Scope of Nursing Practice and Provision of Safe Care

The principles of nursing practice are closely associated with the roles and tasks which should be performed by nurses according to the scope of their practice. In 2013, the International Council of Nurses presented the revised variant of the position statement on the issue of the scope related to the nursing practice. Thus, the modern approach to the scope of nurses’ duties and associated aspects of broadening and adding to it is reflected in the position statement. While determining the nurses’ roles, duties, and responsibilities, it is necessary to pay attention to the main idea of the position statement. According to the statement, “the scope of nursing practice is not limited to specific tasks, functions or responsibilities but is a combination of knowledge, judgment and skill that allows the nurse to perform direct care giving” (International Council of Nurses, 2013, p. 1). The issue of the scope requires further discussion today because of the observed tendencies not only to contribute to the dynamic and responsive practice but also to broaden the scope significantly, involving different ethical and legal implications. Thus, it is important to analyze elements of the position statement and its role in improving the population’s health regarding the issue of the practice’s scope because nurses’ tasks and responsibilities are determined according to the statement’s principles.

The Position Statement: Importance of the Scope Issue for the Nursing Practice

The position statement is developed to determine the clear roles for nurses and the areas of their responsibility and accountability. Referring to the idea that the scope of nursing practice should be “broad and flexible to permit freedom for innovation, growth and change”, the role of health caregiver is expanded to supervising, managing, and researching in relation to nursing and with references to the patients’ needs (International Council of Nurses, 2013, p. 1). From this perspective, the issue of determining the scope of practice is important for the nursing practice because the clear definition of the scope can guarantee the provision of high-quality health care services and the adequate response to patient safety. It is accentuated in the position statement that the clearly defined and formulated scope of practice “communicates to all stakeholders the competencies and accountabilities of the nurse” (International Council of Nurses, 2013, p. 2). Following the definition of the scope of practice, nurses have no right to perform tasks and duties which are beyond their competencies or level of knowledge, and employers cannot rely on performing the activities which are not included in the scope of a nurse’s roles because of the received education and developed skills.

Today, it is possible to observe trends according to which employers are oriented to expanding the nurses’ responsibilities to save costs, overcome the shortage of human resources in health care organizations, and provide the necessary optimization in hospitals (Nieminen, Mannevaara, & Fagerström, 2011, p. 662). As a result, the points stated in the position statement regarding the scope of nursing practice can be violated. That is why the discussion of this issue is important to contribute to providing effective care services and promoting the public’s health and well-being. The definition of the scope of practice provided in the position statement developed by the International Council of Nurses is used to determine the standards for education and practice of nurses to provide them with the possibilities to perform the tasks and duties successfully.

The Aspects of the Issue Related to the Scope of Nursing Practice

Scope of practice in nursing is associated with defining the specific procedures, roles, duties, and responsibilities which can be performed by nurses depending on their education and received certificates and licenses. The question of the scope should also be discussed from the perspectives of broadening the scope according to the international tendencies in the health care provision and differences in duties of nurses regarding their license as well as regarding the national or state legislation in the field of nursing. Nieminen, Mannevaara, and Fagerström state that the roles of nurses are changed significantly to address the reforms in the sphere of health care with references to the rapid development of nursing practice’s aspects. Today, nurses provide care for patients and perform functions which are linked to many other professions or duties performed by physicians (Nieminen, Mannevaara, & Fagerström, 2011, p. 662). Thus, the contemporary claims for expanding the scope of nursing practice are based on the fact that nurses are expected to complete managerial tasks and the definite functions of physicians or diagnosticians while providing care and support for patients. It is important to note that such an expansion is possible only for nurses having the Master’s degree and licenses of certain types (Nieminen, Mannevaara, & Fagerström, 2011, p. 663). However, the tendency to expand the scope of practice is clearly determined.

Pulcini and the group of researchers state that such registered nurses as nurse practitioner-advanced practice nurses (NP-APN) can perform the expanded set of functions and tasks because of their competence and knowledge. The NP-APN needs to demonstrate exemplary and remarkable decision-making skills along with the traditional skills associated with the practice of care giving (Pulcini et al., 2010, p. 32). As a result, the NP-APN becomes oriented to performing a wide range of tasks which can be non-correlated with the traditional vision of the scope of nursing practice. Thus, Pulcini and researchers determine such functions, duties, and skills expected from the NP-APN as the provision of the advanced health assessment and diagnosis, disease management, the supervision associated with health education, the prescription of different diagnostic procedures, necessary medications and plans for providing the care and treatment which are previously performed by physicians; moreover, the NP-APN can focus on evaluating the health care services with references to the conducted research (Pulcini et al., 2010, p. 32). Thus, comparing the roles of the NP-APN with the traditional scope of practice for nurses, it is possible to concentrate on the significant expansion of responsibilities which depends on the current needs of the health care industry globally.

