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Scope of nursing Essay Expanding o r E panding your Scope of N rsing Nursing Practice – a practical g p guide Leanne Boase Deborah Pedron The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Scope of Nursing and p g Midwifery Practice What is it? Why Wh is it so important? Why is everyone y y talking about it? Who manages it? Who is responsible? The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Aims of this Presentation 1. To define what Scope of Practice means for Nurses and Midwives Midwives. 2. To present different concepts around Scope of p p p Practice 3. T 3 To report on findings of a small survey of t fi di f ll f nurses and Scope of Practice 4. To discuss expanding Scope of Practice and provide a framework 5. To relate these concepts to ‘real life’ nursing roles. o es. The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre According to our nurses, Scope Of Practice P ti (SOP) is: i SO SOP is Guidelines G and Frameworks we need to abide and work within SOP relates to what I am allowed and not allowed to do within my profession SOP relates to codes of conduct, ethics and professional conduct SOP relates to what a nurse can do within their skill base Area of tasks, procedures and actions a nurse can legally and safely undertake according to their training and education The scope of which p my role as a RN, specialist or credentialed DNE can work within Maintaining knowledge base and competency through constant learning and professional development The Northern Hospital Panch Health Service Something which I am taught, qualified, taught qualified or competent to do Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre What is Scope of Practice? p â€Å"That which Nurses and â€Å"the range of roles, functions, functions responsibilities activities, which a registered nurse or a registered midwife is educated, competent, and has the authority to perform † perform. (An Bord Altranais p1) Midwives are educated, competent and authorised to perform. † (QNC p3) Scope of p p practice is not defined in many places. We should define nursing practice and outline principles to assist with the expansion of one’s scope p p of practice And/ Or Require the health professional to identify restricted activities. ( (DEST) ) The Northern Hospital Panch Health Service â€Å"What health care workers actually do in the course of their employment which encompasses the full range of nursing activities. † An individuals scope refers to â€Å"the activities which that nurse is educated and authorised to perform. † (NSWNA p1) â€Å"A professions scope of practice is the full spectrum of roles, functions, responsibilities, activities and decision-making capacity which i di id l within th profession are it hi h individuals ithi the f i educated, competent and authorised to perform†. â€Å"The scope of practice of an individual nurse or midwife may be more specifically defined than the scope of practice of their profession. † ti f th i f i † (ANMC 2007 p2;23) Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre What is Scope of Practice? p †¢ Our definition: Full range of activities that we (nurses and midwives) have been educated, deemed competent, and are authorised to do. It is t t d th i d t d i not just a list of activities and j tasks, or a role description. The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre What Evidence supports your SOP? †¢ From our nurses: – Continuing Professional Development (CPD) – Number of hours per week working – Certificates registration Certificates, – Reflection – Document everything y g †¢ From the literature: – Maintaining records of:  » Reviewing journal articles  » In service education In-service  » Conferences  » Informal or formal discussions  » Accredited educational programs The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Who determines Scope Of Practice? p Is it the clinician the employer, the profession, the clinician, employer profession client, the registering body, the area of practice or specialty, the legislation, codes of conduct IT IS ALL OF THESE!! The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Who determines Scope Of Practice? p From the literature, there are several common themes: The primary determinant of scope of practice for all nurses and midwives is the enhancement of outcomes d id i i th h t f t for patients, and meeting consumer needs. Nurses and Midwives are responsible for their own decisions around scope of practice There are many factors that influence and contribute to scope of practice (Nurses Board Western Australia, Nurses Board of Victoria, Australian Nursing Federation, Ohio Nurses Board, Australian Nursing and Midwifery Council) The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Who determines Scope Of Practice? p Employers, Employers Organisations ; their Policies Patient ; Consumer Needs ; Outcomes O t Professional Bodies SOP Individual Scope of Practice Nurse Or Midwife – You! Regulatory Authorities The Northern Hospital Panch Health Service Law Craigieburn Health Service Professional P f i l Scope of Practice Broadmeadows Health Service Bundoora Extended Care Centre Why do we need to expand SOP? Nursing d Mid if N i and Midwifery experience and knowledge are i dk l d invaluable resources. It is natural for a Nurse or Midwife to evolve from being a novice, to an expert, and even further towards expanding their scope of p p g p practice, as