Comprehending and Defining the Nursing Scope of Practice

Imagine the beginnings of nursing and how healthcare was in those days. Florence Nightingale is considered the founder of the modern nursing practice since she established the first nursing school in 1860. At that time, nursing became considered a profession. 

In 1854, Nightingale, during the Crimean War, found out that many soldiers were dying due to infections, so she focused on providing a clean environment and good nutrition, helping to decrease the death rate from 60 to 2.2 percent. In addition, she wrote a book called The Notes on Nursing, which includes some principles that are the foundation of the current scope of practice in nursing.

Nowadays, the nursing standards of practice are provided or defined by different organizations, including the American Nurses Association (ANA), the Nurses Practice Act in each state, and federal regulations.

What Is the Nursing Scope of Practice?

The scope of practice defines the services an RN is qualified and competent to perform according to their license.

According to the American Nurses Association (ANA), the scope of practice for RNs describes the “Who,” “What,” “Where,” “When,” “Why,” and “How.”

• Who: Registered nurses who have finished their studies and met other state requirements have the title and active licensure to practice the profession.
• What: Registered nurses accept to protect and promote the best nursing practices in order to obtain the highest results possible for the patient’s health.
• Where: RNs can practice anywhere where there is a patient in need of care.
• When: RNs practice when there is a need for their nursing expertise and compassion.
• Why: The main objective of the nursing profession is to obtain the best patient outcomes possible through a quality care service. 
• How: These include all the manners, ways, and methods that nurses implement in the practice of their profession.

RN Scope of Practice 

Giving quality nursing care is the RN’s responsibility. This service must be in accordance with the standards of practice and professional performance, which include the actions and principles of the nursing profession. Therefore, understanding these nursing standards is essential to fully comprehend the definition of scope of practice.

ANA Standards of Professional Nursing Practice

These standards set the norm for the actions and behaviors of all registered nurses, no matter their role or specialty. Furthermore, the standards throughout the nursing process demand a competent level of nursing. 

The RN’s critical thinking and clinical reasoning focused on patient care are the foundation of the nursing process. Critical thinking means that nurses do not just follow orders. Moreover, nurses do what is needed to maintain patient safety and base their care plan on research, needs, and clinical practice.   

• Critical thinkers have certain characteristics: Perseverance, integrity, confidence, independent thought, humility, objectivity, curiosity, altruism, and informed decision-making are characteristics that help nurses take the best course of action in their profession while working side by side with physicians and other members of the healthcare team.
• Clinical reasoning: Nurses develop clinical reasoning through experience and previous knowledge. This ability allows nurses to evaluate patients’ information and look for the best action in accordance with the patient’s care.

The nursing process requires constant adaptation that is based on critical thinking and clinical reasoning and changes with the patient’s condition. There are many benefits of implementing this process in the nursing practice, such as improved patient safety and satisfaction, increased chances of obtaining better patient outcomes, and enhanced efficiency through creating care plans or paths to follow, among other benefits.

Nursing Process Standards

The nursing process standards are assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. Here is an explanation for each standard:

• Assessment: Nurses systematically collect data and information about patient’s health, including physiological, psychological, spiritual, and lifestyle data, among others.
• Diagnosis: Nurses analyze the collected data to define potential diagnoses and problems.
• Outcomes Identification: Nurses set long- and short-term goals and outcomes based on their assessment data and diagnosis.
• Planning: Nurses develop individualized and strategic care plans to achieve the expected outcomes.
• Implementation: Nurses implement their interventions according to the care plan, and every intervention is registered correctly in the patient’s electronic medical record. Therefore, different clinicians or physicians can give continuous and quality care. 
• Evaluation: Nurses evaluate the patient’s progress toward the care plan goals and outcomes. Furthermore, nurses asses and compare the results of patient treatment to see if there is a need to modify or change the care plan. This assessment is needed continuously to achieve better patient outcomes.

ANA Standards of Profesional Performance

Registered nurses are responsible for their professional behavior in the practice of their nursing career. RNs are required to practice the profession based on the following standards:

• Ethics: Registered nurses practice their role ethically.
• Advocacy: Registered nurses show advocacy in every role or position to protect the patient’s health, rights, and safety.
• Respectful and Equitable Practice: Registered nurses are humble and inclusive in their professional practice.
• Leadership: Within the profession and setting, registered nurses are leaders.
• Education: Registered nurses constantly search for knowledge and competence reflected in their professional practice.
• Communication: RNs communicate effectively with patients, families, and other members of the healthcare team.
• Scholarly Inquiry: Registered nurses combine research and evidence into their practice.
• Quality of Practice: RNs contribute to the nursing practice’s quality.
• Professional Practice Evaluation: Registered nurses continuously self-evaluate and evaluate others in their professional practice.
• Environmental Health: RNs contribute to the safety of their work environments.
• Resource Stewardship: Registered nurses use pertinent resources to provide and plan care services that are effective, safe, and responsible. 
• Collaboration: RNs collaborate with patients, families, physicians, and other colleagues.

Besides the standards previously mentioned, registered nurses must legally follow the Nurse Practice Act (NPA), which is the regulation for nursing practice in every state. 

The Board of Nursing is the state institution that regulates and licenses nursing candidates. It ensures that registered nurses practice their profession within the state standards and the Nurse Practice Act. 

Registered nurses must follow the institution’s protocols, procedures, and policies where they are working. Also, institutions like The Joint Commission promulgate some federal regulations that nurses need to follow.

Why Is the Registered Nurse Scope of Practice Important?

Registered nurses, nursing candidates, and students must know their scope of practice since it is meant to protect healthcare consumers and RNs. Besides that, the scope of practice for RNs aims to maintain higher nursing practice standards to have positive healthcare outcomes.

During nursing school, students are legally responsible for the quality of care they offer to patients, just like any licensed nurse. Therefore, it is essential that nursing students have a deep understanding of the Standards of Professional Nursing Practice, the Standards of Professional Performance, the Nurse Practice Act of their state, and everything else related to the registered nurse’s scope of practice.

Nursing students must know their limits in accordance with their experience and knowledge and inform a supervisor depending on the situation. In that sense, some classes during nursing school will give a role identification/scope of practice assignment so students have the chance to apply their comprehension of the legal scope of practice for RNs.

Like the nursing profession, the scope of practice evolves over time to maintain the highest standards to obtain the best healthcare outcomes in the nursing practice. Making a transgression or working outside the scope of practice can lead to losing your nurse license, among other consequences.

Find Jobs within Your Scope of Practice

Now that you understand the RN scope of practice better, finding a job according to your license is the next step. There are many ways to find jobs, some of them more traditional than others. However, since nurses are looking to have more flexibility in their schedules and earn higher wages, it is necessary to look for more dynamic and technological ways to achieve these goals.

Technology is changing the world faster than we can imagine, and healthcare is no exception. One of the ways registered nurses can benefit from these advances is by looking for jobs through technological tools that open countless opportunities. One of these tools is Nursa, a nurse market where you can find the flexibility and higher wages you are looking for.

In Nursa, you can find per diem shifts, which means jobs per day. In this type of job, you become an independent contractor, and you can choose the facility and the type of job in accordance with your previous experience as a nurse. In addition, you can decide when you want a break since these jobs end when the shift finishes, giving you the freedom to choose another job or rest and spend time with your loved ones. 

If you have a job already but want to make an extra income, per diem shifts are also a great option to fill a space in your schedule with a high-paying job. Download Nursa and pick up RN jobs near you.

Sources:

• Nursing Fundamentals: Chapter 1 Scope of Practice
• Nurse Practice Act
• The Joint Commission