Scope of Practice for

Registered Nurses
May 2011

Approved by the College and Association of Registered Nurses of Alberta Provincial

Council May 2011.
Permission to reproduce this document is granted; please recognize CARNA.
College and Association of Registered Nurses of Alberta
11620 168 Street
Edmonton, AB T5M 4A6
Phone: (780) 451-0043 or 1-800-252-9392 (Canada-wide)
Fax: (780) 452-3276
E-mail: carna@nurses.ab.ca
Website: www.nurses.ab.ca

SCOPE OF PRACTICE FOR REGISTERED

NURSES
The College and Association of Registered Nurses of Alberta (CARNA) is the regulatory
and professional body for Alberta registered nurses including; nurses in direct care,
education, research and administration as well as nurse practitioners and therefore has the
responsibility to:
set and maintain professional standards of practice
communicate those standards to the public and other stakeholders within the health
care system
appraise the competence, continuing competence and professionalism of its members
through registration, the continuing competence program and disciplinary processes
Inherent in these primary roles is CARNAs responsibility for articulating the scope of
practice for registered nurses for the understanding of the public, individual clients1,
registered nurses and other health care providers and employers.
This position statement builds on the Nursing Practice Standards, which apply to all
regulated members of CARNA in clinical practice, research, education and
administration, and also links with other CARNA standards - see Appendix A Resources as well as with the Competency Profile for Registered Nurses. The CARNA
document Entry-to-Practice Competencies for the Registered Nurses Profession along
with the International Classification of Nursing Practice (ICNP) and the Nursing
Intervention Classification (NIC) describe the competency profile for registered nurses in
Alberta. The competency profile encompasses the activities a professions practitioners
are educated and authorized to perform.
Scope of practice refers to the knowledge of registered nurses and the comprehensive
application of that knowledge to assist clients in meeting their health needs in whatever
setting, complexity and situation they occur throughout the life span. Scope of practice
includes all the interventions that registered nurses are authorized, educated and
competent to perform.

The term client can refer to patients, residents, families, groups, communities and populations.

The overall scope of practice for the registered nurses profession sets the outer limits
of practice for all CARNA members. These outer limits of the profession are described in
Schedule 24 of the Health Professions Act (HPA), the Registered Nurses Profession
Regulation and in CARNA standards, guidelines and position statements.
The actual scope of practice of individual registered nurses is determined by the needs
and health goals of their clients and is limited by the specific competencies of the
individual registered nurse to perform the activities necessary for the client population
with whom that nurse practices, within applicable legislation and requirements of the
employer as described in employer policies. Figure 1 illustrates the scope of practice
boundaries of registered nurses practice.
Figure 1: Scope of Practice Boundaries

Health Professions Act - Schedule 24

Outer
limits of
RN
profession
Scope of
practice

Registered Nurses Profession

Regulation
CARNA Standards, Guidelines
& Position Statements
Employer Policies
Individual RN
Competence

Scope of
practice of
individual
RN

Client
needs

Legislation
The Health Professions Act (HPA) was developed to regulate health professions using a
model that allows for non-exclusive, overlapping scopes of practice. No single profession
has exclusive ownership of a specific skill or health service and different professions may
provide the same health services.

