Understanding Your Scope of Practice

This scenario demonstrates your accountabilities when you are floating to a new practice environment.

Tim, a nurse, works in a hospital on a palliative care unit. Last week, the hospital floated him to support the intensive care unit, a practice setting that uses a team-based model of care. Tim has never worked in an intensive care unit and is not familiar with the team-based model of care approach.

Tim is concerned because he is aware that his knowledge is limited, and he doesn’t want to put patients at risk. He also worries that if something goes wrong, he will be held accountable. Tim is worried he lacks the appropriate knowledge, skill and judgment to work in this practice setting and with this patient population.

Tim reaches out

After reflecting on his scope of practice, Tim decides to meet with the manager and clinical educator of the intensive care unit to share his concerns. Tim tells them he is worried he doesn’t have the competencies to take care of highly acute patients. He asks them what support the unit needs and which resources are available to help his learning.

The manager and clinical educator appreciate Tim’s concerns. They know that working in critical care deals with specific patient care needs and requires certain knowledge and skills. Together, they discuss Tim’s knowledge and skills, and the type of patient care he can provide in the intensive care unit. Their discussion focuses on three key topics:

The patients

  • What are the care requirements of the patient population?
  • What are the associated benefits and risks of Tim providing care to this patient population?
  • How does Tim’s nursing involvement support the broader health care team’s ability to deliver safe, effective and ethical patient care?

The learner (Tim)

  • What is Tim’s knowledge, skill and judgment related to the practice setting?
  • What are his competencies?
  • What are his learning needs?
  • What is Tim’s legislated authority, scope of responsibilities and practice limitations?

The learning environment

  • Does the practice setting support learning?
  • Are the necessary systems and resources in place to support Tim in this new environment (for example, organizational policies, human and environmental resources)?

With these questions guiding their discussion, Tim, the manager and clinical educator identify potential patient care options that would work for Tim, the patients and staff in the intensive care unit. For instance, since Tim is competent in taking vital signs and providing personal patient care, he could perform these activities in the unit while building his other competencies.

Putting patients first

When Tim brought his concerns forward to the health care team, he was advocating for patients by ensuring they would continue to receive the highest quality care. When Tim and the team engaged in a constructive discussion about his learning needs, they prioritized patients by showing dedication to patient-centered care.

Tim put patients first again when he reflected on his own competence and recognized he might not have the knowledge and skills needed for his new role. He took action by proactively seeking assistance and working with his colleagues to create a quality practice environment. At each step of his decision-making, Tim put patients’ best interests first.

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Adapted from College of Nurses of Ontario