Health Professions Council
POST-HEARING UPDATE OF PRELIMINARY REPORT:
LICENSED PRACTICAL NURSES


Irvine E. Epstein, Q.C., Chair
Arminée Kazanjian, Member
David MacAulay, Member

March 2001

This Post-Hearing Update should be read
in conjuction with the Preliminary Report for the profession.

The Council issued its Nurses (Licensed Practical) Scope of Practice (Preliminary Report) in April 2000. The public hearing was held on 16 May 2000. The following are changes to the Preliminary Report which arose from the submissions made either at the public hearing or in subsequent written submissions.

I.     SCOPE OF PRACTICE

The Council’s Preliminary Report recommended the following scope of practice for licensed practical nurses:

The practice of nursing by licensed practical nurses is the provision of health care for the promotion, maintenance and restoration of health; and the treatment and prevention of illness and injury, including assessment of health status and implementation of interventions.

The Licensed Practical Nurses Association of British Columbia (LPNABC) questioned the omission of the words "planning" and "evaluation" in the Council’s recommended scope of practice statement. Similarly, the Provincial Practical Nurse Articulation Committee (PPNAC) stated that the proposed scope of practice statement should include planning and evaluation, as they are part of the four stages of the "nursing process." However, the Council’s task is not to describe the nursing process but to describe, generally, the scope of practice of the profession. In any event, planning and evaluation are undoubtedly integral to and implicit in the practice of all professions.

The issue of palliation was discussed by the Council in its review of registered nursing, and that term was added to the scope of practice of registered nursing. It should also be added to the scope of practice of licensed practical nursing. Therefore, the Council recommends the following scope of practice statement for licensed practical nursing:

The Health Professions Council recommends the following scope of practice for licensed practical nurses:

The practice of nursing by licensed practical nurses is the provision of health care for the promotion, maintenance and restoration of health; and the prevention, treatment and palliation of illness and injury, including assessment of health status and implementation of interventions.




II.     RESERVED ACTS

A.     Independent Reserved Acts

In its Preliminary Report, the Council did not recommend the granting of any reserved acts to be performed independently by licensed practical nurses. The Provincial Practical Nurse Articulation Committee (PPNAC), a group comprised of practical nurse educators, submitted that licensed practical nurses are qualified to perform three reserved acts independently:

Performing the physically invasive or physically manipulative act of putting an instrument, hand or finger(s)

  1. "into the external ear canal": PPNAC stated that licensed practical nurse students clean their patients’ external ear canal, take their tympanic temperature and also use an otoscope to examine cerumen build up. It also stated that "up to the eardrum" constitutes an "ordered" function.

  2. "beyond the labia majora, but excluding the insertion of intrauterine devices": PPNAC stated that licensed practical nurse students perform hygiene measures and wash beyond the labia majora to the urethral and vaginal orifice.

  3. "beyond the anal verge": PPNAC stated that licensed practical nurse students autonomously perform rectal checks on patients whose assessment warrants this intervention.

The Open Learning Agency made an almost identical submission. After reviewing the information received, the Council is satisfied that licensed practical nurses are qualified to perform reserved acts independently in certain limited circumstances. Therefore, the Council recommends the following reserved acts for licensed practical nurses to be performed independently:

The Health Professions Council recommends the following reserved act for licensed practical nurses:

    2(e) For the purpose of assessing an individual or assisting an individual with activities of daily living, performing the physically invasive or physically manipulative act of putting an instrument, hand or finger(s)

  1. into the external ear canal, including applying pressurized air or water, for purposes of cleaning patients’ external ear canal, taking their tympanic temperature and using an otoscope to examine cerumen build up;

  1. beyond the labia majora, but excluding the insertion of intrauterine devices, for purposes of performing hygiene measures and washing beyond the labia majora to the urethral and vaginal orifice;

  2. beyond the anal verge, for purposes of performing rectal checks on patients whose assessment warrants this intervention.

B.     Reserved Acts on Order

In its Preliminary Report, the Council recommend the following reserved acts for licensed practical nurses to be performed "on order":

  1. Performing the following physically invasive or physically manipulative acts:

    1. procedures on tissue below the dermis, below the surface of a mucous membrane;

    1. administering a substance by injection, inhalation, irrigation or instillation;

    2. putting an instrument, hand or finger(s)

      1. into the external ear canal, but excluding cerumen management;
      2. beyond the pharynx;
      3. beyond the opening of the urethra;
      4. beyond the labia majora, but excluding the insertion of intrauterine devices;
      5. beyond the anal verge; or
      6. into an artificial opening into the body.

  2. Administering by any means a drug listed in Schedule I or II of the Pharmacists, Pharmacy Operations and Drug Scheduling Act.

At the public hearing, the Council received many submissions on this issue. Several participants, including the BCNU and the RNABC, suggested that even for acts "on order," the Council should be more specific and thus limited. The BCNU was concerned some of the reserved acts the Council granted "on order" cannot be safely and competently performed by licensed practical nurses. In the Council’s view, the restriction that these acts be performed on order addresses competency concerns. The profession that orders licensed practical nurses to perform such acts can and will determine the services licensed practical nurses can perform competently, and the circumstances in which they can be carried out. Thus, the order making process can impose strict parameters on the performance of the reserved acts by licensed practical nurses.

The Council was however persuaded that some modifications to the reserved acts granted to licensed practical nurses on order were necessary and in this regard took note of the following submissions. First, the Council was satisfied that licensed practical nurses in certain facilities do compound substances for use in administration of therapeutic diets through enteral or parenteral means. Second, licensed practical nurses do not have the competency to safely perform the reserved act of "putting an instrument, hand or finger(s) beyond the pharynx." Finally, the Council was not satisfied that licensed practical nurses have sufficient competency to perform intramuscular injections.

Therefore, the Council recommends the following reserved acts for licensed practical nurses to perform only if ordered by a health professional authorized to perform the reserved act:

  1. Performing the following physically invasive or physically manipulative acts:

    1. Procedures on tissue below the dermis or below the surface of a mucous membrane;

    1. administering a substance, other than a drug, by subcutaneous injection, inhalation, irrigation or instillation;

    2. putting an instrument, hand or finger(s)

      1. into the external ear canal, but excluding cerumen management;

      1. beyond the opening of the urethra;
      2. beyond the labia majora, but excluding the insertion of intrauterine devices;
      3. beyond the anal verge; or
      4. into an artificial opening into the body.

      5(a) Administering orally or by subcutaneous injection a drug listed in Schedule I or II of the Pharmacists, Pharmacy Operations and Drug Scheduling Act.




III.     RESERVED TITLES

The Council’s Preliminary Report recommended the following reserved titles for licensed practical nurses:

  • Licensed Practical Nurse,
  • L.P.N.,
  • Practical Nurse, and
  • P.N.

    The Council recommends that the title "nurse" be reserved for licensed practical nurses, registered nurses, registered psychiatric nurses and Christian Science nurses.

The LPNABC submitted that the title "Nurse" be reserved for all three nursing professions. The Council agrees, and recommends that all three nursing professions be entitled to use the title "nurse" either alone or in conjunction with the adjective appropriate to their branch of nursing.

Although the title "Christian Science Nurse" appears in the current Nurses (Registered) Act, RSBC 1996, c. 335, the Council received no comment or submission on this title, nor did any of the nursing groups reviewed by the Council request this title. Therefore, the Council did not recommend that it be reserved.

The Health Professions Council recommends the following reserved titles for licensed practical nurses:

  • "Licensed Practical Nurse",
  • "Practical Nurse",
  • "Nurse", and
  • any abbreviation of those titles.