Learning Objectives
By the end of this section, you will be able to:
- Describe the scope of practice for the nursing profession
- Explain standards of practice for the nursing profession
- Discuss nursing roles and responsibilities within the profession
Within the realm of health care, nursing stands as a dynamic and essential profession marked by a holistic commitment to patient care and well-being. The scope of practice for nurses encompasses a wide spectrum of responsibilities, ranging from direct patient care to collaboration with interdisciplinary teams. As professionals dedicated to promoting health and preventing illness, nurses play pivotal roles in various healthcare settings. The nursing profession adheres to rigorous standards of practice, ensuring that practitioners maintain the highest level of competence and ethical conduct. These standards guide nurses in delivering safe, effective, and person-centered care. Within this professional landscape, nurses experience diverse roles and responsibilities, encompassing caregiver, decision-maker, collaborator, communicator, advocate, and educator. This section explores the multifaceted nature of nursing as a profession, delving into its scope and standards and the critical roles and responsibilities that define and elevate the practice of nursing in the complex and ever-evolving healthcare environment.
Scope of Practice
The scope of practice refers to the defined limits and parameters within which a professional is authorized to work, make decisions, and provide services. It is a set of regulations, guidelines, and standards that delineate the range of duties, responsibilities, and activities that individuals within a specific profession are educated, trained, and legally permitted to perform. The scope of practice is established by regulatory bodies, licensing boards, and professional organizations to ensure that professionals operate within their competencies, uphold ethical standards, and provide safe and effective care (ANA, n.d.b).
The scope of nursing practice encompasses the range of roles, responsibilities, activities, and interventions that a RN or LPN/LVN is educated, trained, and authorized to perform within the legal and ethical boundaries of their licensure. The scope of practice is defined by regulatory bodies, such as state Boards of Nursing in the United States, and informed by national and international professional organizations like the ANA and the International Council of Nurses (ICN). The specific scope of practice for a nurse is influenced by factors such as education, experience, and additional certifications or specialties. It is important to note that the specific details of the scope of practice can vary by jurisdiction (ANA, n.d.b). Nurses must know the regulations and guidelines set by their state’s or country’s regulatory authority and engage in regular updates and ongoing education to stay current with evolving healthcare practices and maintain competence within the defined scope of nursing practice.
International Council of Nurses
The International Council of Nurses (ICN) holds a pivotal role in shaping and advancing the global nursing profession, providing essential guidance on the scope of practice for nurses. As a worldwide federation of national nursing associations, the ICN serves as a unifying force, representing millions of nurses with a shared mission to elevate the nursing profession and contribute to improved global health (ICN, n.d.).
Recognizing the inherent diversity in nursing practices across countries and regions, the ICN establishes overarching principles and guidelines that underscore the foundational elements of nursing practice. Central to its framework is the acknowledgment of nurses as autonomous professionals, empowered to make independent judgments and decisions within their designated scope of practice. This emphasis on autonomy is complemented by a commitment to accountability, ensuring that nurses are responsible for the outcomes of their practice (ICN, n.d.).
Collaboration is another cornerstone of the ICN’s vision for nursing. The framework underscores the importance of nurses working in close partnership with other healthcare professionals, fostering a collaborative approach to deliver comprehensive and well-coordinated care to individuals and communities. Advocacy features prominently in the ICN’s guidance, emphasizing the vital role of nurses as advocates for patients (ICN, n.d.). Nurses are entrusted with the responsibility to ensure that the needs, preferences, and rights of patients are not only acknowledged but also respected within the broader healthcare system.
Education and professional development are encouraged by the ICN, recognizing the dynamic nature of health care and the need for nurses to continually enhance their knowledge and skills. This commitment to ongoing learning is vital for staying abreast of evidence-based practices and ensuring the delivery of high-quality care. Ethical practice is another core tenet outlined by the ICN, emphasizing the importance of nurses upholding stringent ethical standards. This includes safeguarding patient confidentiality, respecting cultural diversity, and promoting the well-being and dignity of those under their care (ICN, n.d.).
