Overview and Summary: Elimination of Barriers to RN Scope of Practice: Opportunities and Challenges

Abstract

Citation: Baker, K., Williams, T.E., (September 30, 2016) "Overview and Summary: Elimination of Barriers to RN Scope of Practice: Opportunities and Challenges " OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3, Overview and Summary.DOI: 10.3912/OJIN.Vol21No03ManOSIf you could envision a preferred future for registered nurses (RNs), what would that look like? Would you want an RN's voice heard, honored, and considered essential at every healthcare decision-making table? Would you want every RN energized to begin work each day; to experience a continuous journey of professional growth and improvement; to be acknowledged and recognized appropriately for their optimal contribution? Have you pondered how this preferred future could be realized?When the Institute of Medicine's original report on the future of nursing was released (IOM, 2011), it outlined a future full of opportunity and with the challenge for all nurses to practice to the full extent of their education and scope. Over the last several decades, much has occurred to elevate the practice and value of the RN. Patient needs have become more complex and quality and patient safety are now the front and center of reimbursement and regulatory landscapes. Nurses have adapted to these changes by expanding their skill sets and knowledge of science, securing their places as linchpins to provision of improved health outcomes in the era of healthcare reform (IOM, 2011).Still, there is much to be done. Experts agree that the ability of RNs to practice to the fullest extent of their education and scope has not yet been achieved in most healthcare settings (IOM, 2015). In response to this problem, the American Nurses Association (ANA) established a Professional Issues Panel-the Barriers to RN Scope of Practice Panel (Panel)-to explore factors that both promote and inhibit nurses ability to practice to the top of their licensure. The Panel was established as a think tank to create an environment for RNs to consider and identify some barriers to RNs' ability to practice to the full extent of their education, experience, and scope of practice.Five of the six introductory articles in this OJIN topic are based on the work of the ANA panel and written by members of the panel steering committee. These articles include evidence-based recommendations to address some of the barriers identified by the panel that prevent RN practice to the full extent of education and scope. The first four articles are organized in this OJIN topic based on key roles of RNs that emerged from the panel work and demonstrate RN value to the healthcare delivery system: RN as professional, RN as advocate, RN as innovator, and RN as collaborative leader. The fifth article provides an executive summary of the panel work. The sixth article discusses a research study that considered several variables important to full scope of practice, such as nurse educational level and organizational factors.The first article, "Registered Nurses as Professionals: Accountability for Education and Practice," focuses on several key messages. Authors Zittel, O'Sullivan, Siek and Moss write that to ensure the highest possible patient outcomes, preparation of RNs at the BSN level is essential. This can be accomplished either through initial education or through educational progression. To achieve this, individuals, organizations, policy makers, and educators must make policy decisions based on this core message. Seamless academic progression models must be developed to support nurses educational advancement (BSN or higher). This article also focuses on individual level nurse responsibility to practice at the fullest extent of scope of practice and remain accountable for their own educational progression. The article considers timing related to achieving specialty certification and recommendations for basic nursing education and continuing education content related to scope of practice, standards, and competencies, and for individual RN responsibility to obtain a BSN degree upon entrance to the nursing profession. …