‘Scope of practice’ is a concept that several professions use in the context of professional regulation. The scope of practice sets out the procedures, actions and processes that the registered or licensed professional is allowed to perform. The individual practitioner’s scope of practice is determined by a range of factors that gives them the authority to perform a particular role or task.
Scope of practice for nurses and midwives in Ireland is determined by legislation, European Union (EU) directives, international developments, social policy, national and local guidelines, education and the individual practitioner’s levels of competence.
- Scope of Practice: the range of roles, functions, responsibilities and activities which a registered nurse or registered midwife is educated, competent and has authority to perform.
The purpose of the Scope of Nursing and Midwifery Practice Framework (the Framework) is to provide nurses and midwives with professional guidance and support on matters relating to the scope of their clinical practice. It incorporates a flowchart to help nurses and midwives to define and make decisions about their own scope of practice.
Since the first Scope of Nursing and Midwifery Practice Framework was published in 2000 (An Bord Altranais), there have been many changes and developments in the Irish health service and in nursing and midwifery roles. These include changes in systems of care provision, reforms in professional education and expansion of the scope of nursing and midwifery practice roles. For example, patients can choose to have midwife-led care where the midwife is the lead professional looking after the patient, rather than playing a supporting role to a doctor. Nurse and midwife prescribing is another example of a relatively recent and significant change in the scope of practice.
Nursing and midwifery professions have a social mandate to provide distinctive services. So it is appropriate that nursing and midwifery practice should respond to the ever-changing needs of the population and the health service. Nurses and midwives are, therefore, required to be proactive in identifying areas where an expansion in their scope of practice would lead to improvements in patient outcomes and in the quality and range of available services. Nurses and midwives are generally willing to expand their scope of practice and see it as resulting in improved patient care, enhancement in overall quality of standards and increased job satisfaction. To support role expansion, managers, employers and organisations have a responsibility to put appropriate policies, procedures, protocols and guidelines in place (PPPGs).
This Framework provides guidance to all nurses and midwives in determining their roles and responsibilities in relation to the provision of safe, quality patient care. It encourages nurses and midwives to critically examine their scope of practice and expand it, where appropriate.
The Framework fulfils several functions in that it:
- Acts as a framework to underpin decision-making related to nurses’ and midwives’ everyday practice.
- Helps nurses and midwives to identify professional development needs.
- Provides a basis for the expansion of nursing and midwifery roles.
- Encourages reflective practice to improve learning and the provision of safe, quality patient care.
As an enabling framework, it also emphasises nurses’ and midwives’ individual accountability in making decisions about their roles and responsibilities and is, therefore, an empowering resource for practitioners.
Decisions about a nurse’s and midwife’s scope of practice are complex. A number of important determining factors need to be considered. These include:
- Core definitions and values that underpin nursing and midwifery practice.
- Levels of competence.
- Channels of responsibility and accountability.
- The supports and resources available.
Every nurse and midwife is responsible and accountable for making decisions about their own scope of practice. Factors such as the practice setting and collaborative practice can influence a nurse’s or midwife’s scope of practice, and have been considered in this Framework. The Framework document provides a definition of the scope of nursing and midwifery practice and outlines values that should underpin practice.
The Framework also discusses key factors that nurses and midwives need to consider when making decisions about their own scope of practice. The document further outlines the principles that should guide nurses and midwives in reviewing and expanding their scope of practice. For guidance, we have included in this document a flowchart of the decision-making process together with relevant references and resources, that may be used to direct and guide professional practice.