The Role of the Nurse and Scope of Practice Toolkit

RNs and NPs are accountable to practice under relevant provincial and federal legislation, such as the Nurses Act and the Personal Health Information Privacy and Access Act. Each RN and NP is responsible for determining which legislation applies to their nursing practice.

RN and NP practice is outlined by NANB in the entry-level competencies and standards of practice for both RNs and NPs. These documents inform RN and NP practice in New Brunswick.

RNs and NPs must work within the role defined by employer policy and/or job description. The roles and responsibilities of RNs and NPs are specific to the practice environment. You are encouraged to consult with your employer and the health care team to determine if your practice setting supports the performance of the activity. If the employer does not support the activity, you can advocate for and potentially assist in the development of supporting policies.

RNs and NPs must also ensure the necessary clinical supports are available; this includes but is not limited to: guidelines, directives and/or policies to guide practice; proper equipment and/or supplies to safely perform the activity; and appropriate supervision as required. The RN or NP must know what activity within their practice requires direct or indirect supervision (or guidance).

• Direct means that an RN, NP, or physician is physically present at the point of care.
• Indirect means that an RN, NP or physician is available for consultation and guidance, but is not physically present at the point of care. The person providing indirect supervision is readily available and can provide assistance when needed.

Further questions for clarification include:

• Is the procedure or activity within your documented role description?
• Do organizational policies support an RN or NP performing the procedure or activity?
• Are the necessary resources available to support the RN or NP before, during and after the procedure or activity?

Individual scope of practice is unique and specific to each RN and NP. Prior to performing any procedure or activity, nurses are accountable for reflecting on their individual competence and consider whether they have the adequate knowledge, skill, and judgment to perform the activity  safely and competently.

Additional competencies may be gained through experience, on-the-job training, post-basic education and/or certification.

Self-reflecting questions will help the RN or NP determine their individual scope:

• Am I the most appropriate care provider?
• Do I  have the knowledge, skill and judgment to:
  • (a) Assess the appropriateness of performing the procedure?
  • (b) Perform the procedure?
  • (c) Manage the patient before, during, and after the procedure?
• How will I obtain and maintain my competence?

RNs and NPs requiring additional education and training to safely perform an activity within their practice environment, should discuss this limitation with their employer and seek opportunities for educational support.

Each client and clinical situation is unique. Before preforming an activity the RN and NP should consider the specific client and clinical situation.

Further questions for consideration include:

• Level of Complexity – the degree to which a client’s condition and care needs can be easily identified and the variability of their care requirements.
• Predictability – the extent that a client’s outcome and future care needs can be anticipated.
• Risk of Negative Outcome – the likelihood that the client will experience a negative outcome due to their health condition or response to treatment.