Understanding Legislated Scope of Practice
The practice of registered nursing in Saskatchewan is defined and enabled through The Registered Nurses Act, 1988, and is commonly referred to as legislated scope of practice. As a profession-led regulatory body, the College of Registered Nurses of Saskatchewan (CRNS) has the legislated authority and responsibility from this Act to regulate the practice of registered nursing in the public interest. The legislation and bylaws, practice standards, entry-level competencies and code of ethics provide the foundation for Registered Nurse (RN) and Nurse Practitioner (NP) practice in Saskatchewan.
All CRNS registrants have a legislated scope of practice, and each registrant has personal competence within it. For clarity, the term “scope” is reserved for legislated scope of practice within the regulatory framework.
RNs and NPs must practice within their legislated scope of practice and personal competence, as well as work within the policies, procedures and processes outlined by the employer. RNs and NPs recognize that the employer can limit but cannot expand their legislated scope of practice. It is also recognized that as evidence emerges, registered nursing practice evolves to meet the dynamic and changing needs of the clients. RNs and NPs play a key role in shaping employer policies, procedures, and processes in meeting the needs of the public.
Legislated Scope of Practice Self-Assessment Tool
It is the responsibility of each CRNS registrant to understand their legislated scope of practice and to practice within it. Each CRNS registrant must assess personal competence within the legislated scope of practice. CRNS registrants must also work within their employer’s policies and procedures recognizing that the employer can limit their scope of practice but cannot expand it. When assessing if a particular activity or practice is within the legislated scope, it is paramount to ensure it is in the best interest of the client within their surrounding environment.
This self-assessment tool will help determine if a procedure or activity is within the CRNS registrant’s legislated scope of practice. Beginning with the first question, if you answer “Yes” then proceed through all three questions to determine if you should engage in the practice.
1. Is the activity within the legislated scope of practice?
In section 2k of The Registered Nurses Act, 1988, the practice of nursing is defined as:
(k) “practice of registered nursing” means the performance or co-ordination of health care services that includes, but is not limited to:
(i) observing and assessing the health status of clients and planning, implementing and evaluating nursing care; and
(ii) the counselling, teaching, supervision, administration and research that is required to implement or complement health care services; for the purpose of promoting, maintaining or restoring health, preventing illness and alleviating suffering where the performance or co-ordination of those services requires:
(iii) the knowledge, skill or judgment of a person who qualifies for registration pursuant to section 19 or 20;
(iv) specialized knowledge of nursing theory other than that mentioned in subclause (iii); (v) skill or judgment acquired through nursing practice other than that mentioned in subclause (iii); or
(vi) other knowledge of biological, physical, behavioral, psychological, and sociological sciences that is relevant to the knowledge, skill or judgment described in subclause (iii), (iv) or (v);
Additionally, all CRNS registrants must comply with all relevant legislation. This includes, for example, the Public Health Act, or The Facility Designation Amendment Regulations, 2022, or any legislation pertaining to registered nursing practice in a specific practice setting.
Next, the current Bylaws further authorize nursing practice for all CRNS registrants. From there, the RN Practice Standards, RN Entry-Level Competencies, and CNA Code of Ethics form the foundation for legislated scope of practice. Even though there may be the ability in the legislation to perform a particular procedure or practice, it can only be done if it is enabled through the Bylaws. For example, prescribing pertains to NPs and RNs with Additional Authorized Practice [RN(AAP)s] only and the Prescribing Guideline relates to those registrants who are currently authorized, through legislation and Bylaws to prescribe. Currently, RNs in the general practice category are not able to prescribe unless they are RN(AAP)s.
CRNS registrants are held accountable to the legislated scope of practice of their highest designation. The standards of practice for the RN(AAP) and NP build upon the RN Practice Standards and RN Entry-Level Competencies.
NP: An NP who is licensed to practice in Saskatchewan, may diagnose and treat common medical disorders.
Common medical disorders: Common medical disorders refer to health disorders that NPs regularly assess, diagnose and treat with clients and families. Uncommon medical disorders are outside of the scope of practice for NPs. There is recognition that some medical disorders may be uncommon for some NPs, but common for others in their NP practice. It is also recognized that an NP at the beginning of their career may encounter medical disorders that are uncommon for their practice, but over time become common.
