Scope Of Practice

Decision Making Model

As changes occur in the structure of agencies, technology, issues, and programs, nurses often ask the question, “Is this within my scope of practice?” The answer to the question is not simple. Basic parameters of the scope of practice are defined by basic licensure preparation and advanced education. There is not a list of specific tasks, functions, or responsibilities nurses may or may not do. If there were such a list, it would need to be limited to the minimal skills every nurse must possess when they graduate.

As the profession of nursing evolves and technology changes, all licensed nurses continue to share a common base of responsibility and accountability that is defined as the practice of nursing. In addition, nurses who are actively practicing are expected to keep current and increase their skills and expertise. This may be achieved by continuing formal education, in-services, reading professional journals, or other educational opportunities. Therefore, the scope of practice of individual nurses may vary according to the type of basic preparation, practice experiences, and professional development. Each nurse is responsible, both professionally and legally, for determining his or her own personal scope of practice.

When deciding if a task falls within their scope of practice, the nurse has several options. The nurse can decide to accept the assignment, making the nurse legally accountable for its performance. Or, the nurse may learn the skills required for the new task. If the decision is made to learn new skills, the nurse will need to notify their employer that they need additional education to be competent, and make sure there is documentation in their personnel file validating this additional education. The third option is to refuse to perform the task. If this decision is made, it is important for the nurse to document the concerns for patient safety, as well as the process that was followed to inform the employer. The nurse should be aware that if the employer requires a task to be performed that the nurse is uncomfortable with and even if the nurse has legitimate concerns, the employer has the legal right to initiate employee disciplinary action.

To help nurses make decisions about scope of practice, the Missouri State Board of Nursing has adopted the Scope of Practice Decision Making Model. This tool allows the nurse to use their judgment, skill and knowledge to determine if they may perform an activity according to acceptable and prevailing standards of nursing. Click here to view the tool. This tool will help nurses make informed decisions about their scope of practice.

Adapted from Missouri State Board of Nursing Newsletter, Volume 8 No. 1, February, March, April 2006

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