essay on nursing scope of practice

Nursing: Scope and Standards of Practice Essay

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Personal Learning Objective for Each Experience

Some of the objectives for the transitional care unit were learning the vital skills needed to succeed as a nurse, maintaining the nursing code of ethics and preventing injuries. Other objectives included learning how to check patients’ vital signs as well as head-to-toe assessments, performing activities of daily living (ADLs) on patients such as helping them to get dressed, combing their hair and brushing their teeth. I was also expected to learn teamwork and collaboration alongside other student nurses.

Meeting my Personal Learning Objectives

I was able to meet my personal learning objectives each day by teaming up with other student nurses, which helped to create teamwork. Every morning, I managed to help patients with ADLs. I was able to check patients’ vital signs including heart rate, respiratory rates, blood pressure, body mass index (from height and weight measurements) and oxygen saturation. Additionally, I was able to perform head-to-toe assessments while paying attention to all body systems in their respective order. I feel that I adhered to the nursing code of ethics and made all decisions by putting the safety of the patients first.

Observed Instances of Teambuilding and Collaborative Strategies in the TCU

There were several instances where I observed teambuilding and collaborative strategies in the TCU. For instance, every time a fellow nursing student needed assistance, other students would be quick to help out. We served meals to patients as a team. We also lent a helping hand to one another when performing ADLs such as lifting some patients to facilitate their movement.

How the Nurses Advocated for High Quality and Safe Patient Care

The nurses advocated for high quality and safe patient care by adhering to the nursing standards of practice. Some of the codes followed included responsibility and accountability, which stipulates that nurses should practice securely, proficiently and ethically according to their authorized bounds of practice (American Nurses Association, 2015). Patients’ needs were always put first as exhibited in the prompt answering of light calls. However, there were certain instances when there was little advocating for patients’ rights as evidenced by the lack of PRNs that were used less frequently on patients that needed them more frequently. Continuity of health care is influenced by the extent of coherence and linking of care, which in turn relies on the eminence of information dissemination, relational skills, and synchronization of care. Therefore, all the nurses always demonstrated teamwork, good communication and interpersonal skills to ensure that any nurse that forgot any detail that would jeopardize the patient’s safety was reminded to take the required measures.

How I Advocated for High Quality and Safe Patient Care as a Member of the Inter-Professional Team

I championed room 126 patients to receive skin barriers for their wounds. There was also one patient who was supposed to wear Geri sleeves for their arms as needed but did not have his arms attended to daily. Geri sleeves help in the management of skin tears by preventing the skin from sticking on clothes and providing a clean, dry environment that promotes healing. Therefore, failure to cover the patient’s wounds daily would only serve to delay his healing. I pointed out this observation and ensured that the patient received the care he deserved.

Social, Cultural, Spiritual and Ethical Factors Encountered during the Clinical Experience

One spiritual factor I encountered during the clinical experience was going to the chapel and sitting through some of the church services. One of the main aims of nursing is to provide patients with holistic care. Incorporating a spiritual aspect of inpatient care is vital to the road to recovery (Dossey, Keegan, Barrere, & Helming, 2015). In my culture, the young are expected to respect the elderly. During the clinical experience, I encountered several elderly patients who were cognitively impaired. However, I was still expected to respect them as a young individual. An ethical factor observed was maintaining the professional boundary between student nurses and patients. Providing nursing care to patients and helping them perform basic activities such as dressing and grooming fosters a close relationship between a student nurse and the patients involved. In some instances, the patients tend to open up and divulge certain details about their lives. In other cases, the interaction sparks curiosity within me as a student nurse. Therefore, the ethical issue comes in wanting to know more about the patients while at the same time maintaining professional boundaries.

How I used My Clinical Judgment to Impact Client Care Based on my Clinical Experiences

I have minimal clinical experience, which includes head-to-toe assessments, taking vital signs and administration of medications. Therefore, I used these experiences along with the knowledge learned in class to impact client care by maintaining the quality of care provided to clients.

What I learned from these Experiences That I will Take Forward to My Professional Career

These experiences gave me a feel of the actual clinical environment as well as what it comprised. I had a taste of the expectations and the working pace that ensures patients receive the quality of care they deserve in a safe and friendly environment.

American Nurses Association. (2015). Nursing: Scope and standards of practice . Silver Spring, Maryland: American Nurses Association.

Dossey, B. M., Keegan, L., Barrere, C. C., & Helming, M. A. B. (2015). Holistic nursing . Burlington, MA: Jones & Bartlett Publishers.

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Bibliography

IvyPanda . "Nursing: Scope and Standards of Practice." May 26, 2022. https://ivypanda.com/essays/nursing-scope-and-standards-of-practice/.

Scope of Practice

Introduction.

Moreover, the autonomy of performing the restricted activities as well as other possible interventions by the nurses can be limited by the employers until the graduate nurses meet all the registration requirements. Also, graduate nurses are not allowed to work as the nurse in charge until they possess the required clinical competencies and experience for such responsibility and obligation. Furthermore, a graduate nurse should always have the support of a registered nurse in their practice setting unless they have the necessary experience (Dossey and Keegan, 2013).

1. Dossey, B. M., & Keegan, L. (2013). Holistic nursing: A handbook for practice. Burlington, MA: Jones & Bartlett Learning.

2. Institute of Medicine (U.S.)., & Robert Wood Johnson Foundation. (2011). The future of nursing: Leading change, advancing health. Washington, D.C: National Academies Press.

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Nurses’ roles in changing practice through implementing best practices: A systematic review

Wilma ten ham-baloyi.

1 Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa

Associated Data

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Nurses play an important role in the implementation of best practices. However, the role of nurses in changing practice by implementing best practices requires further exploration. No systematic review was found that summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. This study summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. A systematic review was used to search for studies in the English language, where a best practice was implemented in a clinical context and which included findings regarding the roles of nurses when implementing best practices. Scopus, EBSCOhost (Academic Search Ultimate, APA PsycInfo, CINAHL with Full Text, ERIC, Health Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE Complete), PUBMED, and ScienceDirect databases were searched from January 2013 to June 2021. The search generated 1343 citations. After removing duplicates and applying eligibility criteria, 27 studies were included. Five definite roles were identified as follows: leadership, education and training, collaboration, communication and feedback and development and tailoring of the best practice. These roles are interrelated, but equally crucial in order to implement best practices. This study found five interrelated but equally crucial nurse roles in changing practice through the implementation of best practices.

Contribution

The study’s findings and gaps identified can be used for further nursing research, improving practice change and health outcomes through the implementation of best practices and the role nurses can play in this process.

Introduction

Globally, in the last decades, there have been rapid changes in healthcare and nursing practice, based on the best available evidence, to improve patient, nursing and organisational outcomes whilst, at the same time, using resources efficiently (Cullen & Donahue 2016 ; Salmond & Echevarria 2017 ). A sustained change in practice through the implementation of best practices is required to improve health and patient outcomes such as length and costs of hospital stay (Leviton & Melichar 2016 ).

Research findings based on rigorous methods that have been identified as best evidence and evidence-based products such as evidence-based innovations, interventions, strategies, practice improvements, guidelines, initiatives, programmes or recommendations (in this study referred to as ‘best practices’) assist in changing health and nursing practice (International Council of Nurses 2012 ). However, implementation of best practices remains problematic (Greenhalgh, Howick & Maskrey 2014 ). Innovative ways are required to firstly translate best evidence, which is the application of knowledge (Graham et al. 2018 ) and thereafter implement the best practice. This is especially relevant for a healthcare and nursing environment that is increasingly competitive and has to operate in a cost-effective way (Salmond & Echevarria 2017 ).

Furthermore, there are various stakeholders who influence implementation of best practices or change in practice and these stakeholders are also affected by change in practice (Agency for Healthcare Research and Quality [AHRQ] 2016 ). Thus, there is a strong drive for stakeholders to be actively engaged in and to make committed decisions about changing practice (Norris et al. 2017 ). To do so, the roles of the various stakeholders in changing practice – which includes patients and their families, the nurses and other healthcare practitioners and the managers at micro, meso and macro levels of the health system – need to be understood. Understanding the roles of these stakeholders in changing practice will assist in a more effective and efficient implementation and uptake of innovative best practices and, ultimately, will improve healthcare outcomes (Leviton & Melichar 2016 ).

Nurses, as one of the stakeholders, play an important role in the implementation of best practices. However, the role of nurses in changing practice by implementing best practices is not always well understood (Kristensen, Nymann & Konradsen 2016 ). No systematic review was found that summarised the best available evidence on the roles of nurses in changing practice through the implementation of best practices. This review therefore aimed to summarise the best available evidence on the roles of nurses in changing practice through the implementation of best practices.

A systematic review was conducted to collect data, identify high-quality relevant studies and to synthesise the findings in a rigorous and comprehensive way so that a comprehensive picture of current best available evidence could be provided. In this case, the best available evidence on the roles of nurses in changing practice through the implementation of best practices as a preliminary search did not yield any systematic reviews. The systematic review was conducted according to the Systematic Review guidelines of the Joanna Briggs Institute (JBI). The following review question was formulated: ‘What is/are the role(s) of nurses in changing practice when implementing best practices’?

Search methods

Sources of evidence.

The following databases were searched: Scopus, EBSCOhost (Academic Search Ultimate, APA PsycInfo, CINAHL with Full Text, ERIC, Health Source: Nursing/Academic Edition, MasterFILE Premier, MEDLINE Complete), Pubmed and ScienceDirect.

A broad combination of keywords was used to search the literature on the topic. A set of keywords per database was selected to yield the most relevant studies. The following keywords were used: role OR function AND nurse OR nurses OR nursing AND implement* AND best practice OR best practices.

Inclusion criteria and exclusion criteria

Studies of the following levels of evidence, according to JBI ( 2016 ), were included: Level I Experimental studies: (c) randomised controlled trials (RCT), (d) pseudo-RCTs; Level II Quasi-experimental studies: (c) quasi-experimental prospectively controlled study, (d) pre-test, post-test/retrospective control group; Level III Observational Analytical studies: (c) cohort study with control group, (d) case controlled study, (e) observational study without a control group; Level IV Observational Descriptive studies: (b) cross-sectional study, (c) case series, (d) case studies. Only those studies published in English from January 2013 to June 2021 were eligible for selection.

Studies were included where a best practice was implemented in a healthcare or clinical context (inside or outside a hospital setting where nursing care is rendered, e.g. old age setting), published in English, which included findings regarding the roles of nurses when implementing best practices. Systematic types of reviews and non-research studies were excluded as well as studies that were not implementing best practices (e.g. studies where no intervention was implemented or not described, studies regarding the views on the role of nurses implementing best practices in general or general perceived facilitators and barriers).

The entire search strategy, including the choice of keywords and electronic databases was conducted with the assistance of an experienced librarian from the Nelson Mandela University. Similar assistance was provided in obtaining studies, some via Inter-Library Loan services.

Search outcome

For this study, the following steps for selection were followed:

• The researcher read titles and abstracts (whereby irrelevant studies were excluded according to the pre-determined inclusion and/or exclusion criteria).
• Possible relevant literature was selected in order to obtain full-text. The researcher read the full text of potentially relevant studies and selections for inclusion were made according to pre-determined inclusion and/or exclusion criteria.
• When no full text could be obtained to determine inclusion and/or exclusion of an article, Inter-Library Loan services was used and authors were contacted.

EndNote X9 was used for data management, obtaining full-texts and for deduplication. The search and selection process is outlined in Figure 1 .

Search and selection process.

As a result of the literature search, 1343 initial hits were imported from electronic databases. After removing 456 duplicates, 887 titles and abstracts were read. A total of 823 were excluded as they did not meet inclusion criteria. From the remaining titles, total of 59 full-texts were obtained as five articles could not be located. Reading of the 59 articles led to exclusion of a further 29 articles, based on the study criteria.

Critical appraisal

A total of 30 studies fulfilled the review criteria and were included for critical appraisal. Appraisal was done using various tools, according to the different research designs or levels of evidence of the literature, including the various 64 JBI (Pearson, Jordan & Munn 2012 ) tools, including: checklist for analytical cross-sectional studies ( n = 2), checklist for cohort studies ( n = 1), checklist for qualitative research ( n = 7); checklist for quasi-experimental studies ( n = 2) (JBI 2021 ).

The following critical appraisal tools were found most suitable but were not available through JBI: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies (Von Elm et al. 2007 ) ( n = 16), Mixed Methods Appraisal Tool (MMAT) (Hong et al. 2018 ) ( n = 1) and the Effective Practice and Organization of Care Risk of Bias (EPOC RoB) tool for retrospective observational studies such as audits, developed by Cochrane (eds. Higgins et al. 2019 ) ( n = 1).

To reduce bias in review selection and to ensure that the appraisal was performed in a rigorous way, whilst allowing for appropriate consensus, the appraisal was conducted by two reviewers independently using the same critical appraisal tools. The outcome of the critical appraisals was shared amongst the researcher and independent reviewer during a meeting and consensus was achieved in terms of inclusion or exclusion of literature. Out of the total of 30 articles that were included for critical appraisal, three observational studies using audits were excluded because of weak rigour (see Figure 1 ).

Data extraction

Data extraction from the sample was done by recording relevant elements of studies regarding the topic in a tabular format. Headings in the table included: study reference, design, level of evidence, sample and setting, best practice and change strategy and findings relevant to the topic.

Data synthesis

For this review because of the heterogeneous nature of the study designs included thematic analysis, which was done to synthesise the extracted findings of each study, followed by a classification of findings and a summary of findings under thematic headings (as formulated in Academy of Nutrition and Dietetics [ 2012 ]).

Ethical considerations

This study obtained ethical approval from the University’s Faculty Postgraduate Studies Committee (ethics number: H19-HEA-NUR-008). The author adhered to the principles of honesty and transparency in reporting the data. In line with recommendations of Vergnes et al. ( 2010 ), participant consent was not obtained because this study had no participants.

Quality of evidence

The majority of studies ( n = 17) were observational analytical studies: Level III(e) evidence and Level IV evidence ( n = 7, of which n = 4 IV(b) and n = 3 IV(d)). Two other studies ( n = 2) included Level II(d) evidence. One ( n = 1) mixed method study included both Level III(e) and Level IV(b) evidence (JBI 2016 ).

Healthcare or clinical context

Studies were from a variety of healthcare or clinical contexts, with the majority ( n = 20) from a hospital setting. Of these, n = 14 were conducted in specialised hospital-based settings, including: medical and surgical wards ( n = 2) (Siegel 2020 ; Travers et al. 2018 ), paediatric settings ( n = 2) (Rosenberg et al. 2016 ; Yu et al. 2017 ), postnatal ward ( n = 1) (Anderson & Kynoch 2017 ), neonatal intensive care unit ( n = 1) (Ceballos et al. 2013 ), surgical ward ( n = 1) (Hu et al. 2019 ), haemodialysis centre ( n = 1) (Jia et al. 2016 ), haematology–oncology ( n = 1) (Naseer et al. 2017 ), orthopaedic ward ( n = 1) (Ong et al. 2017 ), medical ward ( n = 1) (Ullrich, McCutcheon & Parker 2015 ), intensive care unit ( n = 1) (Chiwaula et al. 2021 ), in-patient rehabilitation ( n = 1) (Mullins 2021 ) and a neurology department (Sheng et al. 2020 ).

A total of five ( n = 5) studies were from outside hospital settings, including long-term care ( n = 2) (Kilpatrick et al. 2020 , Mitchell 2017 ), homecare centres ( n = 1) (Bayly et al. 2018 ), acute ambulatory settings ( n = 1) (Chong et al. 2013 ) and a general practitioner (GP) practice ( n = 1) (Williams et al. 2020 ).

