Expanding Scope of Practice: Inter-professional Collaboration or Conflict?

Deborah Gardner, PhD, RN


Nurs Econ. 2010;28(4):264-266. 

In This Article

Abstract and Introduction


When it comes to many of the issues facing our profession, a large number of nurses are not engaging in the conflict. Nurses will fight for patients, they may fight for safer working conditions or for improved salaries and time off, but we nurses don't like to fight with other health professionals, especially physicians. We want cooperation not confrontation. With the implementation of the Patient Protection and Affordable Care Act, interdisciplinary fights are becoming more public with more to come. Currently, the most visible fight is over scope of practice (SOP) expansion, state laws that govern advanced practice nursing and vary idiosyncratically by state; without clear justification. Until there is an expansion of SOP, APNs in many states will not be able to provide services to the fullest extent of their training and knowledge, skills, and experience and patients will continue to go without care. Individual state and national nurse practitioner organizations are actively engaged in the fray. How will we respond to this dispute as a profession? And how can we work as interdisciplinary professional groups to resolve such a conflict?

While many disputes involve interest-based conflicts, the SOP issue includes values-based and professional identity-based issues. Accepting the premise that the SOP dispute reflects more than conflict over interests, would nursing and medicine consider a mediation process to address this dispute? Are we willing to hold "difficult conversations" with our physician colleagues to find common ground for approaching practice issues by focusing on such shared-values as "patient-centered" care that is quality and cost effective? Or, will we be led to respond to SOP issues through our individual professional positions and identities? Can we guide our professional organizations in direction and process to arrive at a cross-profession coalition on these issues?

The rationale for considering such a process is twofold: mediation can produce beneficial results, and, as noted, nurses are by nature collaborative.

When the public interest is threatened by a strike, collective bargaining conflicts are resolved through the dispute resolution system which is mandated by law. At the federal and state levels, when new regulations are issued, federal and state agencies have the option of initiating negotiated rule-making under the relevant federal and state Administrative Procedure Acts. Mediation can generate agreements that satisfy different parties, cost less, take less time, and enhance working relationships. It is not magic but it can provide many successful outcomes (Susskind, 2010). We have the opportunity to adapt this process by using mediators with expertise in these types of conflicts and, working with the input of key stakeholders, create a dialogue for collaboration rather than the usual win-lose debate process.


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