Is there a place that lists everything within the RN scope of practice?

  1. Is there a list of what skills, activities, etc. are within the RN scope of practice? Particularly within Florida? I've tried looking through the FBON resource page which includes the Florida Nurse Practice act. I found a "Help/FAQ" section which had the following question/answer:

    Q:What can I do to determine if a nursing task which includes procedures/treatments is within my scope of practice?

    A:

    Nurses have the option of filing a “Petition for Declaratory Statement”.In many instances nursing duties and responsibilities are not specifically addressed in the Florida Nurse Practice Act (Chapter 464, FS), or the Rules of the Florida Board of Nursing (Title 64B9, Florida Administrative Codes)
    Declaratory statements are an agency’s opinion as to the applicability of a statutory provision, or of any rule or order of the agency, as it applies to the petitioner’s particular set of circumstances (s. 120.565, F.S.). This page is a listing of declaratory statements.
    Requests to file a “Petition for Declaratory Statement” can be located by selecting the link below:
    Declaratory Statements | Florida Department of Health

    That makes it sound to me like there may not be any place that says what we can or can't do; but I'm hoping that's wrong and I'm just missing something obvious.

    Florida Board of Nursing >> Nursing FAQs - Licensing, Renewals & Information
    Florida Board of Nursing >> Links and Resources - Licensing, Renewals & Information
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  2. 20 Comments

  3. by   BBP42
    In my state (CT) I have tried to look up this type of info as well, everyone on this site always says to look up our scope of practice. Our scope of practice does not include any type of list of procedures, or who can administer what type of meds, etc. I wish the information was easier to locate. Coworkers are not a reliable source of information about nursing scope of practice, as I often hear conflicting opinions between the more experienced members of my staff.
  4. by   elkpark
    Welcome to allnurses!

    Because nursing practice, as part of healthcare in general, is constantly changing and shifting, I don't think any BON publishes a list of specific tasks or procedures that define nursing scope of practice. That list would have to be constantly amended. Some BONs publish a list of identified tasks/procedures/skills that are outside RN or LPN scopes of practice. But they generally frame scope of practice statements in terms of general principles and boundaries.

    Is there some reason that you feel you need a specific list? If you have concerns about a specific task/procedure/skill, have you contacted your BON and asked for an opinion about that specific matter?

    Best wishes!
  5. by   zygee
    Similar to BBP42'S comment the wide variation in what nurses consider to be inside or outside our scope of practice varies and I don't like that.

    For example, In initial orientation to my unit I was told that we cannot take "continue all home medication" orders which I understand to a point, but many nurses take the order. More recently there's apparently been an issue where nurses and aids are not allowed to perform blood sugar checks, ekg's, etc. not even vital sign checks without a doctors order in the computer.

    This seems ridiculous to me, especially when ACLS is expected required on my floor. I would think between my RN license and ACLS certification I would be able to do an EKG if I feel the need.
  6. by   elkpark
    Quote from zygee
    Similar to BBP42'S comment the wide variation in what nurses consider to be inside or outside our scope of practice varies and I don't like that.

    For example, In initial orientation to my unit I was told that we cannot take "continue all home medication" orders which I understand to a point, but many nurses take the order. More recently there's apparently been an issue where nurses and aids are not allowed to perform blood sugar checks, ekg's, etc. not even vital sign checks without a doctors order in the computer.

    This seems ridiculous to me, especially when ACLS is expected required on my floor. I would think between my RN license and ACLS certification I would be able to do an EKG if I feel the need.
    Even if something is within the RN's or LPN's scope of practice per the BON, facilities and organizations are free to set additional limitations on practice if they feel that's appropriate. Often those kind of requirements are facility-specific, rather than required by the BON. If the facility is telling you they don't permit you do those things without a physician's order, it doesn't really matter what the BON says you can.
  7. by   BBP42
    Quote from elkpark
    If the facility is telling you they don't permit you do those things without a physician's order, it doesn't really matter what the BON says you can.
    My last job I had the opposite problem actually, DON telling us to go ahead and do procedures that some of my preceptors thought were outside of our scope. I went online searching for guidance afterwards and couldn't find anything.
  8. by   MunoRN
    There is no single list because there is no single scope of practice for all nurses, everyone posting so far in this thread likely has different scopes of practice. The legally defined scope of practice is basically a short list of things you are required to do, another relatively short list of things you can't do, and everything else that falls in between may or may not be part of an individual nurse's personal scope of practice depending on what they have attained and maintain competency in.

    Quote from zygee
    Similar to BBP42'S comment the wide variation in what nurses consider to be inside or outside our scope of practice varies and I don't like that.

    For example, In initial orientation to my unit I was told that we cannot take "continue all home medication" orders which I understand to a point, but many nurses take the order. More recently there's apparently been an issue where nurses and aids are not allowed to perform blood sugar checks, ekg's, etc. not even vital sign checks without a doctors order in the computer.

