Actual Scope of Nursing Practice and the Influencing Factors: A Single-Center Cross-Sectional Study in China

The "Actual Scope of Nursing Practice" (ASCOP) reflects what nurses are authorized and competent to do and what they do in routine practice. This study examined ASCOP levels and determinants in a tertiary hospital in Suzhou, China, to inform nursing management and hospital administration.

This cross-sectional study followed the STROBE standards.

A random sample of 375 nurses was recruited from a Suzhou tertiary hospital between September and October 2025. We collected data using a demographic questionnaire, the ASCOP questionnaire, the growth need strength (GNS) subscale, the job content questionnaire, and the role stressors scale. Descriptive analyses were performed for each variable. Spearman's rank correlation analyses analyzed key variables, followed by univariate and regression analyses to identify factors associated with the ASCOP.

The mean ASCOP score was 4.03. The final regression analysis explained 38.3% of ASCOP score variance (adjusted R² = 38.3%). Professional title was the strongest positive predictor (β = 0.296). Role stressors (β = 0.294), psychological demands (β = 0.257), and GNS (β = 0.234) were also positively associated with ASCOP. Department was statistically associated with ASCOP; however, the effects were modest.

Professional title was the strongest positive predictor of nurses' ASCOP, suggesting that organizational hierarchy may serve as a key structural influence. This study found a pattern of challenge-related activities in general nursing units. High psychological demands and moderate role ambiguity were not associated with limiting practice expansion in this single-center study. Together with the GNS, they were associated with a broader ASCOP.

This study advises nursing managers to (1) implement tiered authorization with a clear, graded ASCOP list aligning decision rights and roles to nurse competency; (2) introduce structured bounded autonomy by defining clinical safety thresholds while preserving limited discretion for highly competent nurses; and (3) provide development opportunities to motivated nurses and prioritize workflow support for high-demand roles.