2WHAT IS THE SCOPE OF PRACTICE The term scope of practice refers to the range of roles, functions, responsibilities and activities which a registered nurse or midwife is educated, competent and have the authority to perform.The scope of practice of nurses is influenced by:The setting in which nurses practiceThe requirements of the employerThe needs of the patients
3Importance of the scope of practice In spite of the difficulties, it is important to define the scope of practice because it is the base from which:Regulatory bodies prepare standards of practiceEducational institutions prepare curriculaEmployers prepare job descriptions
5Why is it a key concern? Pressure from nurses (personnel) Nurses today work in a dynamic health care environment. Their roles and functions are constantly evolving and changing to meet patient needs. They have developed expertise into areas traditionally viewed as medical services.This creates a felt need for a definition of scope of practice that is sufficiently broad and flexible to enable expansion of nursing practice.The scope of practice will also provide a reasonable degree of direction on the boundaries of the profession.
6Why is it a key concern? Pressure from policy makers and public Policy makers want the roles of various health care providers to be clearly defined to ensure the most appropriate skill mix.The aim is for optimization of personnel to meet emerging health care needs of the population in the most cost effective way.Consumers also need an understanding of the scope of practice to know who is qualified to provide different kinds of services.
7Why is it a key concern? Pressure on the regulatory body To clarify rolesTo delineate professional boundariesTo address regulatory gap
8Definition of nursingExpansion of the scope of practice must be made in the context of the definition of nursing and the values that underpin nursing practice.WHO and ICN definition of nursingNursing helps individuals, families and groups to determine their physical, mental and social potential, and to do so within the challenging context of the environment in which they live and work.Nursing also includes the planning and giving of care during illness and rehabilitation and encompasses the physical, mental and social aspects of life as they affect health, illness, disability and dying.
9Principles for determining the scope of practice The following principles are the basis for making decisions with regard to the scope of practice:CompetenceAccountabilityContinuing professional developmentSupport for professional practiceDelegationEmergency situations
10CompetenceIn determining his/her scope of practice the nurse must judge as to whether he/she is competent to carry out a particular role or function.Competence is not static. One may learn a specific skill, but the knowledge underpinning that skill may change over time.This can affect the ability to practice the skill.The nurse must acknowledge any limitations of competence and refuse in such cases to accept delegated and assigned functions.The nurse must take appropriate measures to gain competence in the particular area.
11AccountabilityAccountability is the cornerstone of professional nursing practice.Accountability means being answerable for the decisions made in the course of one’s professional practice. Tis includes the decision to expand or not to expand his/her practice.Nurse/midwives are accountable to the patient, public, their employer and any relevant supervisory authority and regulatory body.Accountability applies to both actions and omissions.
12Continuing professional development CPD encompasses experiences, activities and processes that contribute towards the development of a nurse as a healthcare professional.It is lifelong process of learning, both structured and informal.Continuing education is a vital component of CPD and takes place after the completion of the preregistration education programme for nurses.
13Support for professional nursing practice In order for nurses to practice competently and to realise their potential in the interests of quality patient care, systems must be in place to support them in determining and expanding their scope of practice. These include:LegislationLocal and national guidelinesPolicies and protocols
14DelegationDelegation is the transfer of authority to another person to perform a particular function.As registered nurses take new activities into their scope of practice , they must give up activities which can safely be carried out by other personnel.The nurse who is delegating is accountable for the decision to delegateThe nurse to whom a particular function has been delegated must acknowledge any limitations of competence.
15Emergency situationsRegistered nurses provide care only within the scope of practice. There is one exception to this rule- life-threatening emergencies. Registered nurses are ethically obligated to provide the best care they can, given the circumstances and their individual competence.
16ConclusionWhile considering the scope of practice of nurses, it must be clear that the focus is on safe and qualified care that meet the needs of patients, not on jobs and territory.It is clear that the new directions in the health care system are expanding the opportunities for the practice of nursing.Many nursing jobs will be different, but nursing will continue to be a crucial part of the health care system.