Ask a Lawyer: Working Under a Different Nursing Class, Designation, or Role

Question: If I am asked to work under a different nursing class, designation, or role, which professional standards will apply to me? Are there additional legal considerations?

To counter nursing shortages or other circumstances that lead to reduced resources, nurses may be asked to work under a different class or designation, work in different roles, be redeployed to a different unit, or simply work in more of a supporting role, such as an unregulated care provider. There are several ways in which the issue of working in different roles can arise:

1. 1. A nurse is registered with one nursing regulatory body in more than one designation or nursing class and works in two different roles, in a different nursing designation or class in each role;
   2. A nurse is registered with different nursing regulatory bodies in different classes of nursing; or
   3. A nurse is registered in one nursing classification and is deployed by the employer to a different role for which the job description is a different class of nursing registration.

When working in an unfamiliar environment in a different role, nurses may be concerned how to best ensure they are providing safe and competent care to their patients while maintaining compliance with their professional nursing standards and the guidelines set out by their regulator.

Scope of Nursing Practice

The nursing profession is governed by a combination of a province or territory’s legislation (Acts and regulations) and the nursing regulator’s bylaws and professional standards. These authorities set out the scope of nursing practice for each designation or registration class. Additionally, they typically identify restricted or reserved activities that only authorized health care professionals can perform (with some exceptions, e.g. health profession students). Nurses will also be expected to demonstrate competency through their knowledge, skill, and judgment, and to adhere to the nursing practice standards and professional ethics.

When working under a different designation or in a different role, nurses may be expected to meet the legal standard of care applicable to their highest level of designation, not the designation that they happen to be employed in at the time. For example, in an emergency, an LPN with dual licensure as an RN may be expected to perform as an RN in order to ensure the client receives appropriate care, until relieved of this responsibility.¹

Use of Title

Nursing legislation and regulations typically contain a prohibition on the use of specific words or initials by anyone who is not a registered member of that health profession. Your provincial or territorial nursing regulator may provide specific guidance on which designation or class to use to identify oneself when working with dual licensure/registration or in different roles. For example, in Ontario, RNs working in RPN roles or NPs working in RN roles are required to document and identify themselves to clients in a manner that reflects their registration status with CNO regardless of the role they are working in.² You may wish to verify which title you should use when working in a different position.

Scope of Employment

A nurse’s employment will have its own scope, often contained within a job or role description. While the nurse would generally be expected to fulfil only the requirements of the position’s job description, an NP may be accountable as an NP even when employed as an RN and could be expected to step into the NP role in unexpected or emergency situations.³

Risk Management

Working in different roles or with different designations may create confusion and increase risks. If you are in this situation, it may be prudent to consider the following risk management questions:

• • Have you reviewed your nursing regulator’s guidance on dual licensure or working in more than one role?
  • Have you discussed this possibility with your current or potential employer and planned how it would be handled prior to accepting a role that could create this situation?
  • If you are already working in different roles, either in different jobs or because of deployment by your employer, have you considered reviewing your regulator’s guidance and your employer’s policies so a plan can be made promptly to manage the challenge?

If a patient’s care need arises from a true emergency, you may decide to act in accordance with your greatest scope of practice and indeed your regulator may expect this, until another practitioner can assume care. If this occurs, consider notifying your employer about the situation and the rationale for acting in these circumstances.

If a patient’s care need is less urgent, you may wish to use your assessment and advocacy skills to report your observations and recommendations to others on the care team and/or management with the goal of achieving the best patient outcome.

CNPS beneficiaries can contact CNPS at 1-800-267-3390 with specific questions related to their practice to speak with a member of CNPS legal counsel. All calls are confidential.

1. Nova Scotia College of Nursing, Dual Licensure Position Statement, (2017) https://www.nscn.ca/sites/default/files/documents/resources/DualLicensure.pdf
2. See for example, the College of Nurses of Ontario, Nurses Working in different roles (July 01, 2023) Nurses working in different roles (cno.org). Please note that in Ontario, “RPN” (Registered Practical Nurse) is equivalent to the “LPN” (Licensed Practical Nurse) designation in other provinces and territories.
3. Ibid.

Published August 2024.

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.