Two ( n = 2) studies were conducted inside and outside hospital settings. One of these studies was conducted in both a residential age-care facility and hospital setting (Ullrich, McCutcheon & Parker 2014 ) and the other study was conducted in a hospital setting (inpatient, acute care medical or surgical, intensive care units) and in a long-term care setting (progressive care/stepdown, community home, long-term care, rehabilitation, palliative/hospice care and spinal cord injury) (Becker et al. 2020 ).

Studies were conducted in a variety of countries, including Australia ( n = 6), United States of America ( n = 6), Canada ( n = 4), China ( n = 4), Singapore ( n = 3), United Kingdom ( n = 2), Malawi ( n = 1) and Thailand ( n = 1).

Best practices and implementation strategies for change

In total, seven ( n = 7) best practices and 11 ( n = 11) implementation strategies for change were identified from the included studies. The best practices included: best practice, intervention, strategy, guideline, initiative, programme and recommendation. The implementation strategies included: educational sessions or workshops, (development of) educational material, champion or knowledge broker, discussions, evaluation and feedback, development of an evidence-based practice (EBP) product, employing team or specialists, meetings, observations, equipment, assessments or examinations. Table 1 outlines the best practice and implementation strategies for change, per included study.

Best practices and implementation strategies for change ( n = 27).

EBP, evidence-based practice.

As outlined in Table 1 , included studies indicated a variety of implemented best practices, with best practice or intervention being mostly identified as best practice. Various implementation strategies for change were used, but most studies used more than one strategy, up to six strategies and had an element of education and leadership.

Roles of nurses

Eleven ( n = 11) of the included studies were nurse-led quality improvement projects, in which a team was formed in the clinical setting with nurses who took the lead and facilitated change through the implementation of the best practice in this setting (Anderson & Kynoch 2017 ; Bayly et al. 2018 ; Ceballos et al. 2013 ; Chong et al. 2013 ; Hu et al. 2019 ; Jia et al. 2016 ; Monkong et al. 2020 ; Naseer et al. 2017 ; Ong et al. 2017 ; Travers et al. 2018 ; Yu et al. 2017 ).

Five definite roles were identified: leadership, education and training, collaboration, communication and feedback and development and tailoring of the best practice. These roles are further described in the following subsections.

Leadership played a role in almost all studies ( n = 21). This could be individuals, for example, a clinical champion (Allen et al. 2018 ; Becker et al. 2020 ), a (clinical) team leader (Anderson & Kynoch 2017 ; Chong et al. 2013 ), a project leader (Hu et al. 2019 ; Mullins 2021 ; Yu et al. 2017 ) or nurse leader (Ceballos et al. 2013 ), a nurse clinician (Nazeer et al. 2017; Ong et al. 2017 ), a knowledge broker (Bayly et al. 2018 ), a practice facilitator (Shade et al. 2020 ), Facilitator CogChamps (Travers et al. 2018 ), a programme or project coordinator (Fleiszer et al. 2015 , 2016 ; Monkong et al. 2020 ) or an audit team leader (Jia et al. 2016 ). In some studies, the leader was the researcher (Mitchell 2017 ) or part of the research team (Kilpatrick et al. 2020 ; Rosenberg et al. 2016 ; Williams et al. 2019 ).

Roles of leaders included:

• recruitment of participants (Becker et al. 2020 )
• facilitating the implementation of the best practice (Anderson & Kynoch 2017 )
• creating educational material (e.g. a computer-based educational module, completion of a comprehensive literature review to inform the educational intervention) (Ceballos et al. 2013 ; Yu et al. 2017 ).
• communication (e.g. sending staff electronic communication with information about the best practice and why practice changes were necessary [Ceballos et al. 2013 ]; explain roles and responsibilities to every team member in fortnightly meetings [Chong et al. 2013 ]; introduce the project to the members and project timelines [Becker et al. 2020 ; Naseer et al. 2017 ])
• data analysis, interpretation of data and report writing (Ceballos et al. 2013 ; Chong et al. 2013 ; Yu et al. 2017 )
• managing the project, process control and promotion and keeping timelines (Monkong et al. 2020 ; Mullins 2021 ; Yu et al. 2017 )
• role modelling in terms of enthusiasm (Chong et al. 2013 ; Yu et al. 2017 ; Williams et al. 2019 ), commitment (Chong et al. 2013 ; Williams et al. 2019 ), approachability, sound clinical knowledge and legitimacy (Williams et al. 2019 ), ability to communicate clearly, being tenacious (keep on going when some nurses showed disinterest) and being able to think creatively about patients and patient care (Travers et al. 2018 )

Education and training

Education and training were found to play a big role in nurses implementing best practices in the majority of the studies ( n = 21). Education and training were sometimes provided by the nurse leader (Shade et al. 2020 ; Travers et al. 2018 ; Yu et al. 2017 ).

Education focused mainly on nursing/healthcare staff in terms of educational sessions (Mitchell 2017 ; Monkong et al. 2020 ; Naseer et al. 2017 ), such as ward-based in-service training (Anderson & Kynoch 2017 ; Chong et al. 2013 ; Hu et al. 2019 ), (1-day) training/workshop (Chiwaula et al. 2021 ; Fleiszer et al. 2015 ; Shade et al. 2020 ; Travers et al. 2018 ), two half-day training sessions including formal presentations, video demonstration of the delivery of the best practice, participative learning and practice sessions (Williams et al. 2020 ), an educational programme (Yu et al. 2017 ), a lecture (Siegel 2020 ), a multimedia educational framework (Rosenberg et al. 2016 ; Sheng et al. 2020 ), online educational videos (Siegel 2020 ), online modules or courses (Bayly et al. 2018 ; Ceballos et al. 2013 ; Williams et al. 2019 ), along with educational tools such as notebooks containing hard copies of online training (Ceballos et al. 2013 ).

