The scope of nursing practice

WHAT IS THE SCOPE OF
PRACTICE

The term scope of practice refers to the range of
roles, functions, responsibilities and activities
which a registered nurse or midwife is educated,
competent and have the authority to perform.
The scope of practice of nurses is influenced by:
The setting in which nurses practice
The requirements of the employer
The needs of the patients
Importance of the scope of practice

In spite of the difficulties, it is important to
define the scope of practice because it is
the base from which:
Regulatory bodies prepare standards of
practice
Educational institutions prepare curricula
Employers prepare job descriptions
Why is it a key concern?
The 3 Ps

SoP
Why is it a key concern?

Pressure from nurses (personnel)
 Nurses today work in a dynamic health care
environment.
Their roles and functions are constantly
evolving and changing to meet patient needs.
 They have developed expertise into areas traditionally viewed
as medical services.
 This creates a felt need for a definition of scope of practice that
is sufficiently broad and flexible to enable expansion of
nursing practice.
 The scope of practice will also provide a reasonable degree of
direction on the boundaries of the profession.
Why is it a key concern?

Pressure from policy makers and public
 Policy makers want the roles of various health care providers
to be clearly defined to ensure the most appropriate skill mix.
 The aim is for optimization of personnel to meet emerging
health care needs of the population in the most cost effective
way.
 Consumers also need an understanding of the scope of practice
to know who is qualified to provide different kinds of services.
Why is it a key concern?

Pressure on the regulatory body
 To clarify roles
 To delineate professional boundaries
 To address regulatory gap
Definition of nursing

Expansion of the scope of practice must be made in the context
of the definition of nursing and the values that underpin
nursing practice.
WHO and ICN definition of nursing
 Nursing helps individuals, families and groups to determine
their physical, mental and social potential, and to do so within
the challenging context of the environment in which they live
and work.
 Nursing also includes the planning and giving of care during
illness and rehabilitation and encompasses the physical, mental
and social aspects of life as they affect health, illness, disability
and dying.
Principles for determining the
scope of practice

The following principles are the basis for making
decisions with regard to the scope of practice:
 Competence
 Accountability
 Continuing professional development
 Support for professional practice
 Delegation
 Emergency situations
Competence

 In determining his/her scope of practice the nurse must judge
as to whether he/she is competent to carry out a particular role
or function.
 Competence is not static. One may learn a specific skill, but the
knowledge underpinning that skill may change over time.
 This can affect the ability to practice the skill.
 The nurse must acknowledge any limitations of competence
and refuse in such cases to accept delegated and assigned
functions.
 The nurse must take appropriate measures to gain competence
in the particular area.
Accountability

 Accountability is the cornerstone of professional nursing
practice.
 Accountability means being answerable for the decisions made
in the course of one’s professional practice. Tis includes the
decision to expand or not to expand his/her practice.
 Nurse/midwives are accountable to the patient, public, their
employer and any relevant supervisory authority and
regulatory body.
 Accountability applies to both actions and omissions.
Continuing professional
development

 CPD encompasses experiences, activities and
processes that contribute towards the development
of a nurse as a healthcare professional.
 It is lifelong process of learning, both structured and
informal.
 Continuing education is a vital component of CPD
and takes place after the completion of the
preregistration education programme for nurses.
Support for professional nursing
practice

 In order for nurses to practice competently and to
realise their potential in the interests of quality
patient care, systems must be in place to support
them in determining and expanding their scope of
practice. These include:
 Legislation
 Local and national guidelines
 Policies and protocols
Delegation

 Delegation is the transfer of authority to another
person to perform a particular function.
 As registered nurses take new activities into their
scope of practice , they must give up activities which
can safely be carried out by other personnel.
 The nurse who is delegating is accountable for the
decision to delegate
 The nurse to whom a particular function has been
delegated must acknowledge any limitations of
competence.
Emergency situations

Registered nurses provide care only within the scope of
practice. There is one exception to this rule- life-threatening
emergencies.
Registered nurses are ethically obligated to provide the best
care they can, given the circumstances and their individual
competence.
Conclusion

 While considering the scope of practice of nurses, it
must be clear that the focus is on safe and qualified
care that meet the needs of patients, not on jobs and
territory.
 It is clear that the new directions in the health care
system are expanding the opportunities for the
practice of nursing.
 Many nursing jobs will be different, but nursing will
continue to be a crucial part of the health care
system.
Thank you
