FAQ – Immunizations

Can nurses provide vaccines (e.g., Flu, Covid) in a Pharmacy setting?

Yes, but nurses must reflect on a number of questions before proceeding.

Is it within the scope of practice of a nurse to provide immunizations (e.g., flu vaccinations)?

Nurses must consider whether they are educated¹, authorized, and competent to perform and are able to manage the outcomes of providing vaccinations, whether legislation permits or prohibits this competency, and whether there is employer authorization (e.g., direct authorized prescriber order, medical directive, employer policy, etc.). Provision of vaccines can be incorporated into the scope of practice of a nurse in NL.

Is it within my individual competence and am I competent to provide immunizations?

Nurses must have the individual competence to provide immunizations, including Flu and Covid vaccines (i.e., have the necessary, skills, and clinical judgment to administer vaccines) and be competent to manage the outcomes of care. Nurses are expected to seek appropriate education to add the administration of vaccines to their scope of practice. The provincial government provides a self-directed learning module on immunizations.

According to the Provincial Immunization Policy:

• RNs and LPNs within acute care and long-term care require an authorized prescriber direct order to administer vaccinations.
• Within community health (including personal care homes), RNs and LPNs authorized to immunize under a medical directive directed by the NL Immunization policy
• In occupational health settings, a medical directive by the Regional Medical Officer is required to authorize RNs and LPNs to provide immunizations.

Each year in NL, the Chief Medical Offer of Health provides a medical directive for RNs and LPNs provide flu vaccinations within the RHAs.

When a nurse is practising in an employer/organization setting outside of the provincial health authority (PHA), nurses must follow the provincial drug schedules. For nurses practising in a community pharmacy, the nurse does not require an order. The Influenza vaccine falls under Schedule II and does not require an order from an authorized prescriber (i.e., Pharmacist); however, the nurse must be knowledgeable of the vaccine and its product monograph before administering the vaccine and be knowledgeable of how to manage the outcomes of providing that vaccine to the client in this particular practice setting.

It is also imperative that the nurse have employer policies that clearly outlines the nurse’s and Pharmacist(s)’s responsibilities, e.g., who completes the client assessment, vaccines dosages, how to manage the outcomes of care, anaphylaxis, etc. These policies can be collaborative in nature and address the roles of the collaborative team (e.g., pharmacist, RN, LPN, RPN) in the provision of Flu vaccines in a pharmacy setting.

How do I manage the outcomes?

Nurses must determine what is best practice to manage the outcomes of administering a vaccine (e.g., the client has an adverse reaction, experience side effects, etc.) In the pharmacy setting, pharmacists are not permitted to prescribe epinephrine other than in pre-filled syringes intended for emergency administration by injection in the event or anaphylactic reactions to allergens. See NAPRA drug schedules.

EpiPen and EpiPen Jr are Schedule II drugs and do not require a direct order from an authorized prescriber. Nurses must ensure that the appropriate medication(s) are available to manage the outcomes of care.

What do I document when I give a vaccine?

Nurses are expected to document the nursing care they provide. Nurses are expected to document administration of the vaccine according to the appropriate provincial legislative requirements. It is best practice to check the client’s current medication profile in the Provincial health information system prior to administering the vaccine. Nurses must also follow employer policies for documentation.

Do I have to inform the College of my new employment setting?

Nurses should update their profile with the College when adding a new employment setting.

Do I have to maintain competency in administering immunizations?

Nurses are expected to engage in continuing education to maintain individual competence and to ensure that they incorporate evidence-informed best practices into their nursing or psychiatric nursing practice.

Note: Registered Psychiatric Nurses (RPNs) administer immunizations to clients five years or older.

RPNs must validate if they are permitted to administer immunizations within the PHA under the Provincial Chief Medical Officer of Health’s medical directive issued each year.