LibGuides: Team-Based Care Design: RESOURCE: Professional Practice Terms

Care Assignment

The process of a regulated health care professional(s) directing aspects of patient care, as authorized by the employer (scope of employment), to be performed by a UCP consistent with their education and practice context.

The provision of care/care activities/interventions and/or being assigned accountability to coordinate and oversee care by a regulated health care professional for a patient/group of patients.

Example

A Physiotherapy Assistant (PTA) providing exercise, or a mobilization regimen based on a plan of care developed by the assigned Physiotherapist.
An LPN who is assigned a group of patients to care for, and ensure care and interventions are completed and associated patient outcomes are assessed/evaluated and adjusted as required.

Controlled Act

Controlled acts are outlined in regulated health care professionals’ legislated acts or regulations. They may also be further outlined in employer policies, in keeping with associated legislation. To help prevent harm, controlled acts are put in place to restrict the performance of activities to only persons who are qualified to do them.

Example

Prescribing medications is an example of a controlled act that can only be performed by certain authorized, regulated, healthcare providers (for example, physicians, nurse practitioners, RN prescribers, pharmacists) who have the knowledge, skills, education and authorization to do so.

Nova Scotia Health Policy Home

Delegation

Delegation refers to situations where a regulated health care provider transfers the authority to perform a clinical activity that is considered a restricted activity, controlled act or an aspect of regulated profession’s scope of practice, to a member of the health care team who does not have authority.

Example

A nurse who delegates to a UCP a care activity (for example, disconnecting a tube feeding) that the nurse would normally perform. This action would be based on an approved employer policy. While the nurse transfers responsibility to perform the activity to the UCP, the nurse is accountable for determining if the decision to delegate is appropriate. This is based on an assessment of:

Client factors
Care context
Actual care activity to be delegated
Level of supervision and communication between the nurse and the UCP
Skill and experience of the UCP
Organizational policy outlining the parameters of what can be delegated and to whom

Nova Scotia College of Nursing. Assignment and Delegation: Guidelines for Nurses

Individual Scope of Practice

Individual scope of practice is a term that can be applied to an individual who holds a licence to practice in a specific regulated discipline. The individual is required to stay within the parameters of practice as outlined by their licensing body, legislation and standards of practice. Their scope of practice is shaped by their experience, additional training or certification and competencies developed within their practice setting(s) or context.

Examples

An RN who has obtained experience and additional certification in Wound and Skin Management consults and advises on complex wound treatment plans.
An RN who has obtained the necessary knowledge, skills, and certifications to become an RN Prescriber.
A Physiotherapist (PT) who, based on their context of practice, orders an X-ray to help determine the required PT interventions to achieve a desired/optimal patient outcome.
A PT or Registered Respiratory Therapist (RRT) who frequently assesses and applies the use of a mechanical insufflator-exsufflator cough assist device for a specific patient population/setting.

Regulated Health Care Provider

This term applies to a person(s) who holds a registration or licence under a governing, regulated health professional college or registrar (Regulated Health Professions Network Act, 2012). Examples include:

Physicians
Registered Nurses
Licensed Practical Nurses
Registered Respiratory Therapists
Pharmacists
Physiotherapists
Occupational Therapists
Social Workers

Regulated Health Professions Network Act (2012, c.48, s.1.). https://www.nslegislature.ca/sites/default/files/legc/statutes/regulated%20health%20professions%20network.pdf

Nova Scotia Government Acts

Scope of Employment

Scope of employment (SOE) is a term often used by employers. This term can apply to both regulated and nonregulated roles. SOE is defined by the job description and may be further defined by the practice setting in which the person works and/or additional employer policies or guidelines.

SOE is influenced by:

Care needs of patients/clients served
Care context
Knowledge, skills and experience of provider(s)

SOE must not fall outside of a regulated licensed professional’s scope of practice.

SOE of unlicensed roles must not:

exceed the parameters of the defined SOE
exceed their education/training
fall into an intervention/procedure/practice that is restricted, prohibited or protected by a licensed, regulated provider’s regulation/acts.

Example

A CTA who received training in a course to measure blood pressure may be supported to continue that practice in a particular practice setting (once competency has been validated by employer). To determine if this falls within the SOE of an individual practice setting, the unit leader would need to assess:

the frequency of the need to perform this duty (for example, adequate performance frequency to maintain the skill).
whether including this skill in the SOE could have implications on the ability of the CTA to meet other core responsibilities.
- For example: A main role for CTAs within certain practice settings is to help provide ADL (activities of daily living) care (ensuring patients meet nutritional, elimination and mobility needs). The addition of other duties must not detract or limit the ability of CTAs to engage in these core duties.
risks to the patient/patient population or gaps/delays in care that could occur if another role were to perform the duty.
- For example: A patient who has been declining and it has been difficult to obtain their blood pressure and/or who is labile and/or who may require immediate intervention by a nurse.

Scope of Practice

Scope of practice outlines activities a health care professional is educated, competent and authorized to perform based on the parameters defined by their license. These activities include:

clinical skills/procedures/interventions
processes (for example, assessments, patient teaching process)
actions (for example, formulation of a plan of care)

Scope of practice and standards of practice help define the who, what, when, where, why, and how of a profession’s role.

Unregulated Health Care Provider

This term, also called an unregulated care provider (UCP), refers to members of the health care team who do not have a legally defined scope of practice or oversight through a governing body (such as a governing college or registrar) for their specific discipline/role. There is no regulating body that sets standards of practice and monitors the practice of these health care providers (Canadian Nurses Protective Society, 2015).

This does not mean that the person fulfilling a UCP role has not obtained skills, training, certification(s) or other post-secondary learning associated with their role.

References

College of Nurses of Ontario. (2022). Working with unregulated care providers. https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/working-with-ucps/

Canadian Nurses Protective Society (2015). Ask a lawyer: Working with unregulated care providers. https://cnps.ca/article/ask-a-lawyer-working-with-unregulated-care-providers/