RN(AAP): The RN(AAP) who is licensed to practice in Saskatchewan is authorized to treat limited common medical disorders according to specific Clinical Decision Tools. There may also be other employer policies and procedures in place to authorize their practice, such as RN Specialty Practices (RNSP).
RN: The RN who is licensed to practice in Saskatchewan may engage in RN Specialty Practices (RNSP) which optimize Registered Nurse (RN) practice in the interest of the public.
The RNSP model can apply to all who are in the RN category in Saskatchewan. There is no additional designation beyond RN for those providing specialty practices. The model supports a proactive approach with the client at the centre and the RN at point-of-care as expert in the practice area. The model is designed to be nimble to meet the evolving client needs and approaches in an interprofessional health care environment. Employer implementation of the RNSP model supports optimal client care when all essential components are in place, which are:
- Client: It is in the best interest of the client in their surrounding environment.
- Evidence: There is evidence, including relevant legislation, to support the practice.
- Authorizing Mechanism: There is an authorizing mechanism in place which is either a client-specific-order for an individual client, or a directive for a client population.
- Competency: It is indicated which RNs with which competencies are approved to perform this RNSP.
If you are satisfied that the nursing practice is within your legislated scope, proceed to Step 2.
If you are uncertain that the nursing practice is within your legislated scope, further exploration is warranted. For example:
- CRNS registrants who engage in self-employed practice have many things to consider about their practice to determine if it is within the legislated scope of practice and practice of registered nursing. The Self-Employed Practice Guideline and Recognition of Practice process support the assessment and appropriateness of the practice. “Is it within my legislated scope?” “Is something I intend to do considered non-traditional, innovative or complex?”
- A discussion with Nursing Practice Consultation could provide some direction.
- A discussion with the Canadian Nurses Protective Society (CNPS) could provide some direction about legislation as well as professional liability protection.
2. Do you have the personal competence, including the knowledge, skill and judgement to safely perform the activity?
CRNS registrants must assess and ensure they have the personal competence, including knowledge, skill, and judgement to safely perform the activity, at that moment, in that environment and for that particular client. This is personal competence within your legislated scope of practice. The RN Practice Standards, RN Entry-Level Competencies and CNA Code of Ethics are the foundation for assessing your personal competence and provide direction about communicating effectively if you are not fit for practice.
Personal competence is unique and specific to each Registered Nurse. RNs and NPs are accountable to reflect on their personal competence and determine that they have the adequate knowledge, skill, and judgment, prior to performing the activity or procedure safely and competently. CRNS registrants can develop personal competence by engaging in different learning activities, such as taking courses, obtaining certifications, or developing new skills. They are accountable for continuing their competence and addressing gaps they may have in their practice, so they are able to safely provide care. When assessing a particular practice, it is:
- important to assess personal competence within the context of the setting and the available resources to support the practice from start to finish.
- important to consider how you will obtain and maintain personal competence for all nursing practices you engage in.
- imperative to note that personal competence within the legislated scope includes the registrant’s specific knowledge and skillset and its uncompromised application to the practice of registered nursing. This would mean, as an example, refraining from consuming intoxicating substances that would impair judgement and affect the ability to competently practice registered nursing.
All CRNS registrants are required to maintain fitness to practice. The specific references in the RN Practice Standards, Entry-level Competencies, and CNA Code of Ethics are as follows:
Standard 5: Self-regulation
The registered nurse demonstrates an accountability to regulate themselves in accordance with their legislated scope of practice. The registered nurse upholds this standard by:
55. Taking measures to maintain fitness to practice ensuring client safety is not compromised.
ELCs: 2. RN as Professional:
2.10 Demonstrates fitness to practice.
Fitness to practice are “all the qualities and capabilities of an individual relevant to their practice as a nurse, including but not limited to the freedom from any cognitive, physical, psychological or emotional condition and dependence from alcohol or drugs that impairs their ability to practice nursing” (CNA, 2017b, p.22).
Code of Ethics: G. Being Accountable
Ethical Responsibilities
5. Nurses maintain their fitness to practise. If they are aware that they do not have the necessary physical, mental or emotional capacity to practise safely and competently, they withdraw from the provision of care after consulting with their employer. If they are self-employed, they arrange for someone else to attend to their clients’ health-care needs. Nurses then take the necessary steps to regain their fitness to practise, in consultation with appropriate professional resources.
Nursing Practice Hours
Nursing practice hours are a component of maintaining individual competence as well as eligibility for licensing.
Continuing Competency Program (CCP)
CCP: The Registered Nurses Act, 1988 requires nurses to review and improve the quality of their nursing care by participating in the Continuing Competence Program (CCP). It is a requirement to complete the CCP annually to continue to hold a practicing license. It is important to note that you determine your own personal competence needs. The CRNS does not approve continuing competence courses and rather supports registrants to identify learning opportunities that provide information to support individual learning and growth.
RNSP (competency component): Refer to the fourth essential component in RN Specialty Practices to consider your personal competency relative to the specialty practice.
"A resource that may be helpful for registrants in assessing learning needs is the fourth essential component in the RN Specialty Practices (RNSP) model. Questions to consider when evaluating required competencies are included and can be used for RNSPs and/or unfamiliar entry-level practice."
If you are satisfied that the practice is within the legislated scope and your personal competence, proceed to Step 3.
3. Is the activity supported by your employer and practice setting?
The employer creates the environment for registered nursing practice to meet the needs of the client in their surrounding environment. Policies and procedures are created to support safe, consistent, evidence-informed practice in the interest of the client. Sufficient human and financial resources also contribute to the environment for registered nursing practice and are important factors to assess prior to engaging in a particular activity. These resources may be helpful to guide this decision:
- Organizational policies and procedures are in place to describe what and how things will be done to standardize care consistent with evidence-informed practice guidelines, and to reduce risk and liability.
- Hospitals/organizations need effective policies and procedures to function effectively and efficiently and keep both clients and employees safe.
- Policies promote consistency; protect the organization, and employees and patients; define and shape culture; communicate expectations to employees, and guide day-to-day operations.
CRNS registrants must work within their employer’s policies and procedures, recognizing that employers can limit but not expand the legislated scope of nursing practice. Registered Nurses play a key role in creating, advocating for, and considering employer policies and procedures within an intra-professional environment.
CRNS registrants must comply with the RN Practice Standards, RN Entry-Level Competencies and CNA Code of Ethics. These foundational documents form a solid basis for discussions with managers and employers to help shape the practice environment through a solutions-based approach. Resolving Professional Practice Issues: A Toolkit for Registered Nurses can support this discussion relative to the standards, competencies and code of ethics. Other CRNS resources for RNs, RN(AAP)s and NPs may be also be helpful, for example:
- RN Specialty Practices (RNSP) Guideline: RNSP Clinical Protocols are developed by the employer with the four essential components in place for the practice to occur, including the RN competence requirements for the practice. RNSPs recognize the RN as an expert in their practice area.
- Graduate Nurse Guideline: The employer creates the environment for the GN to practice and supports them to ensure appropriate supervision, among other things.
- Working With Unregulated Care Providers (UCP): Guidance about working with UCPs can be found in the Working With Unregulated Care Providers resource as well as the Medication Management Guideline.
- Physician to RN Delegation: Several practice situations that are included in the College of Physicians and Surgeons of Saskatchewan regulatory bylaws require a delegation from a physician to an RN.
This Legislated Scope of Practice Assessment Tool is designed to help you consider if all three steps support the practice, and if there is ample evidence currently for you to engage in this practice. Using this tool regularly will be helpful because of the dynamic and changing needs of clients and the evidence to support their care. Sometimes things move swiftly. Be sure to communicate, engage and learn from one another. Also consider these questions: Is this practice being done by a Registered Nurse anywhere else in the province, Canada or internationally? Does the evidence support it being done by an RN? An NP? In which practice setting? What are the risks and benefits to the client? Nursing leadership and advocacy are key roles. How can you use your knowledge, skills and judgement for safe, effective practice in the interest of the public?