How is the Scope of Practice Determined for a Nurse?
Nursing scope of practice refers to professional nursing activities as defined by state law. Each state's Nurse Practice Act (NPA) is determined through the boards of nursing. Nurses use the scope of practice to guide them in varying work environments to ensure they are practicing and providing care within the confines of the law. As states are responsible to protect the public, nurse boards are charged with ensuring nurses practice within defined laws of practice.
Ignorance of the law is not an excuse to not follow the Nurse Practice Act. Nurses are responsible to know the details of the NPA in the states where they practice. Nurses can be held accountable when they, even mistakenly, violate NPA standards. For example, certain states require a nurse to report a driving while under the influence (DUI) violation. If not reported to the Board of Nursing, a nurse may face disciplinary action through the board.
RELATED: RN Scope of Practice
Each state's NPA is governed and enacted by that state's legislature. Because the NPA is not detailed or sufficient enough to stand alone, the boards of nursing were created to further define and interpret laws around the NPA. Each Board of Nursing (BON) may enact more stringent laws related to the NPA, but may not go beyond the boundaries of the act. Each BON reports to the National Council of State Boards of Nursing (NCSBN) who oversees the laws and standards.
According to the NCSBN, each state's Nurse Practice Act language must include:
- Authority, power and composition of a state nursing board
- Education program standards
- Standards and scope of nursing practice
- Types and titles of licenses
- Requirements for licensure
- Grounds for disciplinary action, other violations and remediation
The NCSB collaborates with many nursing authorities to set, revise and define nursing practice. The American Association of Colleges of Nursing (AACN), the American Nurse Association (ANA), the American Organization of Nurse Executives (AONE), and the National League for Nursing (NLN) are some of the major players used to interpret regulations and determine standards of care.
A Standard of Care is different than a Scope of Practice. Standard of Care refers to care that is performed in consistence with other nurses of similar education, competency and experience. Nursing practice and standards of care are often referenced together. For example, professional organizations such as the American Nursing Association publish authoritative statement documents, by interpreting the NPA and Standards of Practice, to define the overall practice of nursing.
As the practice of nursing requires knowledge, skill and autonomous decision making, the Nurse Practice Act is the law that governs those decisions to protect the community from harm. Nurses are expected to know the NPA for the state in which they practice. The NCSB's Scope of Practice Decision-Making Framework tool is a useful tool nurses can utilize to determine nursing practice responsibilities.
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