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

Carolyn Buppert, MSN, JD

Disclosures

September 11, 2018

Answering the Scope-of-Practice Questions

I recommend writing out the answers to each of these questions before engaging in a role, intervention, or activity that you question whether is outside your scope of practice. If any answer would prevent you from moving forward in the algorithm, and you still want to perform the role, activity, or intervention, work toward making the necessary change, whether that is lobbying for a change of law or regulation, getting more education, arranging for an evaluation of your competence, or enlisting resources.

Here's a summary of how to answer each question in the NCSBN's decision-making algorithm for scope-of-nursing practice questions (Table).

Table. Scope-of-Nursing Practice: Decision-Making Framework

# Question How to Answer
1 Is the role, intervention, or activity prohibited by the Nurse Practice Act and its rules and regulations or any other applicable laws, rules and regulations, or accreditation standards? Research your state's Board of Nursing, Board of Medicine, and Board of Pharmacy websites, and any federal and state rules that apply to your practice setting. Start by asking your Board of Nursing for a determination. Hospital or practice counsel could be engaged to help with the legal research. A professional organization or certification organization might provide guidance.
2 Is performing the role, intervention, or activity consistent with professional nursing standards, evidence-based nursing ,and healthcare literature? Do a literature search and/or query professional organizations and certification organizations.
3 Are practice-setting policies and procedures in place to support performing the role, intervention, or activity? Query your hospital or practice administration. If there are no policies and procedures in place, and you still want to perform the role, intervention, or activity, develop policies and procedures and initiate the process of getting them adopted.
4 Has the nurse completed the necessary education to safely perform the role, intervention, or activity? Write down all of your relevant education and training, and gather your proof of such education and training. Keep the documentation in a safe place. If challenged down the road, you will want that proof at hand. A challenge may come in the form of a complaint to the Board of Nursing or a malpractice lawsuit.
5 Is there documented evidence of the nurse's current competence (knowledge, skills, abilities, and judgments) to safety perform the role, intervention or activity? Write down the number of times you have observed, performed satisfactorily with supervision, performed without supervision, been successfully tested on, and taught the intervention. Gather any performance evaluations that support your competence at the intervention, role, or activity. If the role, activity, or intervention is new to you, begin to gather relevant education and training, keeping in mind that you will want to gather and retain instructor's, trainer's, or preceptor's evaluations. If challenged as to whether you are acting within scope of practice, it will help if you can produce evidence that your competence has been evaluated and that you have been deemed competent.
6 Does the nurse have the appropriate resources to perform the activity in the practice setting? Ask your administrators what resources are available to you. If the intervention is something where "rescue" could be needed, such as administration of a sedative, write down how that rescue would be accomplished.
7 Would a reasonable and prudent nurse perform the role, intervention, or activity in this setting? Ask around. Select colleagues whom you respect and ask them whether they would perform the role, activity, or intervention in your setting, under your circumstances.
8 Is the nurse prepared to accept accountability for the role, intervention, or activity for the related outcomes? Ask yourself how you would respond if you were reported to the Board of Nursing for practicing outside nursing scope, or if you were sued for malpractice. Are you confident that you can defend your actions? Defending them by saying your supervisor told you to perform the role, activity, or intervention is not a "yes" answer to this question.
Want a downloadable PDF version of this table? Click here.

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