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The Role of the Nurse and Scope of Practice Toolkit

Healthcare is ever-changing, requiring the role of the nurse to be fluid. Nurses have an accountability to ensure clients are receiving safe, competent, compassionate, and ethical care. This toolkit was created to help nurses, their employers, and the public to have greater understanding of the role of the nurse and what is meant by scope of practice.

Role of the Nurse

Nurses have an integral and valued role in the health care system. Being prepared to articulate the role of the nurse will educate key decision makers, other health members of the healthcare team and the public, regarding the role and the impact RNs have in healthcare.

Scope of Practice

Being able to describe what it means to be a nurse is often difficult because nursing practice cannot be reduced to a list of tasks or activities. Additionally, the over-lapping scope of practice that RNs have with other care providers can create a grey zone of being able to identify where the role of the nurse starts and stops within the healthcare team. The following documents clarify what is meant by the term ‘scope of practice’ in relation to RN practice in New Brunswick.

Can I Do That?

A Decision Making Tool to Help Define Nursing Scope of Practice

This tool is meant to be used in determining safe and authorized practice for registered nurses (RNs) and nurse practitioners (NPs), in all practice settings. The application of this algorithm is shaped by legislation, the needs of the client, the practice environment, and individual RN or NP competence. In all areas of practice, RNs and NPs are accountable to their NANB standards of practice and the CNA Code of Ethics. The following key considerations provide guidance to determine if a specific activity (role, procedure, process) is appropriate for an individual RN or NP to perform.

Begin with Question #1. Answering ‘Yes’ to a question allows you to proceed to the next question. Answering ‘No’ to any question means that practice may not be appropriate at this time and additional consultation with NANB may be required. If ‘Yes’ is selected for all  questions in the tool, then the activity is within your scope of practice.

  • Question 1: Is the activity consistent with relevant legislation and nursing standards?

    RNs and NPs are accountable to practice under relevant provincial and federal legislation, such as the Nurses Act and the Personal Health Information Privacy and Access Act. Each RN and NP is responsible for determining which legislation applies to their nursing practice.

    RN and NP practice is outlined by NANB in the entry-level competencies and standards of practice for both RNs and NPs. These documents inform RN and NP practice in New Brunswick.

  • Question 2: Is the activity supported through employer policy and/or job description?

    RNs and NPs must work within the role defined by employer policy and/or job description. The roles and responsibilities of RNs and NPs are specific to the practice environment. You are encouraged to consult with your employer and the health care team to determine if your practice setting supports the performance of the activity. If the employer does not support the activity, you can advocate for and potentially assist in the development of supporting policies.

    RNs and NPs must also ensure the necessary clinical supports are available; this includes but is not limited to: guidelines, directives and/or policies to guide practice; proper equipment and/or supplies to safely perform the activity; and appropriate supervision as required. The RN or NP must know what activity within their practice requires direct or indirect supervision (or guidance).

    • Direct means that an RN, NP, or physician is physically present at the point of care.
    • Indirect means that an RN, NP or physician is available for consultation and guidance, but is not physically present at the point of care. The person providing indirect supervision is readily available and can provide assistance when needed.

    Further questions for clarification include:

    • Is the procedure or activity within your documented role description?
    • Do organizational policies support an RN or NP performing the procedure or activity?
    • Are the necessary resources available to support the RN or NP before, during and after the procedure or activity?
  • Question 3: Does the RN or NP have the competencies needed to perform the activity?

    Individual scope of practice is unique and specific to each RN and NP. Prior to performing any procedure or activity, nurses are accountable for reflecting on their individual competence and consider whether they have the adequate knowledge, skill, and judgment to perform the activity  safely and competently.

    Additional competencies may be gained through experience, on-the-job training, post-basic education and/or certification.

    Self-reflecting questions will help the RN or NP determine their individual scope:

    • Am I the most appropriate care provider?
    • Do I  have the knowledge, skill and judgment to:
      • (a) Assess the appropriateness of performing the procedure?
      • (b) Perform the procedure?
      • (c) Manage the patient before, during, and after the procedure?
    • How will I obtain and maintain my competence?

    RNs and NPs requiring additional education and training to safely perform an activity within their practice environment, should discuss this limitation with their employer and seek opportunities for educational support.

  • Question 4: Should the RN or NP preform the activity with this specific client?

    Each client and clinical situation is unique. Before preforming an activity the RN and NP should consider the specific client and clinical situation.

    Further questions for consideration include:

    • Level of Complexity – the degree to which a client’s condition and care needs can be easily identified and the variability of their care requirements.
    • Predictability – the extent that a client’s outcome and future care needs can be anticipated.
    • Risk of Negative Outcome – the likelihood that the client will experience a negative outcome due to their health condition or response to treatment.
  • Can I do that?

    By answering ‘Yes’ to all of the above questions, the RN or NP may perform the activity, intervention, or role in accordance with standards of safe nursing care.

    If you have further questions, please call to speak to a nurse consultant at NANB at (506) 458-8731 or send a query to practice