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What Does "Scope of Practice" Mean?

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  • Written By: Lainie Petersen
  • Edited By: O. Wallace
  • Last Modified Date: 30 September 2014
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The term “scope of practice” defines permissible activities for the members of a healthcare profession. In many cases, the scope is determined by laws within a particular jurisdiction, professional standards boards, and the administrators of specific healthcare facilities. Members of a healthcare profession are typically trained to understand the limitations on their professional tasks and responsibilities and to seek assistance from others when appropriate. Healthcare workers who violate these laws risk not only losing their professional license, but may be subject to criminal prosecution and civil lawsuits.

In many areas, laws define the appropriate scope of practice for different healthcare professions. This is done to ensure that the public is receives medical services only from those who are actually qualified to offer them. These laws are often developed in consultation with professionals who can advise lawmakers as to the expected competencies of individuals in a specific occupation. Healthcare licensure laws typically charge professional licensing boards with monitoring licensees to ensure that none of them practice in ways they should not.

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One common feature in a scope of practice is the issue of whether a licensed medical professional has the ability to prescribe medicine. In the United States, only certain healthcare professionals are able to prescribe drugs, and there may even be restrictions on the classes of drugs that a licensee can prescribe. For example, while a registered nurse may be able to dispense medication to a patient under a doctor's orders, he typically is not permitted to prescribe medication unless he has received additional licensing as a nurse practitioner. The scope for the same healthcare profession may vary from jurisdiction to jurisdiction. In some areas of the United States, licensed practical nurses may not be permitted to start IVs, while other places may permit this activity.

The scope of practice as permitted by law may be even more limited in certain healthcare institutions. A hospital may have a policy of restricting the activities of non-physicians as a cautionary measure, even though the law in that jurisdiction permits other licensed healthcare workers to perform the procedure or activity. In such cases, a worker must be careful to understand institutional policy and to not unwittingly engage in a practice that he may have previously had permission to do but is now forbidden by his current employer.

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medicchristy
Post 11

I worked for many years as a paramedic. I remember one particular call that we had. The patient was in desperate need of a chest decompression. However, at that time, it was not within our scope of practice.

My partner was determined that doing the chest decompression was the only way to save the patient's life. We could not get in touch with medical control to get permission because we were way out of range for service. My partner went ahead and did the chest decompression as I drove us to the nearest hospital.

Upon arrival, our patient was breathing and the doctor confirmed that the decompression saved the patient's life. Our supervisor had to do a disciplinary form for my partner working outside of our scope of practice. The doctor called the supervisor of our service and commended my partner and the disciplinary action was dropped.

lighth0se33
Post 10

@Oceana - I understand how frustrating that must have been. However, did you ever consider that maybe your nephrologist thought you might have some other condition that needed to be diagnosed?

If he truly thought that your abdominal pain wasn’t caused by your kidney condition, then something else had to be the source. Since his specialty is kidneys, he knew that a general practitioner’s scope of practice would cover a much broader area.

If nothing else, a regular doctor could draw up papers to send you to a hospital for another scan. Maybe she could ask them to x-ray other organs.

StarJo
Post 9

My friend who is a registered nurse lost her job as a result of operating outside her scope of practice. The reason she did it was admirable, but that did not matter to her employer.

She could only prescribe medication when ordered by a doctor. She was working at a nursing home, and one of the patients there was having a really bad day with his pain level. He had dropped his pills in the toilet by accident, and he really needed relief.

He begged her to prescribe him some more, but she resisted at first. She tried to call the doctor, but he was in emergency surgery and would be for the rest of the day. The man was really hurting, so she went ahead and wrote him a prescription for hydrocodone.

The doctor found out about it and confronted her. She told him what happened, and he told her she could easily lose her license over it, but since he understood her reasons for doing it, he simply fired her.

Oceana
Post 8

My nephrologist once told me that my problem was outside his scope of practice, but I doubted it. I think he said that because I needed pain pills, and he did not like to give them out.

I have a kidney condition that frequently causes pain in my abdomen. It can happen anywhere from my rib cage down to my waist, or it can happen in my sides and back.

I told him that I had been having sharp pains in my abdomen near my belly button that were so severe I could not stand up straight. I had experienced this kind of pain right before I got a CT scan that revealed my kidney disease, so I thought it was related.

He told me that it didn’t sound like kidney pain. He said he would let my regular doctor take care of prescribing my pain pills.

I know that doctors have become paranoid that everyone is a junkie, but when someone actually has a condition known to cause pain, you should listen to their complaints. I did go to my regular doctor, who gave me the prescription without hesitation.

kylee07drg
Post 6

I am studying to become a nurse practitioner. On my first day of class, we discussed our scope of practice. Depending on the state you work in, your scope will vary greatly.

We learned that only eleven states allow nurse practitioners to have independent practices. Twenty-seven states have laws that you must collaborate with a medical doctor.

Ten states require nurse practitioners to be supervised by medical doctors, and though practitioners may prescribe medications in all states, medical doctors usually have to be involved. For example, sometimes you are only allowed to prescribe 30-day supplies of certain medicines.

The state I live in allows for a broad scope of practice. I have often visited nurse practitioners and gotten everything I needed without the help of a doctor.

bagley79
Post 5

I regularly visit a doctor who has her degree in osteopathic medicine. Her scope of practice is limited to areas relating to the spine.

She has helped me a great deal for the pain in my back and headaches. While she is able to prescribe medications, she can only practice medicine that is related to her specialty.

If she detects something else is going on that needs further attention, she will recommend me to another physician. More than once she has been able to get me a quick appointment with another doctor that would have taken me months to get in on my own.

nony
Post 4

@SkyWhisperer - My understanding is that the scope and standards of practice for a physician’s assistant is defined by the physician and the laws of that state.

Basically they do what the doctor tells them to do, but my understanding is that they do have the authority to prescribe medication.

Whether they decide to do that on their own or consult the supervising physician first is something that I think would be up to them, and a part of that relationship they have with the doctor.

SkyWhisperer
Post 3

@David09 - The larger question that I have is not what nurses can do, but what can physician’s assistants do?

The physician assistant scope of practice is a bit murkier in my opinion. I know that physician assistants are a bit higher up in authority than the nurses, but does that mean that they can prescribe medicine and do all the stuff that the doctor does?

I went to an after care clinic once after getting a really bad bee sting that made my index finger swell. I was attended to by a physician’s assistant. She gave me a prescription for some antibiotics to take.

I vaguely recall her saying that it was on the doctor’s orders, so I got the impression that she didn’t write the prescription on her own authority.

David09
Post 2

@everetra - That’s probably not easy to pull off, I agree. However, there is a limitation on even what physicians can do according to the article.

Doctors can be limited in the types of drugs that they are allowed to prescribe. Does a pharmacist always know this information? I don’t think so; I doubt that they dig deeply into a doctor’s background to figure out what they can and cannot prescribe.

In such a scenario, the pharmacist would simply act in good faith. If the doctor were found out, he would be simply stripped of his license.

everetra
Post 1

While I understand the importance of scope of practice as it pertains to prescribing medication for example, I’m not sure how someone without the proper licensing could pull that off.

My wife works in a pharmacy, and anytime she has to fill a prescription she calls the doctor’s office to verify that the prescription is correct and that the doctor in fact did order it to be filled.

I’m not sure how a nurse, for example, could write a prescription on her own, given this procedure. I’m sure that pharmacies are aware of the scope and practice for RN professionals and how they differ from that of physicians.

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