We talk a lot in our profession about our scope of practice yet I am often aware, in discussion with nurses, how few of us really understand what scope of practice means or how to define our own scope of practice. In truth, decision-making within and about our scope of practice can be confusing, it is both complex and dependent on a range of inter-related factors. I will explore nursing scope of practice over the next few weeks.
The scope of practice of nursing practice is recognised as varied and diverse, responsive to meeting the broad range of client/populations health care needs. It is dependent on the context of practice, influenced by;
· type of setting (e.g. healthcare agency, educational organisation, community health service)
· location of the setting (e.g. urban, rural or remote, community, acute care)
· characteristics of patients or clients (e.g. health status, age, learning needs)
· focus of health care activities (e.g. health promotion, research, education)
· complexity of practice (eg health acuity of the client/client population)
· level of responsibility/accountability of the health care provider and
· resources that are available/accessible as part of the health service.
Nurses are increasingly taking on expanded roles and activities in the interest of comprehensively meeting the health care needs of the community a safe and cost effective environment. Nursing practice has long moved toward broad, enabling scope of practice and a move away from prescriptive policy and certification of tasks and activities.
In Australia, as within many western countries, Scope of Practice Decision Making Frameworks/Tools have been endorsed by our regulatory authorities to assist nurses to make clear and transparent decisions about their practice.
Such SOP Tools aim to;
- provide a tool for nurses to use when considering, determining and/or self assessing their individual practice
- provide a tool for employers, managers, and policy makers to interpret, plan and apply practice
- clarify expectations of nursing practice
- describe nursing accountability and responsibility
- present performance criteria for nurses
- stimulate professional discussion and awareness in relation to scope of practice decision making
- articulate a framework for decision making against which nurses may be investigated for unprofessional conduct or incompetence
Scope of Practice of the Professions
The overall scope of nursing practice refers to the broad framework and context of practice for the profession, including the range of roles, functions, responsibilities and decision-making capacity which nurses are educated and authorised to perform in the context of their nursing practice. Some functions within the scope of practice of the profession may be shared with other professions or other providers.
That which the individual nurse is
· authorised and
· competent to perform
The scope of practice of an individual nurse may be more specifically defined than the scope of nursing professional practice as a whole. The scope of practice of the profession is broader than that of the individual nurse, the broadest parameters of which are set by legislation and professional standards and individual practice parameters determined by individual competence, knowledge and skill and largely by organisational policy and culture.
International Council of Nurses (ICN) Position on Scope of Practice 2004 states
The scope of practice is defined within a legislative regulatory framework, and communicates to others the roles, competencies (knowledge, skills and attitudes) and the professional accountability of the nurse.
The scope of [nursing] practice is not limited to specific tasks, functions or responsibilities but includes direct care giving and evaluation of its impact, advocating for patients and for health, supervising and delegating to others, leading, managing, teaching, undertaking research and developing health policy for health care systems.
Furthermore, as the scope of practice is dynamic and responsive to health needs, development of knowledge, and technological advances, periodic review is required to ensure that it continues to be consistent with current health needs and supports improved health outcomes.
Where do nurses get their authority to practice?
Nursing’s authority comes from evidence-based knowledge related to its sphere of practice. However, nursing is also allied [and interdependent] to other health professions through its collaborating, referring, and co-ordinating activities, and thus has developed a distinct as well as a shared body of knowledge and practice.
The practice and competence of an individual nurse within the legal scope of practice is influenced by a variety of factors including education, experience, expertise and interests as well as the context of practice. Therefore, definitions of roles and scope of practice need to reflect what is distinctly nursing, while communicating the multidisciplinary and interdisciplinary nature of health care.
· International Council of Nurses Position on Nursing Scope of Practice Updated 2004 www.icn.org