Registered nurse scope of practice in Australia: an integrative review of the literature

Abstract

The nursing profession comprises Australia's largest regulated health workforce yet its practice boundaries are poorly understood. The ambiguity surrounding the practice scope of nurses limits the profession's ability to fully respond to Australia's current and emerging health system challenges. The aim of this review is to explore the concept of scope of practice of registered nurses (RN) in Australia, as reflected in contemporary literature. An integrative review of literature relating to the scope of practice of the Australian registered nurse published between 2007 and 2014 was conducted. Twenty primary papers and nine secondary source papers were included in the review. Themes that arose from the analysis are: Scope of practice - an elusive concept; Scope of practice and context; Scope of practice and boundaries; and Scope of practice and advanced practice. Discussion of these themes includes consideration of the professional, legal and ethical significance of scope of practice for the RN, as well as the legislative, professional and contextual influences on, and challenges to, defining scope of practice at both a professional and individual level. For the Australian registered nursing workforce to continue to be a significant and influential contributor to Australias dynamic healthcare context, a clearly articulated scope of practice is both necessary and overdue.

Rural and Remote Registered Nurses' Perception of Working Beyond Their Legislated Scope of Practice

“…At the same time, in those settings, healthcare professionals may experience greater autonomy and flexibility in how the boundaries of their practice "are interpreted and applied" (Ford 2016: 244). There may be a lack of formal or informal articulation of scope of practice through policies or protocols (Birks et al 2016), and as a result, some RNs may consider themselves to be working beyond their legislated scope of practice, whereas others may perceive themselves to be working within scope.…”

“…These RNs provided healthcare to the 17% of Canada's population who live in rural locations in the provinces and 52% of those who live in rural locations in the territories (Canadian Institute for Health Information 2017). Rural and remote nurses' practice is generalist and complex (Knight et al 2016) with high levels of autonomy (Birks et al 2016;Kulig et al 2013) and requires well-honed problem-solving skills (Kulig et al 2013). This broad scope of practice is because of geographic isolation, low population density, few resources, limited support and the requirement to address both workplace and community demands (Fowler et al 2018;MacLeod et al 2008;Martin-Misener et al 2008).…”

Competence and confidence in rural and remote nursing practice: A structural equation modelling analysis of national data

“…remote nursing practice is distinct, the complexity of which has been largely underestimated (MacLeod, Kulig, Stewart, Pitblado, & Knock, 2004). Rural nurses are typically expected to work as competent generalists with an expanded scope, often in sparsely populated communities that are isolated and/or under-resourced (Birks, Davis, Smithson, & Cant, 2016;Bushy & Winters, 2013;Hanvey, 2005).…”

“…The context of rural and remote nursing practice is distinct, the complexity of which has been largely underestimated (MacLeod, Kulig, Stewart, Pitblado, & Knock, ). Rural nurses are typically expected to work as competent generalists with an expanded scope, often in sparsely populated communities that are isolated and/or under‐resourced (Birks, Davis, Smithson, & Cant, ; Bushy & Winters, ; Hanvey, ). Rural and remote nurses have identified significant personal (e.g., financial)‐, organisational (e.g., workload, lack of relief staff)‐ and community (e.g., travel distance)‐related barriers that impact their access to continuing education (Penz et al, ).…”

Differences and similarities in scope of practice between registered nurses and nurse specialists in emergency care: an interview study

“…As a concept, scope of practice can be considered a rather abstract construct, and it is poorly understood and inconsistently interpreted . According to the ICN , scope of practice communicates ‘the roles, competencies, professional accountabilities and responsibilities of the nurse’ (p. 16), while competency is ‘the effective application of a combination of knowledge, skill and judgement demonstrated by an individual in daily practice or job performance’ (p. 17).…”