🩹 Let’s Talk Foot Care Practice
A fellow foot care nurse recently asked me, “Do you ever use lidocaine?” It’s a great question — and one that comes up often in nursing foot care.
Topical lidocaine (up to 5%) can offer short-term relief during certain procedures, and in some clinical environments, it’s used to help reduce discomfort for clients with heightened sensitivity. When used appropriately, it can enhance client comfort and help complete care more efficiently.
That said, I personally don’t use lidocaine in my practice. In my experience, a calm presence, strong communication, and confident, gentle technique go a long way. Often, reassurance is the best anesthetic — and if a procedure truly requires pharmaceutical pain management to be tolerable, it may be a sign that it’s beyond the scope of nursing foot care and should be referred.
Whether or not you’re allowed to use it without a prescription depends entirely on where you practice.
In some provinces — like British Columbia and Nova Scotia — LPNs may be permitted to use OTC topical lidocaine under specific conditions, such as employer policy and a stable client condition. But in most of Canada, a prescriber’s order is still required, even for over-the-counter products.
This post breaks down what’s allowed — and what isn’t — across each province and territory in Canada, with direct links to the relevant standards and nursing guidelines.
A Province-by-Province Guide for Nurses in Canada
Topical lidocaine (≤5%) is widely used for minor foot procedures, wound care, and localized pain relief — but can Licensed Practical Nurses (LPNs) apply it without a prescription?
The answer depends on where you practice.
Below is a clear, updated breakdown based on Canadian provincial and territorial nursing regulations and medication standards.
🗺️ Province-by-Province Overview
British Columbia
LPNs in BC may apply over-the-counter (OTC) topical lidocaine (≤5%) within their autonomous scope of practice, provided that:
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The client is stable and predictable
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The nurse is competent
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Employer policy supports its use
According to the BCCNM Medication Guidelines, lidocaine ≤5% is classified as an unscheduled product and may be used autonomously under the above conditions.
Alberta
LPNs in Alberta require a prescriber’s order for any medication, including OTC products like lidocaine.
The CLPNA Medication Guidelines emphasize that medication administration must be authorized by an order or employer-approved protocol.
Saskatchewan
Topical lidocaine requires a medical order. The SALPN Standards do not permit nurse-initiated OTC medication use.
Manitoba
LPNs must have an order to administer any medication, including OTC topicals. The CLPNM Scope of Practice confirms that unscheduled medications still require authorization unless included in a formal protocol.
Ontario
RPNs (equivalent to LPNs) require a prescriber’s order for all medications. The CNO Medication Practice Standardclearly outlines this requirement, including for OTC topicals.
Québec
Infirmières auxiliaires (LPNs) must follow a prescriber’s order to administer medications. Application of lidocaine is only permitted under a medical directive (ordonnance collective).
New Brunswick
According to the ANBLPN Standards, all medications require a prescriber’s order. OTC lidocaine is no exception unless part of a clearly defined care directive.
Nova Scotia
LPNs may independently recommend and administer OTC medications — including lidocaine — when:
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The client’s condition is stable
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The nurse is competent
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There is employer support
This is explicitly supported by the NSCN Scope Guidelines.
Prince Edward Island
LPNs follow employer and prescriber direction. According to the CLPNPEI Standards, there is no independent authority to administer lidocaine without a prescription or directive.
Newfoundland & Labrador
LPNs require a prescriber’s order for all medications. The CLPNNL Medication Administration Standards do not indicate any exceptions for OTC lidocaine.
Territories (Yukon, NWT, Nunavut)
Territorial guidelines generally follow BC or Alberta depending on local policy. If no specific protocol exists, LPNs should assume a prescriber’s order is needed before applying topical lidocaine.
✅ Conclusion
While topical lidocaine ≤5% is available over the counter, most provinces still require a prescriber’s order before an LPN — even a highly trained foot care nurse — can apply it.
Currently, only British Columbia and Nova Scotia permit nurse-initiated use, and even then, only under specific conditions tied to competence and employer support.
When in doubt:
• Know your scope
• Check your employer’s policy
• Confirm your competence
• Consult your regulatory college before reaching for the lidocaine