Schedule 24, Section 3 of the HPA provides the following legislated scope of practice
statement for the profession of registered nurses:
3 In their practice, registered nurses do one or more of the following:
(a) based on an ethic of caring and the goals and circumstances of those
receiving nursing services, registered nurses apply nursing knowledge, skill
and judgment to
(i) assist individuals, families, groups and communities to achieve their
optimal physical, emotional, mental and spiritual health and wellbeing,
(ii) assess, diagnose and provide treatment and interventions and make
referrals,
(iii) prevent or treat injury and illness,
(iv) teach, counsel and advocate to enhance health and well-being,
(v) coordinate, supervise, monitor and evaluate the provision of health
services,
(vi) teach nursing theory and practice,
(vii) manage, administer and allocate resources related to health services,
and
(viii) engage in research related to health and the practice of nursing,
and
(b) provide restricted activities authorized by the regulations
Restricted Activities
Restricted activities are high risk activities performed as part of providing a health
service that requires specific competencies and skills to be carried out safely. Restricted
activities are not linked to any particular health profession and a number of regulated
health practitioners may perform a particular restricted activity. Restricted activities
authorized for registered nurses are described in the Registered Nurses Profession
Regulation.
The legislated practice statement in Schedule 24 of the HPA encompasses all the
activities in which registered nurses engage, although each individual registered nurse
provides services based on the needs of the clients in a specific setting and within the
scope of that individual nurses knowledge, skills and judgment. This position statement
further defines specific roles and responsibilities of registered nurses. Registered nursing
activities are performed through the continuous, ongoing application of the nursing
process: assessment, diagnosis and planning, implementation and evaluation. See
Appendix B for background information regarding the Foundations of Registered
Nursing Practice.

The focus and core of all registered nursing practice is the provision of direct care to
clients. Four major domains are identifiable within the profession of registered nursing:
clinical practice, administration, education and research (CARNA, 2005). The
clinical practice role is fundamental to nursing. Registered nurse administrators,
educators and researchers contribute to the provision of direct client care by maintaining,
supporting and enabling direct care providers; developing and communicating knowledge
and policy; and ensuring that the necessary resources are in place for safe, competent and
ethical care.

Clinical Practice
In providing health services, registered nurses engage in the following key roles, which
are effectively integrated in practice:

direct care provider

critical thinker, assessor and interpreter

coordinator of care, planner and evaluator

participant, developer and/or leader in quality improvement activities

decision-maker and problem solver

case manager

client advocate

health policy advocate

leader

mentor

Registered nurses are knowledge workers. The breadth and depth of knowledge
required by a registered nurse is gained through intensive and comprehensive entry-level
education, nursing experience, commitment to continual learning and advanced
education.
Through a combination of experience, continuing education and advanced education,
registered nurses develop progressive expertise in caring for defined client populations.
All registered nurses practice within an ethical context, according to the Nursing Practice
Standards (CARNA, 2005) and adhering to the Canadian Nurses Association Code of
Ethics for Registered Nurses (CNA, 2008b).
In a changing health care system over the past decade, the acuity and complexity of
clients in both institutional and community settings have increased markedly.
Registered nurses are the most appropriate providers of direct nursing care for clients
with complex, unstable or rapidly changing health status or situations.
The breadth and depth of the scope of knowledge of registered nurses enables
comprehensive assessment of client needs, available resources, work settings, and
many other factors in complex and often rapidly changing situations. Critical thinking
and accurate interpretation of complex information from a variety of sources
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including: client data, environmental factors, diagnostic test results, the assessments of
other professionals and nursing assessment indicators are essential to the clinical
decision-making required for safe and effective client care. Monitoring of client
progress and evaluation of care involve astute observation and critical thinking,
decisive action, and resourceful problem solving regardless of the setting in which the
care is provided. The abilities of the registered nurse to demonstrate evidence-based
practice and participate in research and in quality improvement activities promote
quality client care by ensuring that nursing interventions are supported by scientific
rationale.
As members of interdisciplinary teams, registered nurses effectively coordinate nursing
care as they possess the knowledge, skills and judgment to prudently assign client care to
other regulated or non-regulated care providers. This allows them to fully utilize all
personnel and implement the primary health care principle of providing the most
appropriate level of care by the most appropriate provider.
Registered nurses are uniquely prepared to be case managers because they assess clients
needs in context as whole persons including their life situations. They creatively plan and
provide the most appropriate care in partnership with clients and their families, and
supervise and evaluate the care provided based on client health outcomes. Registered
nurses have the skill, expertise and capacity to take a leadership role in supporting and
enhancing client-centered care across the continuum of health-care experiences and
services. There are a variety of current and emerging roles and opportunities to guide and
enhance a clients journey through the care continuum. Examples include: case managers,
nurse navigators and telehealth nurses (CARNA, 2008a).
In the client advocacy role, registered nurses support clients to obtain the necessary
information, care and resources to meet their health needs, and act on clients behalf to
achieve these ends when clients are unable to do so, individually or collectively.
Registered nurses also advocate for healthy public policy by being politically active at
the local, regional, provincial, national and global levels to contribute to the improvement
of health of populations.
Registered nurses possess the knowledge, skills, judgment, influence, creativity and
public esteem to lead the development of healthy public policy and the implementation of
primary health care models. Their strengths in communication and collaboration allow
them to interact effectively with other health care professionals and with political leaders
to persuade and convince key figures of the benefits of positively affecting the broad
determinants of health.
Registered nurses are professional caregivers. Values fundamental to professional nursing
practice are defined in the Code of Ethics for Registered Nurses (CNA, 2008b) and form
the basis for ethical nursing practice. These values include: providing safe,
compassionate, competent and ethical care; promoting health and well-being; promoting
and respecting informed decision-making; preserving dignity; maintaining privacy and
confidentiality; promoting justice and; being accountable. Registered nurses incorporate
these values into their practice through compassionate involvement with clients,
maintaining and fulfilling commitments and maintaining personal integrity and
professional behaviour.
5