Other educational tools and strategies included: user guide (Kilpatrick et al. 2020 ), demonstration of sample scripts (Ong et al. 2017 ), scripts to educate patients (Siegel 2020 ) and documents and ‘informants’ with knowledge (Fleiszer et al. 2015 ). Training of the stakeholders (e.g. volunteer practice change advocates) in the implementation of best practices (Fleiszer et al. 2015 ) and daily practice under supervision (Chong et al. 2013 ) was also done.

As part of the implementation, nurses also used patient education through the development and use of educational tools such as hand-outs (Anderson & Kynoch 2017 ), a patient education leaflet (Hu et al. 2019 ), an educational booklet (Bayly et al. 2018 ) and pamphlets, posters or slides using an iPad (Jia et al. 2016 ).

The impact of education and training as part of the implementation of best practices for nurses was that it imparted knowledge, increased nurses’ empathetic and adaptable problem-solving skills, raised awareness and compliance with best practices amongst nurses and made nurses more confident in their roles (Allen et al. 2018 ; Naseer et al. 2017 ; Shade et al. 2020 ; Travers et al. 2018 ; Williams et al. 2019 ; Yu et al. 2017 ).

Collaboration

Changing practice was often performed through a collaborative effort, as found in most studies ( n = 20). For example, the nurse often led and formed a team with other nurses (Chiwaula et al. 2021 ; Chong et al. 2013 ; Fleiszer et al. 2016 ; Jia et al. 2016 ; Mitchell 2017 ; Naseer et al. 2017 ; Ong et al. 2017 ; Ullrich et al. 2015 ; Yu et al. 2017 ). Alternatively, a nurse led and collaborated with multiple health professionals besides nurses (specialists and managers) in a team in order to implement the best practice (Allan et al. 2018). Such teams including mainly medical staff/directors (Ceballos et al. 2013 ; Hu et al. 2019 ; Kilpatrick et al. 2020 ; Monkong et al. 2020 ; Rosenberg et al. 2016 ; Shade et al. 2020 ), as well as other professions such as a lactation consultant (Anderson & Kynoch 2017 ), a researcher (Bayly et al. 2018 ), a clinical pharmacist (Rosenberg et al. 2016 ), a respiratory specialist (Ceballos et al. 2013 ) and a dietician (Mullins 2021 ). One study also collaborated with a patient’s family as part of the interventions (Mullins 2021 ).

The various team members or stakeholders served as support (Anderson & Kynoch 2017 ; Chong et al. 2013 ; Kilpatrick et al. 2020 ; Naseer et al. 2017 ; Travers et al. 2018 ). Collaboration overcame challenges (Chong et al. 2013 ), enhanced care policies based on best evidence (Rosenberg et al. 2016 ), enhanced accountability (Fleiszer et al. 2016 ), raised collective awareness and expectations for practice, leading to a change in culture, empowerment, mutual respect and communication (Ceballos et al. 2013 ).

Communication and feedback

Besides education, communication and feedback by nurses played an important role in the implementation of the best practice and often facilitated the implementation and uptake of the best practice, as found by more than half ( n = 16) of the studies. Pre-implementation of the best practice, communication was done through meetings or brain storming sessions with ward stakeholders to discuss current practices (Monkong et al. 2020 ) or outlining the project audit (data collection) and timelines (Anderson & Kynoch 2017 ; Hu et al. 2019 ).

During the implementation, discussions or (feedback) meetings were held to present baseline audits and to gather feedback about the project (Anderson & Kynoch 2017 ; Becker et al. 2020 ; Chong et al. 2013 ; Fleiszer et al. 2015 ; Hu et al. 2019 ; Mullins 2021 ; Naseer et al. 2017 ; Shade et al. 2020 ), to discuss barriers to the implementation of the best practice (Jia et al. 2016 ; Mullins 2021 ; Naseer et al. 2017 ; Ong et al. 2017 ; Shade et al. 2020 ; Ullrich et al. 2014 , 2015 ; Yu et al. 2017 ) and how to overcome the barriers (Mullins 2021 ; Shade et al. 2020 ; Ullrich et al. 2014 , 2015 ; Yu et al. 2017 ), to develop and further improve strategies for implementation (Ceballos et al. 2013 ; Naseer et al. 2017 ; Ong et al. 2017 ) and to discuss progress (Rosenberg et al. 2016 ).

Post-implementation communication was used to brief stakeholders regarding the evaluation of the intervention (Chong et al. 2013 ; Fleiszer et al. 2015 ; Ong et al. 2017 ; Ullrich et al. 2015 ), to discuss how to overcome future barriers (Ong et al. 2017 ; Shade et al. 2020 ) or to celebrate success (Shade et al. 2020 ). Communication was also done online regarding the intervention (Becker et al. 2020 ; Ceballos et al. 2013 ), using emails (Naseer et al. 2017 ; Rosenberg et al. 2016 ) and text messages (Naseer et al. 2017 ).

