When having discussions with nurses about what they can/cannot do in the course of their work assignments, it is interesting to hear them say that they feel comfortable with directions given by their employer. However, when you begin to ask deeper questions, it becomes apparent that nurses are often misinformed about their scope of practice. They are also unsure about their responsibility for knowing about their scope of practice. Boards of nursing provide information that will assist the nurse with decision making. The boards of nursing also make it clear that it is the nurse’s responsibility to know the limits of their practice based on their licensure, education, and experience.
There are several documents that can provide guidance to the individual nurse. Starting with the nurse practice act where a definition of professional, advanced practice and vocational/practical nursing is provided. There are two extensive position statements provided by the Texas Board of Nursing that clearly addresses competencies, and the application of the nursing process related to scope of practice. These documents, one for licensed vocational nurses and one for registered professional nurses gives the nurse direction based on their level of licensure and helps to differentiate the scope of practice. For example, the licensed vocational nurse is responsible for providing safe, companionate, and focused nursing care to assigned patients with predictable health care needs. The registered professional nurse, on the other hand, is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex health care needs. Immediately, after reading these definitions, it becomes evident that the LVN has a limited scope of practice which tells the LVN the level of care they are educated to provide and delineating their scope of practice.
If one is still unsure, the Texas Board of Nursing has developed another document, ‘Synopsis of Differences in Scope of Practice for Licensed Vocational, Associate, Diploma and Baccalaureate Degree Nurses’. This document discusses education, supervision, setting, assessment, planning, implementation, and evaluation. It clearly provides documentation that nurses can use to guide their practice. It is an excellent tool for employers to use and for the education of the public about what nurses do.
For the individual nurse, there is one more document available to help you determine if you are practicing within your scope of practice. The document is called the ‘Six Step Decision-Making Model for Determining Nursing Scope of Practice. Using the decision making model, the nurse is guided through a series of questions to which a yes or no response is required. If the nurse needs additional resources to make a sound decision, the Texas Board of Nursing provides those references. After performing the necessary research, the nurse will be able to answer yes or no, that they are functioning within their scope of practice. Within this document, there is additional evidence available to the registered nurse to support their role in delegation, which is limited to the responsibility of the registered nurses in Texas.
To keep abreast of the requirements, it is imperative that nurses utilize resources available to them. Reviewing best practices from national organizations and specialty groups might be helpful. However, it is imperative to remember that you will be held to the standard established by your state board of nursing. If you are licensed and practicing in more than one state, remember there will be differences and you need to familiarize yourself with each set of rules under which you practice.
Finally, the nurse is advised to consult their state board of nursing to find out what is the scope of practice for the registered or practical/vocational nurse.
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