Understanding Scope of Practice

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There are limitless job opportunities when it comes to nursing. We are lucky to have a profession where we have the option to change what areas and specialties we work in.

What never changes through all the variations of work we can do are the rules and regulations that we have to follow. It’s important that nurses take time to educate themselves on understanding two important terms and how they correlate: scope of practice and the nurse practice act. 

Scope of Practice

The words “scope of practice” can be confusing for new graduates to understand. What scope of practice refers to is the professional activities that you as a nurse can perform and participate in as defined by state law. In simpler terms, it’s the services that a nurse can lawfully provide, such as administering medications intravenously or inserting catheters.

Nursing standards and our scope of practice are outlined within a state’s nurse practice act.

Nurse Practice Act

The state nurse practice act refers to a set of rules defined by your state that governs and ensures safe and competent nursing practices, so people who need nursing care can be properly protected. Knowing how the nurse practice act affects your work is critical in working safely within the boundaries set by your specific state.

What is the Nurse Practice Act?

Each state is responsible for creating its own nurse practice act, which has the purpose of reducing harm to patients by ensuring that licensed nurses are competent nurses. The act states that a board of nursing must be formed and established for the state to govern legal authority. 

Through the nurse practice act, the board of nursing determines what legal authority nurses have over their practice. It sets standards for how to become a nurse in that state and what titles you’re eligible to use. It also covers nursing standards and their scope of practice.

What is Your Responsibility as a Nurse?

As a new nurse, or even for older ones who have been in the field for years, it can be easy to forget or be ignorant of your state’s nurse practice act. However, as a professional who holds a license, it is our responsibility to know it and follow it. Even if a nurse has broken rules of the code in good faith, they can be held accountable. 

If you ever have knowledge of a nurse working outside their scope of practice, putting the health of the community at risk, or falsifying documents or records, complaints to the state board of nursing need to be made so that they can conduct a proper investigation.

What is the Facility’s Responsibility?

A hospital can never have separate scope of practices that say nurses can perform a task outside of those already set in the nurse practice act. A facility can limit the scope of practice in certain situations, but it can’t add to what is already defined as a nurse’s scope of practice in the state nurse practice act. 

Where Do I Find the Nurse Practice Act?

Since nursing is a skilled profession, there may be areas where you’d like to look further into what services you’re legally able to perform. Nurses should know where to access their state practice act as well as keep a copy of their job description, policies, and contracts.

Where Can I Find Help Making Decisions? 

The Tri-Council of Nursing set in place a tool to make decisions easy to make by following a simple framework. This tool can be used by nurses or their employers to help determine what nurses can safely perform. Bookmark this page so you’ll always have access to this information in a pinch.

How Does Scope of Practice Affect Delegation?

Delegation, when done safely, can free up more time for nurses to care for more critical patients. Nurses use delegation to hand down some tasks to skilled nurses aides or licensed practical nurses. But in order to do this safely, nurses must use critical decision making and be familiar with their facility’s policies and the scope of practice for the staff they’re delegating to. 

Understanding Scope of Practice and Delegation - Should You Delegate a task?  Proceed to delegate if:
-There are laws in place that support delegation
-The task is within the scope of the license of the delegee, as determined by state law
-The delegee has been properly trained and deemed competent
-The client has been assessed by an RN
-The task can be done without the judgment of a nurse
-The task can be performed safely and each direction performed unchanged
-You will be available to the delegee in person or by phone
-The delegation of this task is allowed at your facility

If you delegate a task to another health care staff that you supervise, you’re responsible for knowing whether or not that staff member can legally perform that task. And if they can’t or they are unsafe performing the task and cause damage, you’ll be responsible for that, too. So understanding the scope of practice and standards for other staff you supervise is just as important as knowing your own.

When you become a nurse, you accept responsibility and the boundaries set for practicing within the legal scope of practice. As nurses act independently from doctors and autonomously without supervision, it’s important that the nurse knows where to seek information on how to safely administer and delegate care.

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