Ongoing communication and feedback assisted in facilitating the implementation of best practices as it led to the creation of a supportive rapport, which increased engagement (Anderson & Kynoch 2017 ), compliance (Hu et al. 2019 ) and both technical and personal support for the project (Anderson & Kynoch 2017 ; Hu et al. 2019 ). It further helped to keep the knowledge translation strategies on track (Bayly et al. 2018 ; Shade et al. 2020 ), enhance the collaborative processes, enhance the ability to learn from peers’ professional experiences and share and use new information learned (Bayly et al. 2018 ). Finally, ongoing communication helped to identify barriers (Ceballos et al. 2013 ; Hu et al. 2019 ) and enhanced sustainability of the change (Becker et al. 2020 ).

Development and tailoring of the best practice

Nurses play a role in the development and tailoring of the best practice, including the development of intervention materials as part of the implementation, as found in more than half ( n = 16) of the included studies. The roles of nurses mainly involved developing an action plan (knowledge translation) or strategies, which was often done through informal discussions with nursing/midwifery staff and identifying barriers and facilitators of planned practice change (Anderson & Kynoch 2017 ; Bayly et al. 2018 ; Becker et al. 2020 ; Chong et al. 2013 ; Hu et al. 2019 ; Jia et al. 2016 ; Monkong et al. 2020 ; Naseer et al. 2018; Ong et al. 2017 ). Development of the best practice activities were also done (Sheng et al. 2020 ; Ullrich et al. 2015 ).

Other roles included developing educational material based on best evidence as part of the best practice, such as educational content, posters and hand-outs (Anderson & Kynoch 2017 ; Travers et al. 2018 ), videos and slides and a nursing newsletter (Becker et al. 2020 ), a computer-based educational module (Ceballos et al. 2013 ) and notebooks containing hardcopies of the online training information or information/resource booklet (Bayly et al. 2018 ; Ceballos et al. 2013 ).

Checklists to assist nurses to care for patients (Travers et al. 2018 ), a structured tool based on communication skills, workflows and reminder cards (Yu et al. 2017 ) and audit tools to evaluate the best practices were developed by nurses to be implemented as part of the best practice (Becker et al. 2020 ; Chong et al. 2013 ). In one study regarding improving the quality of care for hospitalised patients with cognitive impairment (Travers et al. 2018 ), nurses developed resources (e.g. card games, camouflage aprons/fiddle blankets) for patients to use whilst in hospital as part of the implemented best practice.

This review highlighted five definite roles nurses play in the implementation of best practices: leadership, collaboration, education and training, communication and feedback and development and tailoring of the best practice. The importance of the leadership role nurses play in this regard was also discussed elsewhere (Bianchi et al. 2018 ; Vogel et al. 2021 ). In this review, multiple sub-roles in the nurses’ leadership role in the implementation of best evidence were identified, including recruitment, developing the educational intervention and data analysis. However, it seems from this study that behaviour such as role-modelling, plays a big role in the success of practice change, as found elsewhere (Whitby 2018 ). Furthermore, for nurses to be equipped for this leadership role, they need to have the necessary educational and managerial support and resources required for implementation of best practices (Bianchi et al. 2018 ).

Education and training were found to be one of the major roles, with multiple benefits, that the nurse can play in changing practice. These findings confirmed those of Davis and D’Lima ( 2020 ), who found that teaching and training initiatives can build capacity in dissemination and implementation of best practices. However, the authors also found a need to increase the number of training opportunities to enhance the number of researchers and practitioners who implement best practices.

Changing practice was often carried out through a collaborative effort with other (specialist) nurses and stakeholders, as part of an interdisciplinary team. The concept of the (interdisciplinary) team approach is widely accepted as the ‘gold standard’ of care delivery globally, influencing patient, nursing and organisational outcomes and policy development which, taken together, are aspired for achievement of high-quality care (Ansell, Sørensen & Torfing 2017 ; Soukup et al. 2018 ). Collaboration in changing practice should be fostered through engagement and involvement (Holmes et al. 2019 ), preferably early in implementation as, from the studies included, collaboration showed multiple benefits. Furthermore, evidence-based practice also includes the patient and families as part of clinical decision-making. However, the nurses’ collaboration with the patient during the implementation of best practices was not highlighted in most included studies. Therefore, the collaborative roles of nurses with patients and families when implementing best practices should be further explored.

The nurse also had a role in ongoing communication and feedback when implementing best practices. Doing so could improve care for an increased number of patients and enhance cost-effectiveness (Brown et al. 2019 ). Leaders also have a role in enhancing the facilitation of communication. It is important that they are trained in using various platforms for communication in order to facilitate the implementation of the best practice.

Nurses also had a role in development and tailoring of the best practice. As the included studies were conducted in different clinical contexts, with different resources, using a variety of implementation strategies, a needs assessment and intervention mapping – which refers to planning the implementation of best practices based on using theory and evidence – could assist in systematically tailoring a best practice for both nurses and patients and their families (Van Belle et al. 2018 ).

These identified five roles are interrelated but equally crucial in order to implement best practices. For example, the leadership role will not be fully executed without education and training or collaboration. Communication was found to enhance teamwork (Bayly et al. 2018 ).