Registered nurses are with clients at their least inhibited and most intimate and vulnerable
times to lend them strength and support. Registered nurses establish therapeutic
relationships with clients and their families for the purposes of giving comfort, assisting
with healing and providing a trusted source of health teaching. Using their broad
knowledge base, innovative abilities and facilitative skills, registered nurses work in
partnership with clients, families and other health care professionals to plan care
according to individual needs and goals.
Administration
The nurse administrator is a registered nurse who directs and influences the work of
others in a defined environment to enhance the shared vision of an organization or
institution. The goals of nursing administration practice include quality outcomes focused
on safety and the required infrastructures that seek to meet expectations of clients, the
profession, and society.

Nurse administrators have the responsibility to deal with issues on the employee or
student level as well as address issues that affect delivery of services to clients.

They foster openness, interdisciplinary collaboration, and accountability in colleagues

and those they supervise.

They create an environment that facilitates and encourages nursing staff to

demonstrate accountability for their own practice.

They help define the values of the organization, facility, or team; foster collaboration,
communication, and goal-setting; and strive for excellence among and across the
continuum of care and the populations they work with or affect.

Nursing administration practice occurs in a wide variety of settings from private

enterprises to the public sector, in large or small healthcare facilities, integrated delivery
systems, corporate healthcare companies, professional organizations, academic settings,
research facilities, government agencies, communities, correctional institutions, military
healthcare entities and other facilities. Nursing administration roles are also differentiated
by their level of oversight which include but are not limited to the following:
organization-wide (e.g. Chief Nursing Officer), unit-based or service-line based (e.g.
clinical supervisor, charge nurse), program-focused (e.g. program director), and projectbased (e.g. project manager).

Nurse administrators at every level must develop organizational and management skills
and also hone strong leadership skills in order to be effective administrators. Exerting
good management skills is part of being a good leader and leadership skills are
necessary for good management (CNA, 2009).
Regardless of the setting or level of oversight, the following themes permeate all nurse
administrator roles:

advocacy

leadership

shared vision

knowledge of business practices and processes

mentorship

dedication to the profession

The role of the nurse administrator is multifaceted and requires broad-level thinking and
skill in understanding and balancing business duties and obligations with the ongoing
commitment to nursing. This contradiction can cause tensions or even conflicts of
interest, as they seek to enhance quality nursing practice in organizations with values that
may not always reflect those of nursing. However, even as corporate employees, nurse
administrators must act as registered nurses first by upholding the values of nursing and
advocating for those values to the utmost extent possible (American Nurses Association,
2009).
The CNA Code of Ethics for Registered Nurses provides guidance to nurse administrators
in addressing conflicts of interest that may arise in their practice.
Education
The nurse educator role evolves in academic settings and in clinical practice settings.
Academic Settings
The registered nurse in an educator role within an academic setting ensures the
development and implementation of a broad-based educational preparation for students
that includes a breadth of knowledge and skills from nursing and related disciplines to
meet the complex health needs of clients in constantly evolving practice environments.
Preparation at the baccalaureate level provides the foundation necessary for effective
interdisciplinary practice and for the ethical, accountable and competent professional
nursing practice required to enter the profession. Provision of baccalaureate level
education prepares registered nurses to work with individuals, families, groups,
communities and populations in diverse settings (CNA & CASN, 2004a).
Provision of advanced nursing education at the masters, doctoral and post-doctoral levels
prepares registered nurses to engage in advanced nursing practice roles such as the nurse
practitioner and clinical nurse specialist roles, conduct research, build nursing theory and
disseminate study findings thereby advancing nursing, nursing knowledge and evidencebased practice (CNA, 2008a; CNA & CASN, 2003).
7

Clinical Practice Settings

The registered nurse in an educator role within a clinical practice setting recognizes that
continuing competence through life-long learning is essential to professional nursing
practice because it contributes to the quality of patient outcomes and to the evidence base
for nursing practice (CNA & CASN, 2004b). The registered nurse in a clinical educator
role promotes and facilitates a culture of life-long learning in the pursuit of excellence in
professional nursing practice through the development and implementation of a variety of
learning opportunities such as orientation programs, preceptorship and mentoring
programs and continuing education opportunities in the work environment.
Research
The registered nurse in a researcher role validates and refines existing knowledge and
generates new knowledge that influences all domains of nursing. The knowledge
generated through nursing research is used to support and guide nursing practice as well
as improve nursing care, client outcomes and the health care system.
The nurse researcher benefits from a quality practice environment that fosters
collaborative relationships which enhances the researchers ability to conduct research
and an agencys capacity to use research findings and improve client outcomes.
Collaboration can be achieved through affiliation agreements, joint-appointments,
research institutes, funding assistance and appointing nurse researchers to relevant
organizational committees.
The identification and consideration of knowledge gaps, in conjunction with
practitioners, is a means by which the nurse researcher establishes research priorities. The
nurse researcher has advanced knowledge and skill to generate high quality evidence
through research activities. The nurse researcher also engages in knowledge transfer,
translation and exchange to communicate relevant findings of the results of research to
those who require this information (CNA, 2010).

CONCLUSION
The goal of registered nurses is to assist clients to attain and maintain optimal health,
wellness and independence within each individual clients ability to do so. When clients
are unable to be independent due to their personal health situations, nursing provides the
appropriate care to meet their needs and optimize their quality of life.
Registered nurses address the health needs of clients throughout the life span. These
clients may be individuals, families, groups, communities and populations in any and all
of the various environments and settings in which they live and work. These practice
locations include, but are not limited to: outpost nursing in remote areas, palliative care
nursing, oncology nursing, rehabilitation nursing, home care nursing, continuing care
nursing, street nursing of disadvantaged inner city populations, mental health nursing,
operating room nursing, nursing as a member of a primary care team in an after hours
clinic, nurse practitioner practice in an adolescent health clinic, triage/provision of health
information/way-finding through a telephone nursing service, nursing support for air
ambulance emergency transport, organ transplant care, pediatric intensive care, acute
8

medical/surgical care, critical care nursing, obstetrical delivery/post partum care,

occupational health nursing in industrial settings and immunization and well baby home
visiting in public health nursing.
The scope of practice of registered nurses is determined by the needs and health goals of
their clients and is limited only by the specific competencies of the individual registered
nurse to perform the activities necessary for the client population with whom that nurse
works, within applicable legislation and agency policy. Registered nurses are uniquely
prepared and positioned to provide leadership and serve as change agents in facilitating
and strengthening health services.

