Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Registered Nurse Scope of Practice in Australia: An Integrative Review of the Literature

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Registered Nurse Scope of Practice in Australia: An Integrative Review of the Literature

Article excerpt

Introduction

The aging population, growing consumer expectations, changing disease patterns, increased availability and cost of health-related technology and medicines are straining the Australian health system. The nursing profession represents Australia's largest regulated health workforce yet its practice boundaries are poorly understood. A dynamic nursing workforce practicing to its full scope can assist in addressing current and future health system demands. Before this can occur, a clearer understanding and national application of the nursing scope of practice is required. This paper presents a review of contemporary literature on the scope of practice of registered nurses (RN) in Australia. The findings of the review will be discussed with reference to the implications for nursing practice and healthcare, both in Australia and internationally.

Background

Nursing functions in Australia are addressed in documents such as practice standards and codes of professional conduct (Nursing and Midwifery Board of Australia [NMBA], 2008, 2016a, 2016b) and policy statements produced by professional bodies such as the Australian College of Nursing (ACN) and the Australian Nursing and Midwifery Federation (ANMF). These standards and guidelines focus on describing the roles, competencies and responsibilities of registered and enrolled nurses (EN) in terms that are too broad to provide an individual with sufficient guidance for determining the legal and professional boundaries of their practice. Poorly defined scope of existing and new nursing roles, together with inconsistent use of language contributes to role confusion and ambiguity in practice (Duffield, Gardner, Chang, Fry, & Stasa, 2011; Jacob, Sellick, McKenna and Barnett, 2013; Lowe, Plummer, O'Brien, & Boyd, 2012).

No clearer definition of scope of practice can be found by looking to the international literature. As in Australia, nursing scope of practice is informed in most countries by a number of codes, standards and guidelines produced by professional bodies. The International Council of Nurses (2013) describes scope of practice as the 'competencies (knowledge, skills and judgement), professional accountabilities and responsibilities of the nurse' (p. 2). Internationally, studies are being driven by an evolving nursing profession, which is expanding into new settings and accepting new responsibilities to meet changing healthcare needs. In Canada, a mixed methods study asked nurses to comment on the extent to which they believed they were 'working to scope' (Oelke et al., 2008); in Ireland, scope of practice was reviewed in a study involving a national survey of nurses and focus group interviews with key stakeholders (Casey et al., 2015). These international studies and other similar works (Castner et al., 2013; D'Amour et al., 2012; Fealy, 2014) consistently report the influence of local context in defining scope, and a lack of clarity surrounding the understanding, application and definition of 'scope of practice' within nursing.

In Australia, nursing is undertaken by RN and EN who are listed on respective divisions of a national register in accordance with their qualifications. Registration of nurses is a public-protection mechanism by which statutory authorities ensure these practitioners are prepared for competent and ethical practice. The NMBA is responsible for managing processes associated with registration and practice nationwide through authority delegated by the Australian Health Practitioner Regulatory Agency (AHPRA). To achieve initial registration as a nurse, an individual must meet the minimum English language requirements, have completed an accredited program of study, and demonstrate achievement of Nursing and Midwifery Board of Australia Standards for Practice for the Registered Nurse (NMBA, 2016a) or Enrolled Nurse (NMBA, 2016b). In addition to establishing and maintaining RN and EN status, the NMBA has the authority to apply an endorsement to a nurse's registration, subject to the individual nurse meeting established requirements. …

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