Is It In Your Scope of Practice?

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January 13th, 2012

By , BSN, RN

This week I have been talking about nurse practitioners broadening the scope of their practices in different states: how that would be beneficial, the organizations working for and against, and what some states allow and others don't. But it dawns on me the term "scope of practice" needs some definition.

As a nurse for a number of years, I think I know my own scope of practice. As a nursing student I heard the phrase a lot, read definitions, but they didn't mean much since I didn't really have any practices to fit into a scope—yet. So let's take a look at what the nursing scope of practice is and how it is determined.

To understand your nursing scope of practice you must first know what defines nursing. The American Nurses Association (ANA) provides a contemporary definition:

"Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."

Ok, that sounds like a fancy variation on, "I want to help people." As nurses we commit to protecting the health of ourselves and others through education, hands-on care, and collaboration with other health care professionals. Those others we talk about can be found in hospitals, schools, neighborhoods, free clinics, doctor's offices and next door. So again, what determines if we are within our "scope of practice" to work with these other people?

We go back to the ANA and Nursing: Scope and Standards of Practice.

"The scope of practice statement describes the "who," "what," "where," "when," "why," and "how" of nursing practice. Each of these questions must be answered to provide a complete picture of the dynamic and complex practice of nursing and its evolving boundaries and membership. The profession of nursing has one scope of practice that encompasses the full range of nursing practice pertinent to general and specialty practice. The depth and breadth in which individual registered nurse engage in the total scope of nursing practice are dependent on their education, experience, role, and the population served. "

Now we have this textbook definition. It tells us we must answer certain questions to know if something falls in our "scope" and it tells us there are lots of variables. Let's break it down because even though we all went or are going to nursing school, because we all have or will pass our licensing exams, doesn’t mean we belong everywhere. For example, I am an OR nurse. I know a lot about anatomy, technology, machinery and instruments, positioning, pressure points and personality quirks of my surgeons. I am not an ICU nurse. I know how to take a blood pressure, use my stethoscope, and I actually still remember the differences between wheezing and rales. I no longer know how to set up a pump, am unfamiliar with the many kinds of cardiac drugs used today, and haven't managed a ventilator since nursing school clinicals; those skills are not in my scope of practice.

Here are some guidelines determining your own "scope of practice:"

  • Did I learn this skill or task in my basic nursing program? – Every nurse, everywhere should know how to take a manual blood pressure. It is a basic skill taught in nursing school.

If you determine that the activity was not part of your basic nursing program, try these questions.

  • Did I learn this skill/task as part of a comprehensive training program which included clinical experience? – In my OR residency program I learned about electricity and its uses in surgery, how and where to properly place grounding pad to prevent burns and other electrical accidents. I learned how to pass instruments, including knives, safely to the waiting hands of the surgeon and how to assist the anesthesia provider with intubating the sleeping patient. All skills particular to the operating room environment.
  • Has this task become so commonplace in nursing literature and in nursing practice (wound debridement and dressing, for example) that it can reasonably and prudently be assumed within scope? – At one time only doctors attended to patient's wounds, but wounds of all kinds — burns, diabetic, surgical — are so commonplace today that pretty much all nurses know or have been shown how to do it.
  • Is the skill/task in your hospital's/clinic's/agencies' policy and procedure manual? – If it is in the book, your employer believes it is a skill/task that is part of the job you were hired to do—your "scope of practice."
  • Does this skill/task pass the "reasonable and prudent" standard of nursing? – A large part of nursing is using common sense. Being reasonable and prudent is simply showing care and thought for the future—pretty much the basic tenets of nursing. If what you are about to do fits those definitions it is in your "scope of practice."

If you can answer yes to all these questions, the skill or task is within your scope of practice.

Scopes of practice are the same for every nurse at a basic level and very different by specialty (OR, ICU, ER, Telemetry, Pediatrics, etc.); education (LPN, ADN, BSN, FNP, CRNA, DNP, and all those other initials), where you practice and who you serve. If you have a question about something you are asked to do; if you are uncomfortable with something you see, maybe it's not in your scope of practice. It is always better to hesitate, ask yourself these questions and check with someone else before you commit your patient and yourself to a course of action you shouldn't be on. Stepping out of your scope of practice can be a legal issue and endanger that license you worked so hard for.

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