Scope of Practice
Scope of practice describes the services that a qualified health professional is deemed competent to perform, and permitted to undertake – in keeping with the terms of their professional license.
Scope of practice defined in nursing
The Nursing Scope and Standards of Practice describes the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice:
- Who: Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing.
- What: Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.
- Where: Wherever there is a patient in need of care.
- When: Whenever there is a need for nursing knowledge, compassion, and expertise.
- Why: The profession exists to achieve the most positive patient outcomes in keeping with nursing’s social contract and obligation to society.
When each of these questions is answered, the complex considerations in scope of practice become clear. In a profession as dynamic as nursing, and with evolving health care demands, changes in scope of practice and overlapping responsibilities are inevitable in our current and future health care system.
Nursing Specialty Recognition, Scope and Standards Review, Affirmation of Competencies
The American Nurses Association has an established review program for recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, acknowledgment of specialty nursing standards of practice, and affirmation of focused practice competencies. Details about each component of this program, specialty characteristics, review criteria, and submission process are described here.
Health care licensure
Currently, all health care licensure is state-based, and there is some variability between the qualifications for licensure and re-licensure for each state.
Defining scope of practice is generally a two-step process:
- Step 1: The state legislature passes a law, known as a “nurse practice act.”
- Step 2: Regulatory bodies then create and implement rules and regulations, intended to protect the public.
Choice in health care providers
The American Nurses Association (ANA) believes that patients’ interests are best served by a health care system in which many different types of qualified professionals are available, accessible, and working together – collaboratively. Therefore, it is important for scope of practice to reflect a professional’s true expertise.
ANA is a founding member of the Coalition for Patient’s Rights (CPR), which was establishedto improve patients’ access to the health care providers of their choice, and the range of services those providers offer. The CPR consists of more than 35 organizations representing a variety of licensed health care professionals, each providing a diverse array of safe, effective, and affordable care.
Protecting and advancing scope of practice
Protecting and advancing scope of practice for nurses is a major initiative for ANA. In the fast-moving world of health care, it is vital that nurses are able to practice to the full extent of their education and abilities, in order to deliver the most efficient, quality care to patients.
There is a growing body of evidence to support the safe and cost-effective provision of care by APRNs, and a national call to remove all barriers to full practice authority. ANA remains committed to monitoring and advocating for legislative and regulatory changes relating to scope of practice, with the aim of removing practice barriers for nurses and improving access to care, with particular attention to:
- American Nurses Credentialing Center - administers programs for the following certifications:
- Acute Care NP
- Adult NP
- Adult Psychiatric & Mental Health NP
- Diabetes Management – Advanced
- Family NP
- Family Psych & Mental Health NP
- Gerontolgoical NP
- Pediatric NP
- School NP
- Adult Health CNS
- Adult Psychiatric & Mental Health CNS
- Chld/Adolescent Psych & Mental Health CNS
- Diabetes Management – Advanced
- Gerontological CNS
- Home Health CNS
- Pediatric CNS
- Acute Care Nurse Practioner (ACNPC)
- American Academy of Nurse Practitioners Certification Program - administers programs for:
- Adult NP
- Gerontologic NP
- Family NP
- American Midwifery Certification Board (AMCB) - administers programs for:
- Certified nurse-midwife (CNM)
- Certified midwife (CM)
- National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA)
- Certified Registered Nurse Anesthetists (CRNA)
- Pediatric Nursing Certification Board (PNCB)
- Certified Pediatric Nurse (CPN)
- Primary Care Pediatric Nurse Practitioner (CPNP-PC)
- Acute Care Certified Pediatric Nurse Practitioner (CPNP-AC)
- Pediatric Primary Care Mental Health Specialist (PMHS)
- Oncology Nursing Certification Corportation (ONCC)
Other organizations, including many specialty organizations, publish a number of documents than can be helpful in defining scope of practice, from Scope & Standards documents to position statements.
The American Academy of Nurse Practitioners publishes Standards of Practice for Nurse Practitioners.
The American Association of Nurse Anesthestists (AANA) publishes Scope and Standards for Nurse Anesthesia Practice as well as a number of position statements that serve to define scope of practice.
The American Association of Critical Care Nurses (AACN) publishes a number of practice resources.
Oncology Nursing Society (ONS) publishes Oncology Nurse Practitioner Competencies. This document outlines specialty entry-level competencies for Oncology Nurse Practitioners (ONPs) who care for adult and late adolescent patients throughout the continuum of cancer care.
National Association of Pediatric Nurse Practitioners (NAPNAP)
Pediatric Nursing: Scope and Standards of Practice is a collaborative effort of the ANA, the Society for Pediatric Nurses (SPN), and NAPNAP.
The American Psychiatric Nurses Association (APNA) Web site provides information about the role of the advanced practice psychiatric nurse organized by topic, workplace setting, and/or specialty.
The Scope of Nursing Practice describes the “who,” “what,” “where,” “when,” and “why” of nursing practice.
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