Health Professions Council
POST-HEARING UPDATE OF PRELIMINARY REPORT:
REGISTERED PSYCHIATRIC NURSES

The Council issued its Registered Psychiatric Nurses Scope of Practice Review (Preliminary Report) in March 2000. The public hearing was held on 15 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 STATEMENT

The Council’s Preliminary Report recommended that registered psychiatric nurses be granted the following scope of practice:

The practice of nursing by registered psychiatric nurses is the provision of health care for the promotion, maintenance and restoration primarily of mental, emotional and developmental health, and of associated physical conditions, by assessment of mental and physical health, planning and implementation of interventions and co-ordination of health services.

The Health Employers’ Association of B. C. (HEABC) and the Registered Nurses Association of B. C. (RNABC) questioned the meaning of "developmental health." They queried whether it refers to health across the lifespan or persons with development challenges. The Council agrees with this concern and will remove this term from the scope of practice statement. The Council will add the term "palliation" as it is clear that it forms a large part of registered psychiatric nurses’ practice. Therefore, the Council recommends the following scope of practice statement for registered psychiatric nurses:

II. RESERVED ACTS

In its Preliminary Report, the Council recommended that registered psychiatric nurses be granted several reserved acts, some to be performed independently and some to be performed on the order of an authorized health professional:

The Council recommends the following reserved acts be granted to registered psychiatric nurses:

1. Performing the physically invasive or physically manipulative act of putting an instrument, hand or finger(s)
   1. into the external ear canal up to the eardrum but excluding cerumen management,
   2. beyond the opening of the urethra,
   3. beyond the labia major but excluding the insertion of intrauterine devices, or
   4. beyond the anal verge.

The Council recommends that the following reserved acts be granted to registered psychiatric nurses to perform only if the act is ordered by a health practitioner who is authorized by legislation to perform the act:

1. Performing the following physically invasive or physically manipulative acts:
   1. procedures on tissue below the dermis, below the surface of a mucous membrane;
   2. administering a substance by injection or inhalation, irrigation, or instillation through enteral and parenteral means;
   3. putting an instrument, hand or finger(s)
      1. beyond the point in the nasal passages where they normally narrow,
      2. beyond the pharynx, or
      3. 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.

The recommendations followed closely the Council’s recommendations for reserved acts for registered nurses. While there is some difference in focus between the professions, the Council was generally satisfied that their training and education regarding the reserved acts was basically the same. The Council was also satisfied that both professions required and ought to be granted similar reserved acts. The B. C. Nurses’ Union (BCNU) supported this position.

The one exception to this was for allergy challenge testing. The Council was not satisfied that registered psychiatric nurses had demonstrated the need, or the training and education necessary, to perform this reserved act. Therefore, with the exception of allergy challenge testing, the Council’s reserved acts recommendation will be the same for registered nurses and registered psychiatric nurses. Since the post-hearing memo for registered nurses describes this issue in detail, it will not be repeated here.

III. RESERVED TITLES

The Council’s Preliminary Report recommended the following reserved titles for registered psychiatric nurses:

• Registered Psychiatric Nurse,
• R.P.N.,
• Licensed Graduate Psychiatric Nurse, and
• L.G.P.N.

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

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.