The ICN’s guidance serves as a global compass for nursing, fostering consistency, excellence, and a shared commitment to advancing health care on an international scale. Crucially, the ICN acknowledges that the scope of nursing practice is context dependent, varying based on local regulations, laws, and educational standards (ICN, n.d.). The organization provides a flexible framework that countries and regions can adapt to their specific needs, allowing for a nuanced approach to nursing practice that aligns with local requirements and priorities.
American Nurses Association
The American Nurses Association (ANA) is a national professional nursing organization formed by nurses to represent and advocate for the interests of the nursing profession. It is one of the largest and most influential such organizations in the United States, advocating for the interests of nurses and the nursing profession. The ANA works to advance the profession of nursing by promoting high standards of nursing practice, providing guidance on ethical issues, and influencing healthcare policy (ANA, n.d.a).
The ANA plays a central role in shaping and defining the scope of practice for nurses in the United States. As the premier professional organization representing the interests of RNs, the ANA provides leadership, guidance, and advocacy to ensure the highest standards of nursing practice. The ANA recognizes the dynamic and evolving nature of health care and nursing, and as such, it continually updates and revises its Scope and Standards of Practice to reflect contemporary healthcare needs and professional advancements (ANA, n.d.a).
Through publications such as the Scope and Standards of Practice, the ANA delineates the competencies, responsibilities, and ethical considerations that define the scope of nursing practice. This document serves as a comprehensive guide for nurses, educators, policymakers, and the public, outlining expectations for the delivery of safe, quality, and person-centered care (ANA, n.d.b). The ANA’s influence extends beyond individual practice, contributing to the development of policies and regulations that govern nursing practice at local, state, and national levels, thereby shaping the landscape of healthcare delivery in the United States.
State Boards of Nursing
A board of nursing (BON), typically established at the state or territorial level, is a regulatory body tasked with overseeing the practice of nursing within its jurisdiction. One of the primary responsibilities of a BON is defining and regulating the scope of practice for nurses. The board sets guidelines and standards that govern the legal and ethical boundaries within which nurses can provide care. These guidelines outline the permissible activities, responsibilities, and competencies for different levels of nursing professionals, ensuring safe and effective patient care. The BONs collaborate with professional nursing organizations, educators, and other stakeholders to regularly review and update these standards to reflect advances in health care, changes in legislation, and evolving societal needs. Additionally, BONs are responsible for licensing nurses, establishing educational requirements, and enforcing regulations to uphold the integrity of the nursing profession.
Licensing is a state-specific process overseen by state BONs, ensuring nurses meet the qualifications and standards set by the respective state for safe and competent practice. The Nurse Licensure Compact is an agreement among participating states that allows nurses to hold one multistate license, granting them the privilege to practice in other compact states without obtaining additional licenses. This compact enhances mobility for nurses and facilitates access to healthcare services across state borders, while still maintaining regulatory standards and patient protection. Through these mechanisms, BONs play a crucial role in safeguarding public health while providing a framework that allows nurses to practice within well-defined parameters.
Standards of Practice
The Standards of Practice are comprehensive guidelines that articulate the expectations and ethical conduct required of nurses in their professional roles. These standards serve as a foundational framework, ensuring uniformity, quality, and safety in patient care. While specific criteria may vary across regions, many standards align with overarching principles advocated by professional nursing organizations.
Fundamental aspects found in these standards include the promotion of professionalism, integrity, and accountability among nurses. The emphasis on person-centered care underscores the importance of respecting individual values, preferences, and autonomy. Safety and quality considerations prioritize a culture of continuous improvement and a sanitary and secure healthcare environment. Effective communication and collaboration with patients and healthcare colleagues are highlighted, promoting interdisciplinary teamwork. The integration of evidence-based practice encourages nurses to utilize the best available evidence in conjunction with clinical expertise to inform decision-making.
