Nurse Keith: Know Your Nursing Scope of Practice

Nurse Keith: Know Your Nursing Scope of Practice

Whether you’re a nurse just graduating with an ADN or BSN, or you’re a nurse with decades of experience and an advanced degree under your belt, understanding your scope of practice is essential to safe patient care and effective nursing, as well as protecting your license from liability.

Scope of practice awareness

Our clinical nursing practices can focus on particular areas of specialty, specific diseases or populations, and take place in an enormous variety of settings. We may be employed in home health, hospice, ambulatory care, schools, research facilities, hospitals, and other clinical environments. Since nurses are called upon to do so many things, we need to clearly understand what we can and cannot legally do.

New nurses need to be aware that physicians don’t necessarily understand nursing scope of practice, and some may issue orders that stretch the boundaries of practice past the comfort zone.

Every state has a set of laws governing the scope of practice of nurses in that state, and a state nurse practice act (NPA) is the document that outlines these stipulations. NPAs can change over time—which usually involves legislative action—so keeping abreast of those changes is prudent.

The National Council of State Boards of Nursing is an excellent resource for nursing scope of practice throughout the United States, and wise nurses familiarize themselves with the NPA in the state (or states) where they are licensed.

Another good way to stay tuned into scope of practice issues is to become a member of your state or regional nursing association. Many of these organizations utilize lobbyists to push back against groups who want to limit our scope of practice (e.g.: physicians wanting nurse practitioners to have less autonomy), and they train nurses to advocate for the profession and get involved in the legislative process.

Be willing to question

When working as a nurse—whether you’re novice or seasoned—you must be comfortable asking questions. If a physician issues an order that feels like it’s outside of your scope of practice, be willing to say, “I’m feeling slightly uncomfortable with this order; let me check with my nursing supervisor.”

If you’re working as an Advanced Practice Registered Nurse (APRN), be aware that the scopes of practice for APRNs can vary considerably between states here in the U.S.

If your workplace environment is one in which you feel that nurses are being called upon to stretch beyond their comfort zone, this is a serious matter and should be addressed with management immediately.

Understand the continuum

Nurses are highly skilled professionals, and as such, we carry high liability for our actions. Nursing scope of practice occurs on a continuum that is continually evolving. Remain aware and vigilant, understand the scope of practice that applies to you, and keep your finger on the pulse of changes to scope of practice as they occur. 

Keith Carlson, RN, BSN, NC-BC is a holistic career coach for nurses, award-winning nurse blogger, writer, podcaster, speaker, author, and popular career columnist for Nurse.com. With two decades of nursing experience, Keith deeply understands the issues faced by 21st-century nurses. Keith’s two podcasts, RNFM Radio and The Nurse Keith Show, offer inspiration and practical support to nurses seeking to create meaningful, satisfying lives and careers. Keith’s message of savvy career management and professional satisfaction reaches tens of thousands of nurses worldwide. He can be found at NurseKeith.com.

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