Developing an Australian framework for scope of practice decisions by nurses and midwives - lessons for cross-border standards development

Lessons for cross-border standard development learned in the consultation to create the Australian National Framework for the Development of Decision-Making Tools for Nursing and Midwifery (National DMF).

Although existing tools are broadly consistent, no cross-border or internationally accepted version exists of scope of practice decision-making guides. Development of a national framework in Australia's federated political system required commitment to wide consultation and consensus. Concurrent moves towards national registration stimulated timely completion of the work. Contextual factors such as differentiation of the profession of midwifery from nursing and varying understanding of scope of practice concepts in eight Australian jurisdictions were challenges.

A consultative policy development framework was used.

Thematic analysis of written responses to a draft document and of focus group feedback informed the production of the National DMF.

A widely accepted National DMF allowing nurses and midwives in Australia to engage in planned changes to professional practice, grounded in the professional judgement of the individual nurse or midwife, and collaboration with the consumer.

The project's grounding in consensus influenced the process and outcomes of consultation. A nationally consistent framework, incorporating useful decision-making tools for two professions and principles to guide implementation and evaluation, was a distinct achievement. The article adds to accumulated knowledge by: * identifying the professional and political factors influencing consultation and outcomes in cross-border standard development and * exploring key considerations for future projects to produce national or international professional standards that are relevant across borders and across professions.

Decision-making tools that assist nurses and midwives in determining their scopes of practice and guide them in delegating aspects of consumer care to other health care workers are an essential component of any suite of professional practice standards.