Scope of practice decision tree

  1. The National Council of the State Boards of Nursing has apparently been reading the allnurses.com boards and in response to the many questions about NP scope of practice put out the following document

    http://www.nh.gov/nursing/practice/d...CISIONTREE.doc

    Courtesy of the New Hampshire State Board of Nursing

    David Carpenter, PA-C
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  2. 4 Comments

  3. by   NRSKarenRN
    dave, thanks for giving allnurses the credit!

    however, our profession has practice standards developed by ana and other professional nursing associations, ncsbn and promulgated in our state nursing practice acts. we periodically review and update our standards regarding current healthcare activities and practices to maintain the highest nursing standards and patient protection. many states require regulatory review and passage by legislatures prior to adoption.


    since 1998, maine has issued these standards
    scope of practice decision tree (34k)


    medscape article: scope of practice and the nurse practitioner


    arizona powerpoint: defining scope of practice for nurse practitioners: a regulatory perspective... five star ***** presentation. karen



    joint statement by ana + ncsbn regarding delegation developed in 2005 also using decision making process:

    page 1 joint statement on delegation american nurses association ...
    file format: pdf/adobe acrobat - view as html
    ncsbn decision tree on delegation that reflects the four phases of the delegation ... the nursing profession determines the scope of nursing practice. ...
    https://www.ncsbn.org/joint_statement.pdf
    Last edit by NRSKarenRN on Feb 1, '07
  4. by   traumaRUs
    OKay maybe I'm missing something here (and please tell me if I am) but this decision tree looks like all it is is distinguishing what an LPN, RN and APRN can do. Personally, how is this helpful for all states?
  5. by   NRSKarenRN
    not all states have specific language re scope of practice---- example texas.

    decision tree developed to provide guidance nurses at all levels "should i perform this task/procedure?" and can be used in all states.

    1. describe the act to be performed.

    a. review the scope of practice for your licensure level.
    is this act expressly permitted or prohibited by the nurse practice act for the license you hold?

    unsure: go to #2

    within scope for your license: go to #3

    prohibited: stop


    2. is the act consistent with at least one of the following standards?

    - board of nursing standards of practice (if promulgated in jurisdiction)
    - national nursing organization standards of practice
    - nursing literature and research
    - reasonable, prudent nursing in similar circumstances

    yes: go to #3

    no → not within your scope of practice


    3. do you personally possess the depth and breadth of knowledge to perform the act safely and effectively, as acquired in a pre-licensure program, post-basic program, continuing education program or structured self-study?

    yes : go to #4

    no → stop! until additional knowledge gained


    4. do you personally possess current clinical skills to perform the act safely?

    yes : go to #4

    no → stop! until additional knowledge gained



    5. is the performance of the act within the accepted “standard of care” which would be provided in similar circumstances by reasonable and prudent nurses who have similar training and experience and consistent with appropriately established facility/agency policies and procedures?

    yes: go to #6

    no → stop!
    performance of act may place both patient/client and nurse at risk!


    6. are you prepared to accept the consequences of your actions?
    yes. perform the act*

    no → stop: the accountability is not assumed!
    notify appropriate person(s).

    *with valid order when necessary, and in accordance with agency policies and procedures






    ga: rn scope of practice decision tree

    ky: scope of practice determination guidelines

    ne: http://www.hhs.state.ne.us/crl/nursing/rn-lpn/scope.pdf .

    or: http://www.osbn.state.or.us/osbn/pdf...ision_tree.pdf
    Last edit by NRSKarenRN on Feb 1, '07
  6. by   traumaRUs
    Okay. Thanks.

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