GLOSSARY - ADDITIONAL TERMS USED WITHIN THE DOCUMENT

accountability

the ability to explain rationale for actions taken that is

consistent with the responsibility for which the nurse is
contracted (CARNA, 2005)

advocate

actively supporting a right and good cause; supporting others

in speaking for themselves; or speaking on behalf of those
who cannot speak for themselves (CARNA, 2011).

collaboration

client care involving joint communication and decisionmaking processes among the client, the nurse and other
members of a health-care team who work together to use
their individual and shared knowledge and skills to provide
optimum client-centred care. The health-care team works
with clients toward the achievement of identified health
outcomes, while respecting the unique qualities and abilities
of each member of the group or team (CARNA, 2011).

competence

the ability of a registered nurse to integrate and apply the

knowledge, skills, judgment and interpersonal attributes2
required to practice safely and ethically in a designated role
and setting (CARNA, 2006).

evidence-based practice

practice based on successful strategies that improve client

outcomes and are derived from a combination of various
sources of evidence including client perspectives, research,
national guidelines, policies, consensus statements, expert
opinion and quality improvement data (CHSRF, 2005).

health promotion

the process of enabling people to increase control over and

improve their health. It embraces actions directed not only at
strengthening the skills and capabilities of individuals, but
also at changing social, environmental, political and
economic conditions to alleviate their impact on public and
individual health (CARNA, 2011).

primary care

primary care refers to the first contact people have with the
health system to seek services for diagnosis, treatment and
follow up for a specific health problem, or to access routine
screening such as an annual checkup (CARNA, 2008b).

Interpersonal attributes include, but are not limited to, attitudes, values and beliefs.

10

standard

an authoritative statement that describes the required

behaviour of every nurse and is used to evaluate individual
performance (CARNA, 2011).

11

REFERENCES
Alta. Reg. 232/2005. [Registered Nurses Profession Regulation]
Alberta Health & Wellness, Health Workforce Planning. (2000). Health Professions Act:
An overview. Edmonton, AB: Author.
American Nurses Association. (2009). Nursing administration: Scope and standards of
practice. Silver Spring, MD: Author.
Bulechek, G. M., Butcher, H. K., & McCloskey Dochterman, J. (Eds.). (2008). Nursing
interventions classification (5th ed.). St Louis, MO: Mosby.
Canadian Health Service Research Foundation. (2005). How CHSRF defines evidence.
Links, 8(3), 7.
Canadian Nurses Association. (2008a). Advanced nursing practice: A national
framework. Ottawa, ON: Author.
Canadian Nurses Association. (2008b). Code of ethics for registered nurses. Ottawa, ON:
Author.
Canadian Nurses Association. (2009). Position statement: Nursing leadership. Ottawa,
ON: Author.
Canadian Nurses Association. (2010). Position statement: Evidence-based decisionmaking and nursing practice. Ottawa ON: Author.
Canadian Nurses Association and Canadian Association of Schools of Nursing. (2003).
Joint position statement: Doctoral preparation in nursing. Ottawa, ON: Author.
Canadian Nurses Association and Canadian Association of Schools of Nursing. (2004a).
Joint position statement: Educational preparation for entry to practice. Ottawa,
ON: Author.
Canadian Nurses Association and Canadian Association of Schools of Nursing. (2004b).
Joint position statement: Promoting continuing competence for registered nurses.
Ottawa, ON: Author.
College and Association of Registered Nurses of Alberta. (2005). Nursing practice
standards. Edmonton, AB: Author.
College and Association of Registered Nurses of Alberta. (2006). Entry-to-practice
competencies for the registered nurses profession. Edmonton, AB: Author.
College and Association of Registered Nurses of Alberta. (2008a). Primary health care.
Edmonton, AB: Author.
College and Association of Registered Nurses of Alberta. (2008b). Registered nurse roles
that facilitate continuity of care. Edmonton, AB: Author.
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College and Association of Registered Nurses of Alberta. (2011). Nurse practitioner

(NP) competencies. Edmonton, AB: Author.
Fraser, K. D., & Strang, V. (2004). Decision-making and nurse case management: A
philosophical perspective. Advances in Nursing Science, 27(1), 32-43.
Government Organization Act, R.S.A. 2000, c. G-10.
Health Professions Act, R.S.A. 2000, c. H-7.
Primary health care: Report of the International Conference on Primary Health Care,
Alma-Ata, USSR, 6-12 September 1978 (jointly sponsored by the World Health
Organization and the United Nations Children's Fund.) (1978). Geneva: World
Health Organization.
World Health Organization. (1984). Health promotion: A World Health Organization
discussion document on the concept and principles. Copenhagen: Author.

