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Department: Ask an Expert

Nurse practice acts and the provision of safe, competent care

Lockhart, Lisa MHA, MSN, RN, NE-BC

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Nursing Made Incredibly Easy!: May/June 2020 - Volume 18 - Issue 3 - p 56
doi: 10.1097/01.NME.0000658204.89628.2a
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Q: Nursing's scope of practice is frequently a topic of conversation in healthcare. Can you explain the nurse practice act?

A: According to the American Nurses Association (ANA), scope of practice is defined as “the services that a qualified health professional is deemed competent to perform and permitted to undertake—in keeping with the terms of their professional license.” Essentially, this is the foundation of our nursing practice, but it relies on how we define nursing. The ANA defines nursing as “the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; alleviation of suffering through the diagnosis and treatment of human response; and advocacy in the care of individuals, families, groups, communities, and populations.” The ANA's Nursing: Scope and Standards of Practice defines what safe, competent care looks like, including what actions RNs can perform, what duties they can delegate, and to whom they can delegate.

Scope of practice is carefully outlined by your state's regulatory board. Practice regulations may vary based on the nurse practice act (NPA) adopted by your state. These are the rules and guidelines that professional caregivers must operate within according to their licensing body. Nurses bear full responsibility for knowing and adhering to the details of their state's NPA and can be held responsible even if they mistakenly violate it. Questions regarding interpretation of the NPA must be refereed by the state board of nursing.

Each state's NPA is governed and enacted by the state legislature, with oversight by the individual state board of nursing, which provides interpretation of standards, investigative ability, and recommendations for additions or modifications to the NPA, and the National Council of State Boards of Nursing (NCSBN). According to the NCSBN, each state's NPA must include defined authority and composition of the board, educational requirements for licensure, standards and scope of nursing practice, definition of the types of licenses and titles, licensure requirements, and a disciplinary process. The NCSBN collaborates with many nursing organizations, such as the ANA, American Association of Colleges of Nursing, American Organization for Nursing Leadership, and National League for Nursing, to align practice nationally even though the final authority lies with the state.

The NPA is essential for the provision of safe care. States' NPAs may vary slightly in content, but all have central oversight by the NCSBN and draw from the expertise of our collaborative professional organizations. It's imperative that all licensed professionals be aware of the NPA in their state and adhere to its contents. This law protects us, our patients, and our organizations.

REFERENCES

American Nurses Association. Nursing: Scope and Standards of Practice. 3rd ed. Silver Spring, MD: American Nurses Association; 2015.
    American Nurses Association. Scope of practice. http://www.nursingworld.org/practice-policy/scope-of-practice.
      National Council of State Boards of Nursing. Nurse practice act toolkit. http://www.ncsbn.org/npa-toolkit.htm.
        Registered Nursing.org. How is the scope of practice determined for a nurse? 2019. http://www.registerednursing.org/answers/how-scope-practice-determined.
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