lnfcncrw and C&d Cow Numng ( 1992) 8, 193 @ Longman Group UK Ltd !@2
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EDITORIAL
The scope of professional practice In 1988 the Royal College of Nursing (RCN) issued ‘Boundaries of Nursing’ proposing a different approach to decision-making as to what nurses should or should not accept as part of their practice as time moves on and situations change (RCN, 1988). The Department of Health reaffirmed the approach taken in 1977, a much more task-oriented approach, requiring certification of nurses’ competence to take on specific new tasks. Certificates were often signed by doctors and were frequently not recognised by other authorities when nurses changed jobs. Now the ‘Scope of Professional Practice’ document issued by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC, 1992) has officially sanctioned nurses to decide on adjustments to the scope of their own practice. However such adjustments must follow the principles laid down by the UKCC. These are firmly grounded in the UKCC Code of Professional Conduct, with its emphasis on knowledge, skill, responsibility, accountability and service to patients/clients. Some nurses have mixed reactions. No doubt some find the change anxiety-provoking. Taking personal responsibility for deciding when it is in patients’ interests to extend the scope of practice, and one’s competence to do so, requires more courage than just ‘sticking to the rules’ made by someone else - particularly in some organisational climates. As junior doctors’ hours are reduced (rightly so in most cases) there will no doubt be pressure for nurses to take on some of the tasks these doctors previously performed. There is already pressure for nurses to delegate so-called ‘basic’ tasks to less qualified staff. Nurses will have to discriminate carefully what is in the best interests ofputienti, taking into account all relevant circumstances. There can be no automatic assumption that tasks previously done by doctors are necessarily more important than those activities already consuming the time of fully occupied nurses. Nor do such tasks necessarily require more knowledge and skill than current nursing activities, so delegation of
the latter to less qualified staff may be inappropriate. Nurses have increasingly taken on responsibility for their part in critical care, often developing collegial and complementary relationships with medical staff and others. The increased personal professional freedom resulting from the UKCC’s pronouncements is an acknowledgement that nursing and nurses have now ‘come of age’. There have always been some nurses willing to take on new responsibilities and accept accountability even before it was explicitly required of all nurses in the UK. If there had not been critical care nursing would not be what it is now. But it is good to see nurses’ ability to function fully as self-regulated professionals officially recognised; and to see the increasing number of nurses who are well able to make, and justify, good decisions on the scope of their practice in the best interests of patients. The ‘Scope of Professional Practice’ document (UKCC, 1992) merits much more discussion. But the main point remains that ‘Nurses, as professionally accountable practitioners, must be able to develop their practice in line with new developments. But along with this freedom goes the responsibility to make conscious, deliberate decisions about what activities they take on, with consideration of the consequences’. (Ashworth, 1988) - and in particular the consequences for their patients. PA’I‘ASHWORTH
References Ashworth P 1988 Boundaries of nursing. (Editorial) Intensive Care Nursing 4(3): 9.3-94 Royal College of Nursing 1988 Boundaries of Nursing: a policy statement. Royal College of Nursing, London United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1992 Code of Professional Conduct (3rd edn). UKCC, London. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. 1992 The Scope of Professional Practice. UKCC, London
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I
EDITORIAL
The scope of professional practice In 1988 the Royal College of Nursing (RCN) issued ‘Boundaries of Nursing’ proposing a different approach to decision-making as to what nurses should or should not accept as part of their practice as time moves on and situations change (RCN, 1988). The Department of Health reaffirmed the approach taken in 1977, a much more task-oriented approach, requiring certification of nurses’ competence to take on specific new tasks. Certificates were often signed by doctors and were frequently not recognised by other authorities when nurses changed jobs. Now the ‘Scope of Professional Practice’ document issued by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC, 1992) has officially sanctioned nurses to decide on adjustments to the scope of their own practice. However such adjustments must follow the principles laid down by the UKCC. These are firmly grounded in the UKCC Code of Professional Conduct, with its emphasis on knowledge, skill, responsibility, accountability and service to patients/clients. Some nurses have mixed reactions. No doubt some find the change anxiety-provoking. Taking personal responsibility for deciding when it is in patients’ interests to extend the scope of practice, and one’s competence to do so, requires more courage than just ‘sticking to the rules’ made by someone else - particularly in some organisational climates. As junior doctors’ hours are reduced (rightly so in most cases) there will no doubt be pressure for nurses to take on some of the tasks these doctors previously performed. There is already pressure for nurses to delegate so-called ‘basic’ tasks to less qualified staff. Nurses will have to discriminate carefully what is in the best interests ofputienti, taking into account all relevant circumstances. There can be no automatic assumption that tasks previously done by doctors are necessarily more important than those activities already consuming the time of fully occupied nurses. Nor do such tasks necessarily require more knowledge and skill than current nursing activities, so delegation of
the latter to less qualified staff may be inappropriate. Nurses have increasingly taken on responsibility for their part in critical care, often developing collegial and complementary relationships with medical staff and others. The increased personal professional freedom resulting from the UKCC’s pronouncements is an acknowledgement that nursing and nurses have now ‘come of age’. There have always been some nurses willing to take on new responsibilities and accept accountability even before it was explicitly required of all nurses in the UK. If there had not been critical care nursing would not be what it is now. But it is good to see nurses’ ability to function fully as self-regulated professionals officially recognised; and to see the increasing number of nurses who are well able to make, and justify, good decisions on the scope of their practice in the best interests of patients. The ‘Scope of Professional Practice’ document (UKCC, 1992) merits much more discussion. But the main point remains that ‘Nurses, as professionally accountable practitioners, must be able to develop their practice in line with new developments. But along with this freedom goes the responsibility to make conscious, deliberate decisions about what activities they take on, with consideration of the consequences’. (Ashworth, 1988) - and in particular the consequences for their patients. PA’I‘ASHWORTH
References Ashworth P 1988 Boundaries of nursing. (Editorial) Intensive Care Nursing 4(3): 9.3-94 Royal College of Nursing 1988 Boundaries of Nursing: a policy statement. Royal College of Nursing, London United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1992 Code of Professional Conduct (3rd edn). UKCC, London. United Kingdom Central Council for Nursing, Midwifery and Health Visiting. 1992 The Scope of Professional Practice. UKCC, London
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