diagnostic tests, perform procedures, and prescribe medications in accordance with federal and provincial legislation and policy.
NPs are accountable for their practice and to communicate with clients about health assessment findings and diagnoses, further required testing, referral to other health care professionals and are responsible for client follow-up. Nurse practitioners counsel clients on symptom management, health maintenance, pharmacotherapy, alternative therapies, rehabilitation strategies and other health programs.
Nurse Practitioners have the knowledge to assess population health trends and patterns and design services to promote healthy living. They provide leadership in the development, implementation, and evaluation of strategies to promote health and prevent illness and injury with interprofessional teams, other health care providers and sectors as well as community members. NPs collaborate in the development of policy to influence health services and healthy public policy.
What guides the practice of nursing?
The practice of being an NP is guided by:
- Regulated Health Professions Act (RHPA)
- Registered Nurses and Registered Psychiatric Nurses Regulations
- Standards of Nursing Practice for Registered Nurses
- Standards of Nursing Practice for Nurse Practitioners
- Code of Ethical Conduct
- PEICNM policies, bylaws, practice directives, and other documents
- Employer policies, guidelines, and procedures
- Other provincial and federal legislation
Domains of Nursing Practice
PEICNM register NPs across the four domains of practice, which are:
- Clinical Practice
- Administration
- Education
- Research
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 NPs
An NP 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.
- the reserved activity is within the individual NP’s scope of competence. An individual NP’s scope cannot exceed the NP profession’s legislated scope of practice. Each individual NP must be qualified and competent with their own scope of practice.
- they follow employer’s policies. Employer policies provide further direction on an NP’s practice. An employer may place limits on NPs 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 NPs:
- Diagnosing a disease, disorder or condition and communicating the diagnosis in circumstances in which it is reasonably foreseeable that it will be relied on in health care decisions.
- Performing a procedure on tissue below the dermis, below the surface of a mucous membrane or on the surface of the cornea.
- Setting or casting a fracture of a bone or a dislocation of a joint.
- Ordering a therapeutic diet that is to be administered by enteral instillation or parenteral instillation.
- Administering a substance by injection, transfusion, inhalation, mechanical ventilation, irrigation or enteral or parenteral instillation.
- Prescribing or dispensing a drug, as defined in the Pharmacy Act, or vaccine.
- Administering a drug or vaccine by any means.
- 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
- Ordering and interpreting screening and diagnostic tests that do not use prescribed forms of energy.
- Applying sound energy or electrical energy, other than ionizing radiation.
- Ordering the application of electrical, electromagnetic or sound energy.
- Applying electrical energy in the form of ionizing radiation to conduct an X-ray for the purpose of dental screening, diagnosis, or treatment.
- Performing allergy challenge testing by any method.
- Managing labour in an institutional setting where neither a medical practitioner nor a midwife is present.
- Performing a psycho-social intervention with an expectation of modifying a substantial disorder of thought, mood, perception, orientation or memory that grossly impairs judgment, behaviour, the capacity to recognize reality or the ability to meet the ordinary demands of life.
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 Nursing 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