Under the HPCA Act, all nurses, and not only the registered nurse, have a scope of practice. Basically, the scope of practice refers to the procedures that are permitted by law in various professions, so the RN scope of practice is all about offering safe and proficient nursing care to the patients in their care. Every licensed nursing profession has its own legally defined scope of practice according to the Board of Nursing in each state. The scope of practice is identified by three categories, and requirements for practicing a skill need to satisfy the requirements in the nurse’s scope of practice:
- governing body – does your state allow the particular practice or treatment in question?
- education and training – the registered nurse needs to have been educated academically as well as on-the-job training and also have documentation to prove education
- institution – does the particular institution actually allow a nurse to do certain diagnosis or treatments?
Registered Nurses Need Scientific And Professional Knowledge
A registered nurse is trained in anatomy and physiology and all other aspects of nursing care, and all states recognizing registered nurse licensure allow them to provide total care of a person. In some states and institutions a registered nurse is not allowed to perform certain procedures in their scope of practice. Registered nurses make use of their nursing knowledge and judgment to assess health needs and provide care, and sometimes they practise independently and other times in collaboration with other health professionals. They also delegate to other nurses and health care assistants.
Many times they have to evaluate and assess or come up with interventions that require scientific and professional knowledge for important decision-making. All nurses are accountable for the decisions they take in respect to activities that are in or out of their scope of practice and also whether they decide to consult with other health professionals or not.
Sometime the boundaries of nursing practices stretch or change as the health care industry changes, and then expansion of the RN scope of practice happens when a nurse takes on responsibility for health care activities that are outside the scope of practice. Before even considering an expansion, there are issues that need to be taken into account by the nurse and the employer. These include the following questions:
- is there proof that the expansion will improve the health outcome of health consumers?
- has the nurse thought about all the risks, and are there strategies in place to avoid them?
- are the expanded services supported by legislation?
The motivation of an expanded practice is to add in a health care activity that will enhance a health outcome. This needs to be considered because maybe there is a gap in health services which could be resulting in the patient not getting the best care they can.
Know The Scope Of Practice Of Your Colleagues
It can be helpful for any nurse to know their own scope of practice, but also the scope of practice of other nursing personnel. If you want to know what the scope of practice is for a registered nurse, all Boards of Nursing in the United States provide useful information available on their websites. You will be able to glean information about the rules and regulations which apply to each area of nursing. For instance, what may be accepted in one facility in one state may not be acceptable elsewhere. Working outside the scope of practice could end up with disciplinary action being taken against a nurse.
Registered nurses are accountable for ensuring that all the services they deliver to their patients are consistent with their training and competence, and that the decisions they make, and treatments they provide meet legislative requirements. There will be conditions placed in the RN scope of practice in keeping with their qualifications or experience which limits them to a specific area of practice.
Registered nurses have to make use of their knowledge, skills and nursing judgment to assess health needs and provide the appropriate care. The subjects they will have taken include anatomy, behavioral sciences, chemistry, nutrition, psychology, physiology, microbiology and nursing. They practice independently but in collaboration with other health professionals.
Different Types Of Registered Nurses
There are many different types of registered nurses. Oncology nurses care for patients battling with various types of cancer and their scope of practice will include assisting patients with radiation and chemotherapy. They can specialize in one or more areas of patient care. They can choose a particular work setting that appeals to them like a maternity nurse or a perioperative nurse, working in theater and assisting surgeons. They assist surgeons by selecting the correct instruments, controlling bleeding, and suturing incisions. Gastroenterology nurses treat patients with digestive disorders and their scope of practice may include assisting with endoscopies and abdominal bleeding.
Some registered nurses might fancy the idea of working in emergency and trauma departments while others opt for being a rehabilitation nurse and caring for patients who are recovering after a stroke or who may be recovering from an overdose of drugs. Critical care nurses provide care to patients who are seriously ill and who need to be monitored 24/7.Other registered nurses are drawn to the needs of the frail and the elderly helping them with feeding themselves and dealing with problems like incontinence.
Other registered nurses are interested in the skin and they may become a dermatology nurse with their scope of practice including things like attending to patients with skin cancer and psoriasis as well as working with patients with all kinds of skin disorders. Some registered nurses even become involved in telehealth services where they provide advice through electronic communications media.
Home Care Nursing
Home care nursing is also gaining in popularity as more and more people hire nurses to care for patients in the home environment. The nurse feeds, washes and administers medication to the patient. The scope of practice for these nurses includes being trained on and carrying remote patient monitoring equipment. Some home patients may require constant observation, when the presence of a full-time nurse is not possible, and this remote patient monitoring assists with keeping an eye on patients without having to work beside them around the clock. They also make use of mobile monitoring equipment to monitor blood pressures, blood sugar and pulse rates for instance.