Commitment to ongoing education and professional development is emphasized, ensuring nurses stay abreast of evolving healthcare practices. Ethical conduct, legal compliance, and cultural competence are integral components of these standards, ensuring nurses uphold ethical principles, adhere to legal regulations, and provide culturally sensitive and equitable care. Adherence to standards of practice is crucial for upholding the integrity of the nursing profession and delivering safe, ethical, and high-quality patient care.
Code of Ethics
An ethical principle is a fundamental concept that guides individuals and professionals in determining what is right or wrong in a given situation. Ethical principles provide a framework for appropriate decision-making and behavior, helping to ensure that actions align with moral values and standards. Within nursing, these ethical principles are collated into the nursing code of ethics, a comprehensive set of principles that defines the ethical responsibilities and standards expected of nurses in their professional practice (ANA, 2015; Gaines, 2023).
The nursing code of ethics, as articulated by organizations like the ANA, is based on five main ethical principles: nonmaleficence, beneficence, autonomy, justice, and confidentiality (Table 1.1).
| Ethical Principle | Definition | Example |
|---|---|---|
| Nonmaleficence | The principle that nurses have an obligation to do no harm intentionally | Nurses take the time to double-check patients’ allergies before administering medications. |
| Beneficence | The principle that nurses have an obligation to do good and promote the well-being of patients | Nurses spend extra time providing emotional support to terminally ill patients, demonstrating compassion and empathy, even though no specific medical intervention is required. |
| Autonomy | The principle that an individual has the right to make their own decisions about their own life and body, even when those decisions might be different from what healthcare providers recommend | Nurses discuss treatment options with patients, allowing them to make informed decisions aligned with their personal values. |
| Justice | The principle that all individuals should be treated with fairness and equity | Nurses allocate resources, such as time and attention, equitably among patients to ensure fair and unbiased care. |
| Confidentiality | The principle that nurses should respect and safeguard their patients’ personal and health information | Nurses safeguard patient information and only share it with authorized individuals, maintaining trust in the nurse-patient relationship. |
In adhering to this code, nurses commit to upholding the highest standards of ethical practice, ensuring the well-being and safety of patients. The code encompasses a set of principles that underscore the essential values and obligations of nursing professionals. Central to the nursing code of ethics is the principle of patient-centered care. Nurses prioritize the needs and preferences of patients, recognizing and respecting their autonomy, individuality, and right to make informed decisions about their health care. This commitment extends to fostering open communication, building trust, and maintaining confidentiality to uphold the privacy of patients. Another fundamental principle is the obligation to provide competent and safe care. Nurses continually strive to enhance their knowledge and skills, staying abreast of advancements in health care to deliver evidence-based and quality care (ANA, 2015; Gaines, 2023). This includes advocating for a supportive work environment that facilitates ongoing education and professional growth.
The nursing code of ethics underscores the importance of maintaining integrity and honesty in all professional interactions. Nurses are expected to uphold the trust placed in them by the public and colleagues, fostering a culture of transparency and accountability. This involves addressing any conflicts of interest and ensuring that decisions are guided by ethical considerations rather than personal gain. Collaboration and advocacy are integral components of the nursing code of ethics. Nurses work collaboratively with interdisciplinary teams to optimize patient outcomes, promoting a holistic approach to health care. Additionally, they serve as advocates for patients, ensuring that their rights are upheld and that they receive equitable and compassionate care. Finally, the nursing code of ethics emphasizes the responsibility of nurses to contribute to the advancement of the profession (ANA, 2015; Gaines, 2023). This involves engaging in scholarly activities, participating in professional organizations, and actively contributing to the ongoing development of nursing knowledge and practice.
Link to Learning
Take some time to review the Code of Ethics for Nurses as set forth by the ANA.
Quality and Safety Education for Nurses
The Quality and Safety Education for Nurses (QSEN) initiative serves as a framework for nursing education and practice, emphasizing the integration of quality and safety principles into nursing education and clinical care. While QSEN itself is not a set of formal nursing standards of practice like those established by regulatory bodies or professional organizations, it has influenced nursing education and practice standards by promoting key competencies essential for delivering safe and high-quality patient care (QSEN Institute, n.d.).
