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Top-of-license practice for registered nurses: A scoping review.

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Standardizing top-of-license (TOL) nursing practice is crucial. This review found inconsistent definitions and applications of TOL, highlighting the need for a unified approach to improve nursing efficiency and patient care.

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Area of Science:

  • Nursing Practice
  • Healthcare Management

Background:

  • Registered nurses are essential but often burdened with non-nursing tasks, leading to inefficiency and turnover.
  • The concept of top-of-license (TOL) nursing practice, introduced in 2013, lacks consistent definition and application.

Purpose of the Study:

  • To explore the definitions and applications of top-of-license nursing practice in existing literature.
  • To identify themes related to TOL nursing practice's impact on efficiency, patient care, and nurse perceptions.

Main Methods:

  • A comprehensive scoping review was conducted following established frameworks (Arksey & O'Malley, PRISMA-ScR).
  • Searches across 15 databases and gray literature identified 1,377 articles, with 45 meeting inclusion criteria.

Main Results:

  • Definitions and applications of TOL nursing practice were found to be varied across the literature.
  • Three emergent themes included workforce efficiency, improved patient care and outcomes, and enhanced nurse perceptions of clinical practice.
  • A limited number of studies measured the outcomes of TOL nursing practice.

Conclusions:

  • Standardizing the definition of top-of-license nursing practice is essential for advancing research and policy.
  • A clear definition and differentiation from scope of practice are provided.
  • Standardization is key to improving care quality and patient outcomes.