What Can a Nurse Do? How to Make Scope-of-Practice Decisions

Carolyn Buppert, MSN, JD

Disclosures

September 11, 2018

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Scope of Practice: Can a Nurse Do This?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

State laws give nurses the legal authority to perform assessments, formulate nursing care plans, and administer medications, among other things. Laws on advanced practice authorize nurse practitioners to take histories, perform examinations, diagnose medical problems, order tests, and prescribe medications. The legal language usually is general in nature and often doesn't address specific activities or procedures. Nurses often send questions to Medscape's Legal and Professional Issues for Nurses feature, in which the nurse describes a specific procedure or practice situation and asks, "Can a nurse do this?" For example, a few recent questions have been whether a nurse can perform a laser treatment for vaginal atrophy, and whether a nurse practitioner can perform stem cell injections.

Over the past several years, on Medscape, we've answered these specific questions:

Can RNs Perform Cosmetic Procedures?

May Nurse Practitioners Perform Vasectomies?

Can RNs Remove Peripherally Inserted Central Catheters (PICCs)?

Can RNs Bolus Propofol?

Legal Authority Versus Competence

The answer to "Can a nurse do this?" should have two prongs: what the nurse has the legal authority to do and what the nurse is capable of and competent in doing. Legal authority comes from statute, regulation, or a Board of Nursing opinion. Competence usually is determined by graduation from nursing and graduate school, passing the licensing exam, completing continuing education and residency programs, and becoming certified by an accredited certification organization.

Some procedures are taught routinely in nursing baccalaureate and graduate programs, and students are evaluated and passed if competent. Many nurses gain competence in doing procedures through on-the-job training. In that case, it is the employer's responsibility to ascertain that a nurse who is trained on the job to perform a procedure has attained a level of competency that ensures patient safety. The Joint Commission, in its review process, tells hospitals and nurse staffing firms to evaluate nursing competency, and explains the difference between "competency assessment" and "orientation."[1,2] Hospitals evaluate advanced practice nurses' competencies through the credentialing and privileging process.

A nurse may be competent in performing a procedure, but may not have the legal authority to do it. A nurse may have the legal authority to perform a procedure but may not be competent to perform it. A nurse needs both legal authority and competence before performing a procedure on a patient.

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