The QSEN identifies six core competencies that align with nursing standards and guide nursing education:
- Patient-centered care focuses on the individual needs, preferences, and values of patients. This competency aligns with nursing standards that emphasize a person-centered approach, recognizing the importance of involving patients in their care and decision-making.
- Teamwork and collaboration together promote effective communication and cooperation among healthcare team members, aligning with standards that highlight the significance of interdisciplinary teamwork and communication to enhance patient outcomes.
- Evidence-based practice (EBP) integrates the best available evidence with clinical expertise and patient values to guide nursing practice. Evidence-based practice is a foundational standard in nursing, emphasizing the importance of using the latest evidence to inform decision-making.
- Quality improvement involves continuous efforts to enhance patient care and outcomes, which aligns with nursing standards that advocate for ongoing quality assessment and improvement within healthcare organizations.
- Safety prioritizes the safety of both patients and healthcare providers. It is a core principle in nursing practice standards, and the existence of QSEN reinforces the importance of creating a culture of safety within healthcare settings.
- Informatics promotes the use of information and technology to support and improve healthcare delivery, which aligns with nursing standards that recognize the role of these tools in enhancing patient care and communication.
Nursing Roles and Responsibilities
Nursing roles and responsibilities encompass a diverse array of critical functions within the healthcare system. At its core, nursing involves being a compassionate caregiver, providing holistic and person-centered care that addresses physical, emotional, and psychological needs. Nurses act as decision-makers, exercising clinical judgment, prioritizing care, and contributing to ethical discussions. In the role of a manager of care, nurses coordinate and optimize healthcare services, overseeing interdisciplinary teams and navigating complex healthcare systems. As communicators, nurses bridge the gap between patients, their families, and the healthcare team, facilitating effective information exchange and fostering therapeutic relationships. Nurses also serve as advocates, ensuring that patients’ voices are heard, their rights are respected, and their choices are considered in decision-making processes. Additionally, nurses act as educators, imparting essential knowledge to patients and communities, promoting health literacy, and empowering individuals to actively participate in their well-being.
Caregiver
A caregiver is an individual who provides physical, emotional, or practical support to individuals in need of assistance due to illness, disability, age-related challenges, or other conditions that impact their ability to perform daily activities independently. As a caregiver, one of the primary roles and responsibilities of a nurse is to provide compassionate and holistic care to individuals, families, and communities. This aspect of nursing involves addressing the physical, emotional, social, and psychological needs of patients, with a focus on promoting health, preventing illness, and facilitating healing. Cultural competence is woven into the role, as nurses recognize and respect the diverse backgrounds, beliefs, and values of their patients; tailoring their approaches to care to accommodate individual cultural preferences.
The caregiving role encompasses several key responsibilities, such as assessment, planning, implementation, and evaluation. In the first phase of caregiving, the nurse conducts thorough assessments to understand the unique health circumstances of each individual, considering factors such as health history and environmental influences. Following the assessment, nurses take on the responsibility of developing personalized care plans in collaboration with patients, their families, and the healthcare team. These plans establish specific goals and interventions tailored to the individual’s needs and preferences. In the implementation phase, caregivers carry out the care plan by administering medications, performing treatments, and coordinating various healthcare services. Simultaneously, they provide emotional support and education, aiming to empower patients and their families in their health journey. Nurses also continuously monitor patient health status, evaluate the effectiveness of interventions, and make necessary adjustments to optimize outcomes. Finally, during crises or emergencies, caregivers respond swiftly and effectively to stabilize the patient’s condition. This requires quick thinking, adaptability, and the ability to work effectively under pressure.
Decision-Maker
As a decision-maker, an individual or entity responsible for making choices or reaching conclusions in a particular context, in the healthcare setting, nurses bear a crucial responsibility in influencing and determining various aspects of patient care. At the core of this role is the exercise of clinical judgment. Drawing on their knowledge, experience, and analytical skills, nurses assess patient data, discern patterns, and determine interventions that best address the unique needs of each individual. This process extends to active participation in the development of patient care plans, as nurses collaborate with a diverse healthcare team to establish goals and interventions aligned with patient conditions and preferences.
