Applying or ordering the application of a form of energy is a controlled act listed under the Regulated Health Professions Act, 1991 (RHPA).

The following activities, procedures or diagnostic tests are forms of energy under the RHPA.

  1. Electricity for
    • aversive conditioning
    • cardiac pacemaker therapy
    • cardioversion
    • defibrillation
    • electrocoagulation
    • electroconvulsive shock therapy
    • electromyography
    • fulguration
    • nerve conduction studies
    • transcutaneous cardiac pacing
  2. Electromagnetism for
    • magnetic resonance imaging (MRI)
  3. Soundwaves for
    • diagnostic ultrasound
    • lithotripsy

Procedures not listed above (for example, laser therapy) do not fall within the controlled act of applying or ordering a form of energy.

Before doing any procedure, nurses must make sure

  • they have the legal authority and knowledge, skill and judgement to do the procedure safely
  • it is the right procedure within the context of the client’s needs and the practice setting

For more information, refer to the Scope of Practice standard.

Nurse Practitioners (NPs)

NPs have the authority to order

  • electromagnetism for magnetic resonance imaging (MRI)

NPs have the authority to order and apply

  • soundwaves for diagnostic ultrasound

Effective Tuesday, July 1, 2025, NPs will be authorized to order and apply electricity for

  • cardiac pacemaker therapy
  • defibrillation
  • electrocoagulation
  • transcutaneous cardiac pacing

Transvenous pacing

Transvenous cardiac pacing is not listed specifically as a form of energy under the Regulated Health Professions Act, 1991 (RHPA). It falls under “cardiac pacemaker therapy.” As of Tuesday, July 1, 2025, this procedure will be part of NPs’ scope of practice.

Registered Nurses (RNs) and Registered Practical Nurses (RPNs)

RNs or RPNs have the authority to apply

  • soundwaves for diagnostic ultrasound to conduct routine nursing assessments (for example, portable bladder ultrasound scanning), within a therapeutic nurse-client relationship, to help develop or carry out the client’s care plan.

Applying automated external defibrillator (AED) in emergency situations

Using an AED falls under the controlled act of defibrillation, which is a form of energy not within the legal scope of practice for nurses.

Therefore, nurses may apply defibrillation in only one of two scenarios:

  1. through delegation and treatment order: when someone authorized to do the controlled act transfers the authority to a nurse through a delegation process and with an order or directive in place
  2. through the emergency exception: when giving first aid or temporary help during an emergency.

For more information on requirements for delegation and emergency situations, see the Scope of Practice standard.

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