    This seems ridiculous to me, especially when ACLS is expected required on my floor. I would think between my RN license and ACLS certification I would be able to do an EKG if I feel the need.
    Those rules aren't due to scope of practice issues, they are due to what's required to bill for these services as well as how facilities attempt to screen out 'excessive' use of resources.
  9. by   brownbook
    I assume the hospital can't bill for, can't get reimbursed for, blood sugar checks, EKG's, (? vital signs ?... that honestly makes no sense), if there isn't a doctors order.

    It would be nice if there were a nursing educator or unit manager or even a director of nursing, who would clarify the issue.

    Can the doctor order be entered afterwards? What are you suppose to do if you're patient is "crashing" and you think their sugar could be low? I vaguely remember that getting vital signs (and maybe a few other things) were "covered" under a generic admission form that patients sign. Get a copy of the admission form for your hospital, see if it mentions anything.
  10. by   KelRN215
    Quote from zygee
    Similar to BBP42'S comment the wide variation in what nurses consider to be inside or outside our scope of practice varies and I don't like that.

    For example, In initial orientation to my unit I was told that we cannot take "continue all home medication" orders which I understand to a point, but many nurses take the order. More recently there's apparently been an issue where nurses and aids are not allowed to perform blood sugar checks, ekg's, etc. not even vital sign checks without a doctors order in the computer.

    This seems ridiculous to me, especially when ACLS is expected required on my floor. I would think between my RN license and ACLS certification I would be able to do an EKG if I feel the need.
    This has nothing to do with scope of practice and everything to do with facility policies and likely, as others have said, billing.
  11. by   SummitRN
    Scope varies a little between states... and a lot between RNs.

    Scope of practice is based on need. Need is based on a combination of practice environment, patient population, and provider competence.

    I can do things you can't. I bet you can do things I can't. Why? In most places, RN scope relies of skill/judgement competence supported by a foundation of education.

    It is why a PICC Nurse can place a PICC and a Flight Nurse can intubate, but not vice versa.

    It would be impractical to list out all the possible procedures, skills, and medications within the average RNs scope, much less all encompassing.
  12. by   gcupid
    Quote from BBP42
    In my state (CT) I have tried to look up this type of info as well, everyone on this site always says to look up our scope of practice. Our scope of practice does not include any type of list of procedures, or who can administer what type of meds, etc. I wish the information was easier to locate. Coworkers are not a reliable source of information about nursing scope of practice, as I often hear conflicting opinions between the more experienced members of my staff.
    welcome to nursing...
  13. by   gcupid
    Quote from elkpark
    Welcome to allnurses!

    Because nursing practice, as part of healthcare in general, is constantly changing and shifting, I don't think any BON publishes a list of specific tasks or procedures that define nursing scope of practice. That list would have to be constantly amended. Some BONs publish a list of identified tasks/procedures/skills that are outside RN or LPN scopes of practice. But they generally frame scope of practice statements in terms of general principles and boundaries.

    Is there some reason that you feel you need a specific list? If you have concerns about a specific task/procedure/skill, have you contacted your BON and asked for an opinion about that specific matter?

    Best wishes!
    If the BON is clearly here to protect the public.... Shouldn't there be clear cut tasks listed so that the nurses maintain practice within their designated safe guidelines?

    Also, shouldn't the excuse of changes in healthcare be more of an argument for justification to having someone on payroll responsible for continually updating & amending the list because of our ever evolving role in healthcare?

    It's called, let's take the power away from the nurse telling the organization 'NO" unless it's blatantly dangerous. Our job description includes everything under the sun while all the other disciplines have clear cut boundaries and protections from employer abuse.

    I'm a nobody, but if it were up to me there'd be a list of specialties along with a list of common tasks associated as okay and a list that also includes most frequently asked controversial practice questions as to what RN's can do and not perform in those settings.
  14. by   gcupid
    Quote from SummitRN
    Scope varies a little between states... and a lot between RNs.

    Scope of practice is based on need. Need is based on a combination of practice environment, patient population, and provider competence.

    I can do things you can't. I bet you can do things I can't. Why? In most places, RN scope relies of skill/judgement competence supported by a foundation of education.

    It is why a PICC Nurse can place a PICC and a Flight Nurse can intubate, but not vice versa.

    It would be impractical to list out all the possible procedures, skills, and medications within the average RNs scope, much less all encompassing.
    While I agree it may be impractical, can we at least both agree also that the BON should be more readily available and tangible asap when gray areas in practice ensue. For the nightshift nurse that is being bullied into doing a task who has 2 kids to support and extended family, forms of intimidation are ever so greater in the hands of the employer/supervisor etc. Whereas if a hotline clearly sends out asap responses via email, there's a less likely attempt for bully-like tactics to take place in the work setting.

    We all know, every thing would be the nurses job if facilities could get away with it.

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