Nurses' scope of practice and the implication for quality nursing care

Area of Science:

• Nursing Practice
• Patient Safety
• Healthcare Quality Management

Background:

• Nursing scope of practice is defined by regulatory bodies like the South African Nursing Council.
• Different nurse categories have specified competencies aligned with their scope of practice.
• Unsupervised performance of tasks beyond a nurse's licensure can impact patient health status and care needs.

Purpose of the Study:

• To examine the implications of patient assessments performed by unlicensed or incompetent nurses.
• To use the Waterlow scale as a case example to illustrate risks associated with improper assessments.

Main Methods:

• A retrospective quantitative study design was employed.
• A checklist audit was conducted on a random sample of 157 patient files from an accessible population of 849.
• Data collected in May 2012 were analyzed using frequencies and percentages, ensuring reliability, validity, and ethical adherence.

Main Results:

• 80% of patient risk assessments were conducted by nurses not licensed or enrolled for unsupervised performance.
• Inaccurate scoring occurred in areas including tissue malnutrition, neurological deficits, and medication.
• 50% of Waterlow risk assessments were misinterpreted, posing risks to patients and healthcare institutions.

Conclusions:

• Lower-category nurses and student nurses must perform tasks strictly within their licensed scope of practice.
• Nurses with limited theoretical training are unprepared for unsupervised task performance, despite global nursing shortages.
• Registered professional nurses should conduct risk assessments to coordinate safe and quality patient care, assisted by lower-category nurses.