Scope of Practice: What You Need to Know as a Nurse Practitioner

One of the biggest challenges for Nurse Practitioners today is facing the lack of independent practice. This problem stems from an even bigger problem: The fact that the Scope of Practice for Nurse Practitioners is not always clearly defined.

What's more: "Scope of practice" is just a fancy way of saying "what advanced practice nurses can and cannot do."

As you advance in your nursing career, you will find that there are some problems with your ability to practice that can cause problems for you. In fact, this problem affects all Nurse Practitioners.

Knowing the scope of your practice is an essential part of being a Practical Nurse today. You cannot go to work without knowing your rights and responsibilities.

Therefore, in this article we will explain these to you, we will explain why problems related to the scope of nursing practice arose and what can be done about it.

Obviously, to understand this topic in the best possible way, we will have to start with a little piece of history.

How Nurse Practitioners Came About

Do you know who the first Nurse Practitioner was?

It's okay if you don't know the answer, as no one knows for sure. In the United States, the term "Nurse Practitioner" has been used formally since the 1960s. It initially described nurses who assumed certain medical tasks due to a shortage of skilled primary care professionals.

In 1965, a nurse named Loretta Ford and a pediatrician named Dr. Henry Silver devised developed the first Nurse Practitioner program at the University of Colorado, with a special emphasis on pediatrics.

Right about 1979, Loretta Ford predicted that Nurse Practitioners would grow up to become nurses "for all settings". She had a concrete vision for the future of nursing, in which nurses could practice within four principles:

• Assess
• Treat
• Diagnose
• Evaluate

That was the beginning of what we now call "scope of practice", which we will analyze below.

Scope of Practice in Nursing: A Bit of History

The academic program designed by Loretta Ford and Henry Silver managed to combine the traditional role of the nurse (patient education, health promotion, family medicine, etc.) with advanced and specialized medical training (treatment, diagnosis, etc.)

Unfortunately, this approach to patient care was not well-received by the medical and nursing communities.

In fact, the discussion about the Scope of Practice for Nurse Practitioners began as soon as the first Nurse Practitioner graduates from left school to begin their careers.

One of the main concerns of the nursing community was thinking that their program would only create nurses who were supervised by physicians all the time, rather than being viewed as colleagues. Unfortunately, they were right. Each Nurse Practitioner can attest to this.

This was the root of the problem when it came to the Scope of Practice for Nurse Practitioners, the idea that nurses couldn't do medical work themselves, and even the background that the medical community felt threatened. They were even debating whether Nurse Practitioners should be allowed to use stethoscopes.

The dilemma between Nurse Practitioners and doctors eventually led to other concerns, which you've surely heard by now, even recently:

Can Nurse Practitioners prescribe medications?

Can Nurse Practitioners perform certain medical procedures?

Will Nurse Practitioners ever "replace" doctors?

So the onus was on the Nurse Practitioners to prove themselves to the world, and they have been trying to do so from the beginning. Let's see the results of those first efforts.

Advances in the Nurse Practitioner Scope of Practice

 In 1974, the American Nurses Association established the Council of Primary Care Nursing Professionalsç. Its creation gave us the first description of the functions of a PN.

This first attempt to describe the Scope of Practice for Nurse Practitioners created an early standard that Nurse Practitioners and clinicians could follow to begin thinking about what these professionals could and could not do.

However, the Council's description failed to unite all Nurse Practitioners under one banner, especially as the profession began to expand to include different specialties.

The following decades saw the growth of Nurse Practitioners as graduate professionals. The first NP programs started as simple certifications but were also expanded and enhanced to become master's programs.

This change helped legitimize the Nurse Practitioners, but it was not enough to clearly define their scope of practice. There were advances at the federal level, but because there was no standard, each state began regulating practices in its own way.

This created more confusion. In the 1980s, some states began to adopt measures that would expand the Scope of Practice for Nurse Practitioners. That helped a bit with the independence issue, but it didn't help in the case of a unified scope of practice.

A consensus model for the scope of practice

One of the most important advances occurred almost 30 years later, in 2008. It was then that the Consensus Model for APRN regulation was first established.

The Consensus Model for APRN regulation advanced the cause for a better understanding of the Scope of Practice for Nurse Practitioners, but it did not solve everything. In fact, the Consensus Model for APRN regulation itself states that the scope of practice must be constantly improved and redefined with better information, and this is something that is still happening today.

Scope of Practice in 2021: How to Determine It

So with all of that in mind, as a Nurse Practitioner, how do you know where your scope of practice begins and ends? Who do you turn to?

The consensus model is a great resource to start figuring it out. As previously indicated, this document is constantly evolving, as its primary goal is to eventually become the national standard for PN practice.

However, as each state has a varying definition of what a nurse is, you will still have to consult your local state laws and the Board of Nursing to find out what it can and cannot do.

What does the Nurse Practitioner practice scope include?

In general, the practice of Nurse Practitioner includes many of the circumstances:

• Patient evaluation.
• Order, perform, supervise and interpret diagnostic and laboratory tests.
• Make diagnoses.
• Initiate and administer treatment, including prescription of drugs and non-pharmacological treatments.
• Coordinate care, advice, and education for patients, their families and communities.

This does not mean that PN is limited to these tasks, but it does not mean that it covers all of them. Therefore, the best option to avoid career problems is to familiarize yourself with the laws of your state, as well as the resources provided by your state board.

How does your specialty affect the field of practice?

It is important to know the standards of practice that certain organizations have established. For example, the ANCC provides specialty-specific resources to understand the scope of its practice.

One of the points of agreement among most nursing organizations attempting to define the scope of practice is the fact that the Nurse Practitioner should practice only within their specialty.

Primary care Nurse Practitioners can help with acute care patients, but there are limits to what they can do because their specialty is not fully established to provide acute care.

As a bonus, here’s a great resource: The Scope of Practice Decision-Making Framework. This document was created by a large coalition of nursing organizations and serves as a guide for you to determine whether a certain action or procedure is allowed in your case.

You may be a little disappointed with the current situation in nursing practice. But nothing is perfect, keep in mind that every day more progress is made in this matter.

At FHCA, we work so that one day all Nurse Practitioners can practice with more confidence, protected by a standard of practice that serves all specialties.

In the meantime, keep practicing, keep learning, and always be proud of the path you have chosen. Being a nurse is a pride and we are even prouder to train you for this path!