Some registered nurses have jobs that require hardly any contact with the patient, but in spite of that they still require an RN license. Registered nurses also need to be relatively fit because their scope of practice requires them to be walking, bending and assisting patients in and out of bed and onto examination tables.
All registered nursing programs include classroom instruction as well as hands on experience in hospitals or clinics where they rotate around the different departments.
Qualifications For Registered Nurse
There are different ways to qualify as a registered nurse:
- Bachelor’s Degree in Nursing
- Associate Degree in Nursing
- Diploma Program
Once a nurse has completed one of these qualifications, the registered nurse will have to complete a national licensing examination known as the NCLEX-RN to obtain a nursing license. The NCLEX-RN test is a computer-based test which measures the skills and knowledge of potential nurses. This test covers hundreds of questions, and where a question is answered wrong, the student nurse will stay at that level until they answer correctly and move on to the next level.
When a registered nurse is qualified, many of them go on and pursue further education programs because they realize that further education can advance the career of a registered nurse into a specialized area.
Some Of The Duties Of A Registered Nurse
- treating sick or injured patients
- keeping a record of patients symptoms and medical history
- perform diagnostic tests and analyze results
- educates the public on different medical conditions
- analyzing the results of diagnostic tests
- administering medication and treatments
- patient follow-up and rehabilitation support
- monitoring patient’s symptoms
- taking patients medical histories
- operating specialist medical equipment
- supervising nursing assistants and licensed practical nurses
Registered nurses practice in a variety of different settings and need to ensure that their services are consistent with their education and meet legislative requirements. RN scope of practice is a guideline for nurses and employers to use when faced with decisions about practice roles, and before considering certain practices, there are certain things that need to be considered by the nurse and the employer.
Nurses are found working in hospitals in ICU, maternity ward or paediatrics for instance. The State laws govern the tasks that a registered nurse can perform. To avoid malpractice claims, as a registered nurse, it will pay to take the time to understand the legal principles of malpractice, and incorporate these into your nursing practice. Be sure you’re familiar and compliant with your state’s nurse practice act, your facility’s policies and practices as well as applicable standards of care related to your practice area.
Stay With Your Scope Of Practice For Safety’s Sake
If you are a registered nurse, you will know how the many tasks you perform also bring increased responsibility, and this also includes those who fall under the registered nurse and who have tasks delegated to them. Sometimes limited resources can place high demands on nurses and also cause stress and a certain amount of anger as nurses are expected to perform without the necessary resources. The registered nurse often acts quickly in these high pressure situations, and often out of the scope of practice. When things go wrong, patients are quick to sue healthcare providers. Registered nurses should always try to practice within the boundaries of their professional licensure and in fact only perform those skills that are within their scope of practice.
Tips And Advice For RNs To Stay Within Their Scope Of Practice
Always stay updated in your specialty area by attending the latest education opportunities, and remember to do the following:
- document everything – in the medical care field, failure to document something will mean other health care providers not having adequate information needed to apply the right care to the patient. Not documenting treatments could mean that patients could receive a double dose of medication because a colleague failed to make a record of the first medication received. RN scope of practice requires documenting all patient information and findings.
- only accept assignments if you are competent enough.
- know how to use your specific medical equipment, and learn to recognize faults with the equipment. Failure to use equipment in a responsible manner could land a nurse in trouble when the equipment is used for something other than what the manufacturer intended. Using equipment you are not familiar with or you haven’t been trained to use is also a breach.
- know how to implement orders and maintain open communication.
- it is a good idea to carry your own malpractice insurance so that in the event, you have an attorney dedicated to your cause.
The RN scope of practice is not intended to merely list all the activities a profession performs, but rather it aims to properly lay out and describe what a profession does and how it does it. The aim of the scope of practice is so that the public knows what to expect from the profession. The public needs to know that diagnosis is carried out through detailed guidelines and protocols developed by specialist medical professionals who have advanced education.
Nurses who are particularly involved in patient care are always needing to make decisions and diagnoses based on their clinical experience, and often that decision can be a life and death decision for the patient. For instance it is easy for a nurse in their scope of practice to make a diagnosis of a simple laceration of the skin, but what about when it comes to making a diagnosis of a laceration of the scalp? Knowing what to do will involve clinical skills because registered nurses do more than just assess patients; they also make important clinical judgments based on their scope of practice.