Professional Guidelines

In British Columbia, health professions are regulated by self-governing bodies known as colleges. Under the authority of provincial laws, these colleges serve and protect the public by setting practice standards and guidelines for their registrants. The colleges are also responsible for establishing licencing requirements and ensuring that their registrants are appropriately qualified and fit to practice. Finally, the colleges are empowered by law to manage and respond to complaints from patients, and to take appropriate disciplinary or remedial action against registrants who violate the college’s practice standards.

While there are 30 different health professions in BC, this section will focus on the following groups: doctors (physicians and surgeons), registered nurses (including nurse practitioners), and midwives. In British Columbia, the entity responsible for regulating doctors is the College of Physicians and Surgeons of BC (CPSBC), while nurses, nurse practitioners, and midwives are all regulated by the BC College of Nurses and Midwives (BCCNM).

All physicians and surgeons are expected to meet the practice standards set by the CPSBC. A practice standard reflects the minimum standard of professional behaviour and ethical conduct on a specific topic or issue expected by the College of its registrants. Practice standards also reflect relevant legal requirements and are enforceable under the Health Professions Act, RSBC 1996, c. 183.

The CPSBC has issued practice standards in the following practice areas:

In their practice of medicine, the CPSBC expects doctors to conduct themselves according to the CMA Code of Ethics and Professionalism in the following areas:

Virtues Exemplified by the Ethical Physician
Fundamental Commitments of the Medical Profession
Professional Responsibilities
Physician-Patient Relationship
Decision Making
Physicians and the Practice of Medicine
Physicians and Colleagues
Physicians and Society

While physicians are required to observe practice standards, professional guidelines reflecte a recommended course of action established based on the values, principles and duties of the medical profession. That said, the CPSBC expects doctors to exercise reasonable judgement and discretion in their approach to the following issues:

The scope of practice of a nurse practitioner is outlined in section 9 of the Nurses (Registered) and Nurse Practitioners Regulation. Within this scope of practice, nurse practitioners are expected to meet the standards, limits and conditions set by the BCCNW in the following areas:

The BCCNM sets the following standards of practice which all nurse practitioners are expected to meet:

All nurse practitioners are expected to meet the following standards of professionalism, as determined by the BCCNW:

The scope of practice consists of tasks and activities, as defined by provincial law, that a registered nurse is authorized to perform.

Unrestricted activities refer to the set of skills that form the fundamental basis for the practice of nursing:

Assisting clients with activities of daily living
Carrying out an electrocardiogram
Communicating appropriately with clients, colleagues and others
Collaborating with others on the health care team
Coordinating care services for clients
Counseling clients
Developing professional relationships with clients and others
Documenting timely, accurate reports
Managing or applying physical restraints
Mentoring and preceptoring
Planning client care
Pronouncing death
Providing some disease prevention and health promotion services (e.g., blood glucose screening)
Recommending or administering some medications (e.g., Schedule III drugs)
Teaching
Using isolation techniques
Using some types of equipment (e.g., lifts, slings)

Nurses do not require an order to carry out these activities, although they are restricted by the standards, limits and conditions set by the BCCNW.

In addition to adherence to the BCCNM standards, nurses must obtain an order to complete these activities:

The BCCNM sets the following standards of practice which all registered nurses are expected to follow:

All registered nurses are expected to meet the following standards of professionalism, as determined by the BCCNW:

In 2020, the College of Midwives of BC amalgamated (combined) with the BC College of Nursing Professionals, thus giving rise to the BC College of Nurses and Midwives (BCCNM), which now governs and regulates the nursing and the midwifery professions.

Under provincial law, the midwifery scope of practice is defined as “the health profession in which a person provides the following services during normal pregnancy, labour, delivery and the postpartum period:

assessment, monitoring and care for patients, newborns and infants, including carrying out appropriate emergency measures when necessary
counselling, supporting and advising persons, including providing advice and information regarding care for newborns and infants
conducting internal examinations of patients, performing episiotomies and amniotomies and repairing episiotomies and simple lacerations
contraceptive services for patients during the 3 months following a birth

Midwives can also obtain additional training and certification in the following specialized areas of practice:

As of March 2023, all registered midwives are expected to meet the following BCCNM standards: