There is a lack of clarity and consistency in the terminology ‘scope’ and ‘parameters’ of practice. It is important to understand the differences between the two as well as the potential implications for clinical application.
Scope of practice (SOP) is relevant at micro, mezzo and macro levels. At a micro level, it refers to the limits of a health professional’s knowledge, skills, experience and professional competence and confidence.
“The role of the registered nurse must be always be valued as being unique, distinctive and intrinsically linked to the delivery of safe and effective care”
It reflects all actions, processes, tasks procedures and activities undertaken within the context of that role.
It is important for health professionals to be aware of their own individual SOP, to ensure they are practising safely, effectively and lawfully and in the best interests of patients.
SOP is not static, it can evolve over time in relation to patient need, changing professional roles and technological developments in healthcare provision.
Skills development and growth beyond the point of NMC registration, must always remain with the NMC’s Code of professional standards of practice.
At a mezzo level, SOP is determined primarily by employers, practice settings and the health needs of local populations, set out in policy and procedure documents.
Knowledge and skill will inevitably be context specific and determined locally, regionally or nationally; for example, the SOP of a practitioner working within an acute intensive care hospital setting will be different from that of a practitioner in a community mental health facility.
Similarly, SOP for community practitioners within an inner-city environment may be vastly different from those in a rural geographic area. At the macro level, SOP is an important concept for health regulators.
It is directly related to professional regulation which is set out within the NMC’s professional Code of standards of practice and behaviours for nurses, midwives, and nursing associates.
The Code includes four themes: prioritise people, practise effectively, preserve safety and promote professionalism and trust; each theme has a series of statements that together signify good practice.
SOPs also relate to what is permitted in law, for example with public health, mental health and medicines management specific elements of practice.
Failure at any level whether it be micro, mezzo or macro, can put patients, colleagues and the individual practitioner at risk.
Failure to comply with organisational requirements may result in disciplinary action being taken by the employer.
Failure to act in accordance with the professional code could result in sanctions by the regulator and failure to comply with the law could, in extreme cases, result in legal prosecution.
Inconsistency and confusion between SOP and professional practice parameters (PPPs) exist. SOP, as previously set out reflects the knowledge and skill set required for a particular context and it is appropriate that SOP is an iterative process in order to respond to societal changes.
Failure to enable such growth could lead to patient needs not being met. Conversely, PPPs or boundaries do need to exist; they are the outer parameters of practice or boundary limits, underpinned by clinical governance.
PPPs provide clear role differentiation and role domains; for example, they can distinguish between the registered nurse and the registered nursing associate, specifying activities not suitable to delegate as well as setting out care activities which can be safely delegated.
While recognising that there will always be some role overlap, the role of the RN must be always be valued as being unique, distinctive and intrinsically linked to the delivery of safe and effective patient care.
Dr Carolyn Middleton is project lead, Welsh Government, and visiting professor, University of South Wales; Rhiannon Jones is project lead, Welsh Government