This review found several best practices and implementation strategies. However, studies were found from predominantly middle- and high-income countries. More nurse-led intervention studies describing the role of nurses in the implementation of best practices could therefore be conducted in lower- and middle-income countries where resources are often limited and where the role of nurses is inclined to be more innovative and cost-effective in order to implement these best practices (WHO 2020 ). Finally, there is a need for nurse-led quality improvement studies to be conducted to produce Level I (e.g. randomised controlled trials) as no such studies were identified.

Conclusions

The role of nurses in changing practice by implementing best practices is not always well understood. This study found five interrelated, but equally crucial nurse roles in changing practice through the implementation of best practices, namely leadership, education and training, collaboration, communication and feedback and development and tailoring of the best practice. Further exploration on the roles of nurses in changing practices, using randomised controlled trials, including low- and middle-income settings, is required. The study’s findings and identified gaps can be used for further nursing research and education to improve the implementation of best practices and enhance the role nurses can play in this process, thus enhancing patient, nursing and organisational outcomes.

Acknowledgements

The author would like to thank Vicki Igglesden for editing the article.

Competing interests

The author declares that she has no financial or personal relationships that may have inappropriately influenced her in writing this article.

Author’s contributions

W.T.H.B. is the sole author of this review article.

Funding information

This work is based on the research supported in part by the National Research Foundation of South Africa in partnership with FUNDISA for the PLUME grant (unique reference: FUNDISA/NRF 2019/009). Any opinion, finding and conclusion or recommendation expressed in this material is that of the author. The NRF and FUNDISA do not accept any liability in this regard.

Data availability

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

How to cite this article: Ten Ham-Baloyi, W., 2022, ‘Nurses’ roles in changing practice through implementing best practices: A systematic review’, Health SA Gesondheid 27(0), a1776. https://doi.org/10.4102/hsag.v27i0.1776

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Home — Essay Samples — Life — Nurse — Understanding the Nursing Scope of Practice

Understanding The Nursing Scope of Practice

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Words: 350 |

Published: Sep 14, 2018

Words: 350 | Page: 1 | 2 min read

• 1. In making decisions about their personal scope of practice, nurses should keep to the fore the rights, needs and overall benefit to the patient and the importance of promoting and maintaining the highest standards of quality in the health services.
• 2. Nurses treat all patients as equals without discriminating on the grounds of age, gender, race, ethnicity, religion, civil status, family status, sexual orientation, disability (physical, mental or intellectual), or membership of the Traveller community.
• 3. Fundamental to nursing practice is the therapeutic relationship between the nurse and the patient that is based on open communication, trust, understanding, compassion and kindness, and serves to empower the patient to make life choices.
• 4. Nursing practice involves advocacy for the rights of thei individual patient and for their family. It also involves advocacy on behalf of nursing practice in organisational and management structures within nursing.
• 5. Nurses recognise their role in delegating care appropriately and providing supervision to junior colleagues and other healthcare workers, where required.
• 6. Nursing care combines art and science. Nursing care is holistic in nature, grounded in an understanding of the social, emotional, cultural, spiritual, psychological and physical experiences of patients, and is based upon the best available research and experiential evidence.
• 7. Nursing practice must always be based on the principles of professional conduct stated in the latest edition of the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (2014). 

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Practical Nurse Scope of Practice White Paper

This paper was written after NCSBN brought in a focus group of LPN/VN experts from around the country. The paper reviews the rich discussion that took place at the focus group, presents internal and external research findings of the PN scope of practice, and reviews surveys that were sent to boards of nursing and external PN groups. The paper makes six recommendations. Adopted August, 2005.

Scope of Practice of Rn and LPNs

Introduction.

Certain registered nursing programs have been developed to provide more affordable medical services for Americans and reduce the strain on healthcare costs, including Registered Nursing (RN) and Licensed Practical Nurse (LPN). Registered nurses (RNs) care for patients with various conditions, including those related to injury, surgery, or illness, and provide relief during acute stress or emergencies (Toney-Butler & Martin, 2018). However, these roles may differ from that of the Licensed Practice Nurse (LPN) in terms of scope of practice. This article, therefore, discusses the roles and scope of practice of the RN and LPN, with the similarities and differences between the two depicted.

Roles of the Nurse for the Registered Nursing Program

There are a few different roles nurses play in the Registered Nursing program. Nurses can be generalists or specialists and work in many different settings, such as hospitals, workplaces, and nursing homes. Nurses in the Registered Nursing program are obliged to provide health care to patients, prevent illness, educate patients and family members, and advocate for positive health changes. The Registered Nursing program prepares students for a variety of positions in the nursing field, such as providing care to children and adults in a hospital setting or providing care to adult individuals who need assistance with daily living skills in home settings (Exstrom, 2001).

Additionally, registered nurses have a variety of roles they can use to make an impact in the health care system, including, but not limited to, education, advocacy and research. Nurses provide education by teaching nurses and other healthcare workers new skills throughout the nursing field. They also provide advocacy by educating patients about their care options and advocating for positive changes in healthcare systems. Nurses also research curing diseases, helping prevent disease and other topics that would benefit the health care field. In addition, nurses also develop new technology to help increase the quality of life for patients in both hospital settings and home settings (Exstrom, 2001).

Scope of practice for the nurse in Florida state.