In addition, following the position statement, it is necessary to pay attention to the fact that the “periodic review of scopes of practice is … essential to ensure consistency with current health needs” (International Council of Nurses, 2013, p. 1). That is why, any changes in the vision of the scope in relation to broadening it can be discussed as influential not only for the practice’s development but also for its theoretical determination with the help of providing the position statement. If Nieminen, Mannevaara, Fagerström, and Pulcini focus on the international vision of the scope of practice and associated discussions of possibilities for broadening the scope regarding the changes of approaches to nurses’ competencies and education, Couig discusses the current tendencies in the sphere applying them to the situation in the United States. Examining the issue of the scope and aspects influencing its definition, the researcher states clearly that the scope within which a nurse can operate and perform definite functions “depends on the type of licensure or certification granted by the state. Nurses practicing in specialty areas may obtain certification to perform additional or more complex tasks than nurses without certification” (Couig et al., 2011, p. 13). From this point, the scope of functions and responsibilities performed by a nurse can be limited in the USA with the standards and duties granted with references to the certain certification. As a result, the issue of broadening the scope of practice should be discussed in its close connection with the question of nurses’ education.

Moreover, it is also important to refer to the differences in legislation and regulation of the nursing practice typical for the states in the country. Thus, in spite of the fact that a lot of the initial licensure requirements developed for nurses are determined strictly and standardized, “state and federal regulatory standards and scopes of practice vary throughout the United States” (Couig et al., 2011, p. 14). That is why, the work of nurses in the United States is regulated with the help of standards and requirements designed and enacted by the state boards of nursing. This approach to distribution of the legal responsibilities guarantees the patient safety and provision of the high-quality care and services.

Legal and Ethical Implications of the Issue

The issue of scopes in relation to the nursing practice is closely associated with a range of ethical and legal questions. Thus, focusing on the legal aspects, it is important to note that the impossibility to broaden the duties of nurses without references to their competence and position is reflected in the statement. According to the position statement, employers have no rights to ask nurses “to practice beyond their level of competence or outside their legal scope of practice” because this behaviour violates the legal and ethical norms related to the sphere of nursing (International Council of Nurses, 2013, p. 1). As a result, the position statement is helpful in preventing the violation of the legal norms related to the nursing practice and set standards.

However, there is the other side of the question because the expansion of the scope of functions performed by a nurse can be legal if the nurse has the certificate allowing the performance of a wide range of roles and functions. In this case, the effective legislation at the state and federal levels is important to regulate the issue of the nurses’ scope of practice in the United States, and the additional discussion of the problem is necessary to resolve the issue with references to the international vision of the nurses’ scope regarding their qualification (Couig et al., 2011, p. 14). From this perspective, employers and nurses do not violate the general definition of the scope of nursing practice provided by the International Council of Nurses if they respond to the standards and norms set for different categories of nurses depending on their competence and education.

Ethical implications are closely connected with the problem of nurses’ responsibility and accountability for functions and duties performed. Thus, nurses cannot perform the functions and focus on procedures which are not included in their scope of practice in spite of the employers’ decision because of the necessity to follow ethical norms. Nurses should be fair in relation to patients and while performing their professional duties (Pulcini et al., 2010, p. 33). That is why, being responsible for patients’ safety, nurses should be consistent in promoting their direct duties without expanding them beyond their competency and skills.

The Role of the Position Statement to Improve the Population’s Health

It is also necessary to summarize the role of the position statement regarding the scope of nursing practice to improve the population’s health because the public’s welfare directly depends on changes in the industry. Thus, the position statement determines the areas within which nurses can perform clearly in order to avoid the situations when nurses do not provide the necessary care for patients ignoring the patients’ needs and safety and to prevent the situation when the responsibilities of nurses can be expanded illegally (Pulcini et al., 2010, p. 32). As a result, the provision of the competent care services in order to promote the population’s health and welfare is guaranteed with references to the position statement.

The position statement contributes to improvement of the public’s health because the focus on the ethical and legal aspects associated with the scope of nurses’ duties is important to distinguish between the roles which can be performed by all the nurses without references to their qualification or only by nurses of the highest qualification. That is why, the expansion of functions for the nurse practitioner-advanced practice nurses can be discussed as reasonable when it is inappropriate for the other positions. In this case, those limits fixed in the position statement contribute to increasing the quality of the provided services and improvement of the public’s health.

References

Couig, M., Johnson, K., Thorne-Odem, S., & Rick, C. (2011). Nursing scope of practice issues in public health emergencies. Journal of Nursing Regulation, 2(3): 13-18.

International Council of Nurses. (2013). Position Statement: Scope of Nursing Practice. Web.

Nieminen, A., Mannevaara, B., & Fagerström, L. (2011). Advanced practice nurses’ scope of practice: a qualitative study of advanced clinical competencies. Scandinavian Journal of Caring Sciences, 25(4): 661-70.

Pulcini, J., Jelic, M., Gul, R., & Loke, A. (2010). An international survey on advanced practice nursing education, practice, and regulation. Journal of Nursing Scholarship, 42(1), 31-39.