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APPENDIX A - RESOURCES
College and Association of Registered Nurses of Alberta. (2005). Health professions act:
Standards for registered nurses in the performance of restricted activities.
Edmonton, AB. Author.
College and Association of Registered Nurses of Alberta. (2005). Standards for
supervision of nursing students and undergraduate nursing employees providing
client care. Edmonton, AB: Author.
College and Association of Registered Nurses of Alberta. (2006). Standard for the use of
the title Specialist in registered nurse practice. Edmonton, AB: Author.
College and Association of Registered Nurses of Alberta. (2008).Registered nurses with
a blood-borne virus infection: Standards for reporting and guidance for
prevention of transmission of infection. Edmonton, AB: Author.
College and Association of Registered Nurses of Alberta. (2010). Decision-making
standards for nurses in the supervision of health care aides. Edmonton, AB:
Author.
College and Association of Registered Nurses of Alberta. (2011). Complementary and/or
alternative therapy and natural health products: Standards for registered nurses.
Edmonton, AB: Author.

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APPENDIX B FOUNDATIONS OF REGISTERED NURSING PRACTICE

Registered nurses view people as unique, complex beings who must be perceived in their
entirety to understand and effectively promote their health according to their individual
life circumstances, health needs and goals. Clients of nursing care may be individuals,
families, groups, communities or populations. Clients life experiences and health are
interconnected, interdependent and continuous, and cannot be separated into isolated
episodes. People have the capacity for self-direction, learning, making choices, coping,
adapting and changing.
Registered nurses address the clients ongoing health situation within the context of the
persons wholeness, including biophysical, psychological, emotional, social, cultural and
spiritual dimensions. In partnership with the client, the registered nurse identifies, relates,
interprets and integrates the clients various needs with the input and contributions made
by others concerned with the clients care. Registered nursing practice is individualized,
focused on identifying the clients unique needs and facilitating the achievement of
specific health goals with the client.
Registered nurses define health as the extent to which an individual or group is able to
realize aspirations, to satisfy needs and to change or cope with the environment in which
they live. Health is a resource for everyday life, not the objective of living. Health is a
positive concept emphasizing social and personal resources and physical capacities and
not only the absence of illness or disease (World Health Organization, 1984).
Registered nurses recognize the broad determinants of health as encompassing income
and social status, social support networks, education, employment and working
conditions, physical environments, biology and genetic endowment, personal health
knowledge, health practices and coping skills and the health care system.
Regardless of practice setting, registered nurses practice is guided by the primary health
care model. Primary health care is essential health care made accessible at a cost a
country and community can afford, with methods that are practical, scientifically sound
and socially acceptable (World Health Organization, 1978). Essential activities under the
primary health care model are:

a focus on health promotion and illness/injury prevention without sacrificing

excellence in treatment and rehabilitation

provision of services based on the needs of a defined population

appropriate use of technology

integration of health services to avoid duplication and increase continuity and

accessibility for the client

intersectoral collaboration

public participation in design of services and allocation of resources

establishment of interdisciplinary teams of health care providers based on the needs

of the individual, family or community

equitable access to health through the most appropriate health care provider in the
most appropriate setting.

15

Registered nursing services are a key component in all sectors of the health care system.
Because of their holistic view of people and health, registered nurses are ideally prepared
and positioned to play a significant role in transforming the health system. Utilizing the
full breadth and depth of their knowledge combined with the pragmatic understanding
gained through their contacts with people in homes, schools, workplaces, institutional and
other community settings, registered nurses contribute to improved health and sustainable
health care for all citizens.

16