A central responsibility in the decision-making realm involves prioritization. In the dynamic and often fast-paced healthcare environment, nurses must adeptly discern the urgency and importance of various tasks, ensuring that critical aspects of care receive immediate attention. Resource allocation is another critical facet of the decision-making role. Nurses are tasked with judiciously utilizing limited healthcare resources, including time, staff, and equipment, to optimize care delivery. Adaptation to change is also an essential aspect of decision-making, as nurses must make informed decisions that enable them to navigate shifts in patient conditions, treatment modalities, and healthcare policies.
Clinical Judgment Measurement Model
Take Action: Prioritizing Nursing Care
The nurse is caring for two patients, Mr. Johnson and Mrs. Rodriguez. Mrs. Rodriguez calls out complaining of a “bad headache.” Immediately after, Mr. Johnson rings the call bell complaining that he is having trouble breathing. The nurse quickly assesses Mr. Johnson’s respiratory status, noting increased respiratory rate, use of accessory muscles, and decreased oxygen saturation. Recognizing that respiratory distress can lead to life-threatening complications, the nurse analyzes the severity of the situation and the need for prompt intervention. Applying clinical judgment, the nurse prioritizes care based on the urgency and potential impact on patient outcomes and decides to prioritize addressing Mr. Johnson’s respiratory distress first due to the immediate threat to his physiological stability. The nurse initiates interventions to improve Mr. Johnson’s respiratory status, such as administering supplemental oxygen, positioning for optimal breathing, and notifying the healthcare team for further assessment. The application of clinical judgment in prioritizing nursing care ensures that the most urgent and critical needs are addressed promptly. This structured approach contributes to enhanced patient safety, improved clinical outcomes, and the delivery of person-centered care.
Manager of Care
In the capacity of a manager of care, nurses assume a pivotal role in directing and overseeing the comprehensive delivery of healthcare services. This multifaceted responsibility encompasses various key aspects of patient care coordination and management. Nurses are charged with organizing and optimizing care delivery by planning and prioritizing interventions based on patient needs and available resources. Nurses play a crucial role in coordinating interdisciplinary teams, fostering effective communication and ensuring seamless collaboration among healthcare professionals.
As managers of care, nurses also navigate the complexities of healthcare systems, utilizing their leadership skills to advocate for patients and optimize the use of healthcare resources. This role involves overseeing the implementation of care plans, monitoring patient outcomes, and making timely adjustments to interventions as needed. Furthermore, nurses in this role are instrumental in promoting a culture of safety, quality improvement, and adherence to evidence-based practices within the healthcare setting. Through their managerial responsibilities, nurses contribute significantly to enhancing the overall efficiency, effectiveness, and quality of patient care.
Clinical Safety and Procedures (QSEN)
Embracing QSEN Principles for Effective Management of Patient Care
Quality and Safety Education for Nurses (QSEN) is a cornerstone in shaping the nurse’s role in managing patient care. As nurses take on the responsibility of managing care, the principles of QSEN become fundamental in shaping effective leadership and decision-making to deliver safe and high-quality health care.
Key aspects of QSEN in managing care include the following:
- Patient-centered care: Embracing the principles of QSEN emphasizes the significance of patient-centered care, aligning with the nurse’s role in managing patient care. Nurses ensure that care delivery is personalized to meet individual patients’ needs, preferences, and values, fostering a patient-centric approach.
- Teamwork and collaboration: Effective patient care management requires collaboration among healthcare team members. The QSEN principles advocate for teamwork, encouraging nurses to create a collaborative environment where communication and cooperation thrive, ultimately benefiting patient outcomes.
- Evidence-based practice: As frontline caregivers, nurses play a pivotal role in promoting EBP. The QSEN emphasizes the integration of the latest evidence into decision-making, guiding nurses in adopting practices that are rooted in research and proven to enhance patient safety and care quality.
