What Is the Nursing Scope of Practice? An Overview
Nursing is a dynamic profession that’s evolved in many ways over the past century. A role that began with the concept of caregiving now encompasses the entire continuum of health promotion, patient education, disease prevention, and care coordination. Nurses currently make up the largest workforce within the healthcare industry, and the nursing scope of practice has become pivotal in regulating standards of care.
But what exactly does scope of practice mean and why is it so important for nursing professionals? If you’re a facility leader, this is a fundamental concept to understand since it helps shape facility-level policies and workflow. We’ll walk you through everything you need to know, from how scope of practice is defined to why it’s important to follow.
What Is the Scope of Practice in Nursing?
Theoretically, the nursing scope of practice encompasses the who, what, when, why, where, and how of the nursing profession. Under the American Nurses Association (ANA) Scope and Standards of Practice, this more specifically refers to:
- Who is educated and licensed to provide care.
- What nursing responsibilities and duties are.
- When there is a need for nursing knowledge or leadership.
- Where there are individuals in need of nursing care.
- Why nurses are committed to promoting health outcomes.
- How nursing is defined by standards of care.
In a more practical sense, the scope of nursing practice is a regulatory framework defining how clinical duties should be carried out under licensure or certification. While specific duties vary by state, the nursing scope of practice for different certifications and licensures can broadly be defined as follows:
| Certification/Licensure Type | Description |
|---|---|
| 1. Certified Nursing Assistant (CNA) | Assists with basic patient care tasks, such as vital sign monitoring and aiding with activities of daily living (ADLs), as assigned by LPNs and RNs |
| 2. Licensed Practical Nurse (LPN) | Carries out basic nursing responsibilities, such as wound care and catheter insertion, with certain tasks requiring RN supervision |
| 3. Registered Nurse (RN) | Completes all nursing care processes, such as medication administration and patient education, in addition to overseeing basic care duties |
| 4. Advanced Practice Registered Nurse (APRN) | Manages complex and specialized care processes, such as diagnosing conditions and recommending treatment |
| 5. Certified Registered Nurse Anesthetist (CRNA) | Administers pain medication and anesthesia during medical procedures and surgeries |
What Factors Shape the Nursing Scope of Practice?
There are many different factors that go into shaping the scope of practice. Nursing licensure requirements and federal regulations dictate what nurses can and cannot do, while facilities implement protocols to meet standards of care. We can take a closer look at how these factors come into play below.
State Licensure Requirements
Under the Nurse Practice Act, each state holds jurisdiction over how nursing professionals practice. Therefore, the nurse’s scope of practice definition also varies depending on where they practice. Each state board not only determines the competencies required for licensure, but also defines which tasks nurses are allowed to carry out, how activities should be delegated, and who RNs should report to.
For example, some states limit a nurse practitioner’s scope of practice by requiring physician oversight to prescribe medications. Other states permit nurse practitioners to practice completely independently.
Federal Regulations
While state-based requirements shape most of the nurse’s scope of practice, federal health agencies, such as the Center for Medicare and Medicaid Services (CMS), also play a role. To meet the standards of nursing practice as defined by these agencies, facilities must enact certain protocols that nurses are expected to follow as they deliver care.
For example, CMS outlines regulations aimed toward preventing medical errors, one of which specifies what information must be validated prior to medication administration. Since medication administration is an RN’s responsibility, validating necessary information also falls under the nursing scope and standards of practice.
Facility Protocols
Beyond the responsibilities defined by state boards of nursing, some facilities may implement more specific guidance on how tasks should be carried out in their units. For example, LPNs and RNs are trained to insert catheters, but some hospitals require additional certification before they can carry out this task. This is a common quality improvement initiative to help prevent catheter-associated urinary tract infections (CAUTI).
Additionally, many organizations employ certified medical assistants (CMAs) to assist CNAs in completing basic care tasks like patient feeding and bathing. This can also affect the scope of nursing practice for clinicians working in these facilities as tasks and responsibilities are divided between assistive personnel and may be assigned based on skill level or license type.
What Are Some Key Terms Related to the Nursing Scope of Practice?
Authority, competence, and context should all be considered when establishing a clinician’s legal scope. While the differences among these terms may seem nuanced, understanding how each plays a role in shaping clinical practice guidelines is essential to providing safe patient care. Below, we review the definition of each term and explain how it impacts scope of practice decision-making.
Authority
Authority refers to a clinician’s legal capacity to carry out a task. In healthcare, authority is generally established by a clinician’s license or certification. For example, advanced practice registered nurses (APRNs) have the authority to prescribe medications because their licensure allows it, although the scope of this authority can vary by state. RNs and CNAs don’t have this authority and therefore are never allowed to prescribe, under any condition.
Competence
Competence refers to the training, education, and clinical experience required to carry out a certain task. A clinician’s competence is usually set by the organization that they work for, not a federal or state legal body.
For example, some organizations only allow RNs who have completed a facility-specific peripherally inserted central catheter (PICC) insertion training course to complete this clinical task. Even though all registered nurses generally have the authority to insert PICC lines, (as is established by RN licensure rules), only nurses who have proven their clinical competence at PICC line insertion are allowed to carry out this task.
Context
Clinical context refers to the circumstances or factors that could impact a clinician’s ability to provide safe patient care. The care setting, availability of resources, and stability of the patient are all factors that play a part in establishing clinical context. These factors should be considered, in conjunction with a clinician’s authority and competence, when establishing whether they should be allowed to carry out a given task.
For example, CNAs have the authority and competence to bathe patients. However, if a patient has an open wound, large surgical incision or complex dressing in place, the task of bathing the patient would generally fall on a clinician higher in the chain of command, like an RN or an NP.
What Are Some Nursing Scope of Practice Examples?
To provide more context, we can take a look at examples of nurses working outside their scope of practice and within their scope of practice.
Example 1: Outside Scope of Practice
Scenario: An RN is having a particularly busy day in a clinic based in Alabama. She asks an LPN to help administer an IV push medication to one of the patients on the floor. The LPN agrees and completes this task without supervision.
Explanation: The Alabama Board of Nursing prohibits LPNs from administering any medications via IV push, unless hospitals apply for standardized certification. In this case, the LPN carried out a duty that fell outside of her scope of practice without the certification to do so.
Example 2: Within Scope of Practice
Scenario: A nurse asks a CNA on the floor to check on one of her patients. The CNA notices that the patient’s wound dressing is soaked in blood and needs to be changed. The CNA reports this to the nurse who then comes in to conduct a full wound care assessment.
Explanation: While CNAs are expected to report any noticeable changes in skin condition, they’re not trained to examine or clean wounds. The CNA stayed within her scope of practice by sharing these findings to the nurse, who then came in to complete wound care.
Why Is It Important to Stay Within the Scope of Practice?
Defining the nursing scope of practice ensures nursing professionals at all levels understand what their duties are and how to carry them out efficiently. This framework sets a standard that ensures nurses are equipped with proper skills to deliver safe and quality care.
If a nurse carries out a task that they’re not properly trained or qualified to do, this could endanger patients and lead to major consequences. Nurses risk losing their jobs, facing financial penalties, or even having their licenses revoked. To help prevent this at the facility level, it’s important for leaders to provide guidance and training so that their staff have a clear understanding of what their scope of practice is.
Looking for More Ways to Support Your Nursing Staff?
With this overview of the nursing scope of practice, you may be looking for more ways to help your staff practice safely and effectively. Check out IntelyCare’s additional expert insights for more practical ways to bridge gaps across the nursing profession.
Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.