When to Escalate
Scope Is the First Safety Check
A technically correct procedure can still be unsafe if the nurse is not authorized, competent, supported, or working from an appropriate order.
A technically correct procedure can still be unsafe if the nurse is not authorized, competent, supported, or working from an appropriate order. Before beginning, establish four things: whether the activity is permitted in the jurisdiction and role, whether the nurse has documented competence, whether the client-specific order is present when required, and whether the necessary monitoring and rescue resources are available. The order answers what is to be done. Competence, assessment, and clinical judgment determine whether and how it can be done safely. Requirements vary across Canada. In Ontario, registered nurses and registered practical nurses may insert a peripheral IV catheter after completing the required competency education and when a client-specific order is present. The activity is a restricted act and requires documented competence and employer support. In British Columbia, the activity may fall within autonomous scope when the nurse is authorized and competent. A nurse does not gain authority from habit, staffing pressure, or another nurse’s informal instruction; the applicable regulator, employer policy, and client-specific circumstances govern the decision. Ordering and administering are separate responsibilities. Nurse practitioners and RNs...