- Quality improvement: Managing patient care involves overseeing processes for continuous improvement. The QSEN’s focus on quality improvement aligns with the nurse’s responsibility to assess, monitor, and enhance care delivery processes to ensure optimal patient outcomes.
- Patient safety: In the role of managing patient care, nurses are crucial to the success of patient safety initiatives. The QSEN’s focus on safety science guides nurses in implementing strategies to prevent errors, minimize risks, and create a culture of safety within their practice.
The integration of QSEN into nursing care management positively influences patient outcomes. Nurses, equipped with QSEN principles, deliver care based on best practices, contributing to improved patient safety and well-being. The QSEN’s emphasis on communication aligns with the nurse’s role in fostering open and effective communication within the healthcare team. This, in turn, promotes better coordination of care and a more responsive healthcare environment. Nurses, influenced by QSEN’s focus on continuous improvement, are better equipped to adapt to changes in healthcare practices and technologies. This adaptability ensures that patient care remains aligned with the latest advancements.
Communicator
The role of a nurse as a communicator (an individual who engages in the process of conveying information, ideas, or messages to others) is integral to effective healthcare delivery and patient outcomes. Nurses serve as the primary liaisons between patients, their families, and the broader healthcare team, translating complex medical information into understandable and actionable insights. Communication involves not only the dissemination of information but also active listening, empathy, and the fostering of therapeutic relationships. Nurses communicate critical details about patients’ conditions, treatment plans, and progress to other healthcare professionals, ensuring a coordinated and comprehensive approach to care. Additionally, they advocate for patients’ needs and preferences, facilitating shared decision-making in the care process.
The ability to communicate effectively extends to providing emotional support, addressing concerns, promoting health literacy, and empowering patients and their families/caregivers to actively participate in their care. In emergencies or critical situations, nurses must convey information swiftly and clearly to ensure prompt and appropriate interventions. Effective communication is paramount in fostering understanding and trust among patients, families, and the interdisciplinary healthcare team.
Advocate
An advocate is an individual who actively and vocally supports, defends, or promotes the rights, interests, and well-being of another person or a group. The nursing role as an advocate is a cornerstone of person-centered care, reflecting a commitment to safeguarding the rights, well-being, and preferences of individuals within the healthcare system. Nurses serve as vocal proponents for patients, ensuring their voices are heard, concerns addressed, and choices respected. Advocacy involves not only communicating patients’ needs to the healthcare team but also empowering patients to actively participate in decision-making regarding their care. Nurses navigate complex healthcare systems on behalf of patients, assisting them in understanding their rights, treatment options, and available resources (Morris, 2023).
Beyond the individual level, nurses engage in systemic advocacy, contributing to policy discussions and initiatives aimed at improving overall healthcare delivery and outcomes. The advocacy role extends to at-risk populations, where nurses work to address disparities and promote equitable access to quality care. In essence, the nursing responsibility as an advocate is rooted in the principles of justice, autonomy, and beneficence, aiming to ensure that each patient receives the highest standard of care in a supportive and respectful environment.
Educator
The nursing role as an educator (an individual who engages in the process of facilitating teaching and learning) is foundational to promoting health literacy, empowering patients, and fostering informed decision-making. Nurses are entrusted with the responsibility of providing clear and accessible information to patients, their families, and communities. This educational role involves explaining medical conditions, treatment plans, and preventive measures in a comprehensible manner, taking into account individual differences and cultural considerations. Nurses utilize their expertise to enhance patients’ understanding of their health status, medications, and self-care practices.
Beyond the bedside, nurses contribute to community health education, offering insights on disease prevention, healthy lifestyles, and wellness promotion. In the context of chronic conditions, nurses guide patients in managing their health proactively, emphasizing the importance of adherence to treatment plans. By serving as educators, nurses play a vital part in empowering individuals to take an active role in their health, ultimately contributing to better health outcomes and the overall well-being of the communities they serve.