Lanette L. Anderson, MSN, JD, BBA, RN, speaker, writer and educator. Lanette has been in the nursing profession for almost thirty years, and has served on a variety of committees with the National Council of State Boards of Nursing and committees for the Council on Licensure, Enforcement, and Regulation. Lanette is an instructor with two online universities, and she also teaches at the University of Charleston in West Virginia.
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In the nursing profession, a variety of different types of caregivers exists. You may work with unlicensed assistive personnel, licensed practical nurses, registered nurses, and/or advanced practice registered nurses. Each of the licensed professions has its own legally defined scope of practice, as stated by the Board of Nursing in each state. The term “scope of practice” is used to define the actions, procedures, etc. that are permitted by law for a specific profession. It is restricted to what the law permits based on specific experience and educational qualifications. It is imperative that you know not only your scope of practice, but the scope of practice of the others which make up a part of your nursing team providing patient care. Remember, if you delegate an activity or task to another caregiver, you remain accountable for the delegation in terms of its appropriateness. Most, if not all Boards of Nursing in the United States, have information available on their websites with regards to the laws and rules which govern nursing practice, legal standards/scope of practice, etc.
Determining whether an activity or task is within your scope of practice can be accomplished by following three (3) specific steps:
1) Define the issue. You must clarify what the specific activity or task entails, and obtain any additional information that you may need, such as facility policies or procedures. You must also conduct a self-assessment with regards to your own skills and abilities, and your documented competency to perform the task. If you question your abilities, you must express this concern to the appropriate supervisor/staff person. Once you accept an assignment, you are accountable for completing it in a safe and competent manner. If other options may be available to you, explore these and obtain assistance if you are unsure as to how to proceed.
2. Review laws, rules, standards, etc. What may be common practice in a facility may not be appropriate or legal in terms of the performance of activities or tasks by nurses or other caregivers. For example, LPNs in a facility may do independent assessments and care planning without collaboration with the RNs, and may have done so for years. In most, if not all jurisdictions, this would be beyond the scope of practice for LPNs. Working outside the scope of practice or delegating inappropriately to another person could potentially be grounds for disciplinary action against your nursing license by your Board of Nursing. Again, your Board is an excellent resource as to what is within and what is outside of the legal scope of practice.
3. Make the decision. Following consideration of the elements as stated above, you must also decide whether you are willing to accept the consequences of your actions. If you are not, do not perform the activity or task. If another reasonably prudent nurse with similar education and experience would perform the task, if you have a valid written order from an MD, PA, or APRN, and if you have documented competency in that skill, you may perform the activity or task.
Our primary concern as nurses must always be safe and proficient nursing care.
Scopes of practice for the various levels of nursing providers exist specifically for that reason.