Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”
It is important for every registered nurse to know their scope of practice. The purpose of this posting is to discuss the nurses scope of practice as defined by the ANA and the state of Ohio, a clinical situation that applies to the scope of practice, and why every nurse should know and understand their nurse practice acts. According to the ANA’s book, Nursing: Scope and Standards of Practice, the scope of nursing practice is defined by who, what, when, where, and why. I will explain each one in more detail in alignment with what the ANA says. The “what” of this scope is referring to nursing, which in short is described as preventing illness and injury, advocacy for patients and family members, and the protection, promotion, and optimization of health. The “who” includes all registered nurses and advanced practice registered nurses who maintain active licensure. The “when” is anytime a nurse is needed to educate, care, lead, practice, or share wisdom and nursing knowledge with whomever is in need of it. The “where” could be in any environment in which an individual is needing advocacy, care, or education. The “how” of nursing practice includes the means, manners, methods, and ways that are used to professionally get the job done. Finally, the “why” is a nurses response to the needs of society that are ever changing so there can be good outcomes for healthcare consumers (ANA, 2015, pg. 2).
Now I will define the scope of nursing practice in Ohio according to the Ohio Board of Nursing. It states in a document entitled, Scopes of Practice: Registered Nurse and Licensed Practical Nurse, that the registered nurse is to provide care that requires specialized knowledge, skill, and judgment that comes from social, behavioral, biological, physical, and nursing science principles. This includes identifying human responses/health problems, executing a nursing regimen, assessing health status, providing health teaching and counseling, following through with treatments prescribed by a professional who is legally able to do so in the state of Ohio, and lastly teaching, delegating, supervising, administering, and evaluating nursing practice (Ohio Board of Nursing, 2015).
In this paragraph I will share an example of how I’ve put the scope of nursing practice into effect in my own career. I will share an example of delegation. I recently took care of a gentleman who underwent extensive back surgery. I always assess my post operative patient’s urinary status to make sure they are voiding following anesthesia. This particular man had not voided for 8 hours following the removal of his foley catheter, so I delegated to my nursing assistant to obtain a bladder scan. The result came back at 400ml so I obtained an order from the house officer to straight cath. the patient. I practiced within my scope by delegating a bladder scan to my nursing assistant. It’s very important for nurses to have knowledge of their state’s scope of nursing practice in order to work within the law and to avoid malpractice or negligence. In conclusion, nurses have the power to change health consumers lives but it is paramount that it is done within the scope of nursing practice.
Nursing: scope and standards of practice (3rd ed.). (2015). Silver Spring, Maryland.: American Nurses Association. Scopes of Practice: Registered Nurse and Licensed Practical Nurse.(2015). Columbus, Ohio. Ohio Board of Nursing. Retrieved from: www.nursing.ohio.gov.
This discussion is to help better define the scope of practice and standards required by nurses in the United States. These terms have been defined to assist in providing equalized patient centered care while holding all nurses accountable for the care they provide. The purpose of this posting is to discuss these rules and apply them to a clinical situation or scenario. The American Nurses Association outlines the standards of practice as the ability of a nurse to demonstrate the nursing process while providing safe patient care. The nurse creates a foundation of care through education, training, and critical thinking. This foundation serves as a baseline for practicing nurses through assessment, diagnosis, outcomes identification, planning, implementation, and evaluation (American Nurses Association, 2010).
Michigan currently does not have a standard scope of practice but does have a consolidated practice act. This act regulates nursing practice while also covering 25 other health occupations. Within this act, the practice of nursing if defined by the knowledge and skills learned in state accredited nursing programs. It is practiced via the nursing process. From care to education, this process is used to help manage illness and prevent further injury or debility. The act further defines the role of the registered nurse and states that this role specifically focuses on teaching and delegation of appropriate nursing activities (Michigan Legislature 1978).
In my experience as a nurse, I use the nursing scope of practice daily. One example that comes to mind is when I was taking care of a patient who was admitted with a urinary tract infection. The patient was elderly, from a long-term care facility, and was only oriented to self at baseline. I admitted the patient, did my initial assessment, and was back on hospital day 2 to provide care. This is when I noticed a setback. The patient was restless and seemed more confused than baseline. I did a thorough head to toe assessment and determined the patient had not voided in about 3 hours. It also appeared the measured amount of urine changed from day 1 and was minimal over the last 6 hours. I performed a bladder scan because the patient had a known history of BPH, and had not received his Flomax due to not being able to refill the prescription. The scan determined the patient was retaining urine. After further discussion with the physician, a Foley catheter was placed, and Flomax was resumed. The patient became less restless after the catheter was placed. Urine cultures came back and showed a need to change antibiotic therapy. I notified the physician of the new culture which initiated a change in antibiotics. I cared for this patient on day 3 of their hospitalization, and was able to see an improvement in patient status. The patient’s overall outcome would be to resume outpatient medications, not require a catheter to void, and to be at his baseline mentation. The patient’s family was grateful that I was able to recognize a change in the patient’s behaviors and advocate for a change in care.
It is important for all nurses to know and understand their states scope of practice, so they can provide safe and effective patient care. I have been able to use these guidelines as a newer nurse and it has helped me become more confident in my nursing abilities.
American Nurses Association. (2010). Nursing: Scope and Standards of Practice
(2nd ed.). Silver Spring, MD: Nursesbooks.org.
Public health code (excerpt): Act 368 of 1978. (1978). In Michigan Legislature.
Retrieved from http://www.legislature.mi.gov/(S(ej1bjc4i4sffsdehp… GetObject&objectname=mcl-act-368-of-1978
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