A registered nurse may provide health care and treatment as an independent practitioner or in a collaborative relationship with other healthcare professionals by carrying out the following tasks: checking vitals involving taking vital signs and performing related functions such as pulse rate, blood pressure, temperature, respiration rate, oral temperature; assessing the client’s level of consciousness; identifying orientation to time and place; assessing skin conditions and extent of injury or illness; administering oxygen therapy, and assisting with physical exam procedures such as the rectal exam for prostate cancer screening in males over 40 years old by using ultrasound guidance (Toney-Butler & Martin, 2018).

A registered nurse is also expected to monitor a medical condition or disease process within its scope of practice, including but not limited to measuring electrolyte levels, monitoring oxygen saturation levels, measuring blood glucose levels, monitoring and changing oxygen flow, observing sputum production, and conducting limited pulmonary-function tests such as spirometry (Toney-Butler & Martin, 2018).

In terms of medications, a registered nurse is obliged with the functions of administering prescription and non-prescription medication, including intramuscular, subcutaneous, intravenous, and inhalation medications, administer drugs to control allergic reactions, provide first aid treatment of minor injuries, and assist with minor surgical procedures (Toney-Butler & Martin, 2018).

Additionally, registered nurses are charged with the responsibility of performing physical examination procedures such as skin lesions, monitoring muscle strength, observing circulation and breathing levels of pulse oximetry or pulse oximetry readings, observing bladder function through urinalysis procedures such as urine test strip studies or blood test strips, measuring the circumference of the abdomen by measuring the abdomen at its midpoint with an arm measurement tape or by using a tape measure of a similar type. The RNs may also be responsible for transporting clients to appropriate healthcare sites for initial evaluation and follow-up care.

Comparison and contrast of the scope of practice for the LPN and RN

The scope of practice for the licensed practical nurse and registered nurse in Florida is not identical. A licensed practical nurse will have the authority to perform certain nursing functions. At the same time, an RN will typically be limited to physician-directed activities such as decision-making, ordering/referring tests, managing medications, and prescribing medications (Toney-Butler & Martin, 2018).

The RN primarily supports the physician’s role in patient care. The LPN may also contribute their expertise in several medical contexts requiring advanced skills, such as wound care or cares for special populations or minors. Additionally, LPNs may supervise RNs and other health care providers. However, LPNs do not generally gain authority in new practice areas like the RN (Toney-Butler & Martin, 2018).

Generally, RNs are authorized to manage or direct the management of patients’ conditions or disease processes as determined by a licensed physician, diagnose patient conditions, prescribe drugs, preparations, and medicines, order and interpret diagnostic tests, and operate medical, surgical, and dental equipment. On the other hand, the LPN has a much broader scope of practice and may perform nursing functions directly in the patient care setting (Exstrom, 2001). Some states provide a speciality certification process for LPNs with advanced skills or expertise in a particular practice area, such as wound care or cardiac nursing.

In conclusion, an RN and LPN have different scopes of practice. The RN is charged with the responsibility of caring for patients as a member of a healthcare team. They must follow physicians’ orders and administer appropriate care to support treatment plans. Meanwhile, LPNs are allowed to practice independently. They can make decisions regarding the plan of care for their patients based on the documented orders from their supervising physician or registered nurse. Despite this difference, RNs and LPNs play equally important roles in delivering quality patient care in various healthcare settings.

Toney-Butler, T. J., & Martin, R. L. (2018). Florida Nurse Practice Act Laws and Rules.

Exstrom, S. M. (2001). The state board of nursing and its role in continued competency. The Journal of Continuing Education in Nursing, 32(3), 118-125.

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The American Nurses Association (ANA) defines nursing practice for all professional nurses. “Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning: prevention of illness and injury; facilitation of healing and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.” ANA Scope and Standards of Practice 4th edition, 2021.

The National Association of School Nurses (NASN) states “School nursing, a specialized practice of nursing, protects and promotes student health, facilitates optimal development, and advances academic success. School nurses, grounded in ethical and evidenced-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for the quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.” NASN School Nursing Scope and Standards of Practice 4th edition, 2022.

The information on this webpage is intended to guide nurses within the specialty practice of school nursing but also help to inform educators, administrators and others who have limited knowledge about school nursing practice and the implications when practicing nursing in the school setting.

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• Adapting the CanMEDS framework to develop an advanced practice nursing competency framework in Belgium
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• http://orcid.org/0000-0002-2670-7667 Louise Racine ,
• http://orcid.org/0000-0001-5090-3775 Janet Luimes
• College of Nursing , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
• Correspondence to Dr Louise Racine; louise.racine{at}usask.ca

https://doi.org/10.1136/ebnurs-2024-104102

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• Nursing Education Research

Commentary on: Van Hecke A, et al. Development of a competency framework for advanced practice nurses: a co-design process. J Adv Nurs 2024; 1-13. doi.org/10.1111/jan.16174

Implications for practice and research

A CanMEDS-derived APN (Advanced Practice Nurse) competency framework informs APNs’ personal and professional development and guides APNs’ practices within educational and healthcare settings in Belgium.

Further research is required to validate this competency framework and determine its usability in education and practice.

Advanced practice nursing (APN) refers to an expanded scope of practice beyond the generalist level to provide direct healthcare services, including prevention, diagnosis, therapeutics and illness management. 1 2 APNs require roles and levels of practice based on measurable competencies. 1 Competency frameworks can be used to develop APN graduate programmes and serve for quality improvement. A change in the legal framework for APNs’ roles and responsibilities represented an …

Competing interests None declared.

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