they y continually learn and adapt to the needs of their clients Again, i A i primarily, expanding scope of practice must il di f ti t be driven by the need to provide improved outcomes and meet the needs of consumers. The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Why do we need to expand SOP? The Health Care Landscape is changing! y Think about the shift to community based and outpatient care, higher acuity patients, technological advances, etc. advances etc The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Why do we need to expand SOP? Nursing and Midwifery evolves along with the i d id if l l ih h health care sector. Nurses and Midwives are: †¢ Participating more and more in evaluation, g patient care assessment and decision making in p †¢ Professional – educated, competent, authorised and registered †¢ Participating in the growth and evolution th d l ti of health care The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Expanding Scope of Practice p g p †¢ How our nurses and midwives have d id i h maintained/expanded theirs: – Conferences/workshops/courses – Self-directed learning i. e. research on-line, journal g ,j reading – In-service education †¢ How they plan to expand in the future: – As above – Presenting in-services in area of expertise The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Expanding Scope of Practice p g p The key concepts for Expanding Scope of Practice found in the literature include: 1. The primary motivation of any expansion to scope of practice is to meet needs of the client or improve outcomes and access 2. The competency or task must be well defined and understood 3. Any expansion must enhance the existing aspects of professional practice 4. The expansion to scope is lawful, appropriate for the context, consistent with relevant standards, acceptable to the profession, consistent with the relevant profession organisations’ policies and consultation and planning has occurred. The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Expanding Scope of Practice p g p Key concepts of Expanding Scope of Practice – continued: 5. The registered nurse/midwife expanding their practice is already practising at an advanced level and has the education p p , p p and competence to perform the task, and is prepared to be accountable. They have been assessed by a competent health professional. 6. Nurses and midwives are accountable for making professional 6 N d id i t bl f ki f i l judgements when an activity is beyond their capacity and to initiate consultation/referral 7. Nursing and midwifery decisions are best made in a collaborative context, with ongoing risk assessment, planning, planning evaluation and support Always discuss expanding your scope with your peers, employers, professional organisations and your registering body. d i i b d The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Expanding Scope of Practice p g p There should be no artificial barriers to Scope Of Practice or expanding SOP such as: †¢ Ambiguous or inconsistent policy †¢ Overly specific or restrictive policy †¢ Inconsistent guidelines and frameworks eg. differences between States and regions †¢ Turf wars or uninformed attitudes The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Expanding Scope of Practice p g p When developing policy and planning for expansion consider: †¢ Permissive versus restrictive approaches – do you want to specifically restrict practice, or allow expansion to proceed within the broader guidelines? †¢ Profession versus client focussed approaches – it is best to be responsive to the needs of the client – ‘nurses will do what nurses needs to be done, providing he or she is competent to do it’. †¢ Competency standards should recognise the characteristics of nursing as well as the broader attributes or potential and i ll h b d ib i l d evolving roles. †¢ Overarching or broad statements are more effective than detailed or overly-specific statements when defining or expanding scope of practice. The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre SOP Expansion Framework Self-inquiry Define the task or activity you wish to add to your role, then ask: Is it legal? No STOP No Yes STOP Am I covered by Hospital Policy? Yes Yes Am I competent? Do I have relevant knowledge and confidence? Yes Am I willing to accept . accountability? Yes PROCEED The Northern Hospital Do you need to develop policy in line with the evidence base? Will this improves outcomes for the patient/consumer and will it improve access to services? Panch Health Service No STOP No STOP Can you access relevant education, education are you willing? NO STOP Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Key Take Home Messages y g †¢ This is relevant to all nurses and midwives. †¢ Not one single factor determines Scope Of Practice. †¢ Scope o p act ce should be shaped to benefit the of practice s ou d s aped be e t t e patient, and improve outcomes, as should any expansions to SOP. †¢ Governance of SOP is complex, but is essentially the responsibility of the nurse or midwife . †¢ Use this frame ork and information in conj nction framework conjunction with NMBA/AHPRA guidelines, relevant State or Federal Legislation, and your g , y employing organisation and it’s policies. The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre Questions The Northern Hospital Panch Health Service Craigieburn Health Service Broadmeadows Health Service Bundoora Extended Care Centre