Encroachment Into Practice
Norma J. Gomez

Norma J. Gomez, MBA, RN, CNN,  is Director of Education, DaVita Inc., Homestead, FL. She is ANNA National Treasurer, and is a member of the South Florida Flamingo Chapter of ANNA.

As Registered Nurses (RNs) take on more responsibilities due to work environment issues, we also concede some of our nursing duties to other practitioners. We need to perceive this overlap as a “threat” to our role because other health care disciplines are beginning to see it as an opportunity for enhancing their roles. The boundary between the professional and nonprofessional practitioner has become blurred.

Nursing is defined as “the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities and populations” (ANA, 2003). Even though skills and knowledge may change and evolve over time, there are certain core nursing values that remain consistent.

As health care costs continue to rise, the use of other licensed and nonlicensed caregivers to provide nursing care is increasing. Pharmacists, emergency medical services (EMS) providers, and unlicensed assistive personnel (UAP) lead the list of practitioners looking to expand their role into the nursing arena. Pharmacists are looking to increase their scope of practice to include administration of medication as well as prescriptive authority. EMS personnel are usually restricted to prehospital care, but in some areas they are being used inappropriately in emergency room settings to provide direct care.

I believe RNs are the best advocates for themselves. Legislative and regulatory routes may not be the best way to resolve encroachment issues. The political process is slow and may not actually fix the problem. Once “laws” are enacted, the process may slow down our ability to be proactive on the really important professional issues.

We have made inappropriate assumptions about nursing’s role due to our different levels of education (entry into practice issues), experience, and cultural background. Defining the nurse’s role can be difficult, as nursing itself continually debates “what nursing is and is not.” Other professionals may embrace our role as a leader within the health care system, if our role was understood and agreed upon within our own profession.

What Can Be Done
So, what can we do to address encroachment issues? As nurses, we need to be aware of the boundaries of our own knowledge and skills and only undertake care for which we are prepared, competent, and confident to assume. The same goes for delegating a “nursing” task. Any nurse who exceeds his/her scope of practice not only puts his/her own license at risk but the license of any RN who carries out those orders. We must be aware of our State Nurse Practice Acts as well as ANNA’s Standards of Practice and Guidelines for Care. We need to address the work environment issues through mechanisms other than “giving away our nursing tasks” to nonlicensed practitioners. We need to be role models and mentors for nursing students and colleagues within our own practice settings. The organization’s nursing leadership must provide opportunities for enhancing nursing such as ensuring representation at all organizational meetings where decisions affecting nursing practice will take place and supporting role modeling so that nursing practice behaviors may improve. They must effectively encourage professional advancement and empowerment for nurses within their organizations.

Summation
In the end, it is up to each one of us to uphold the profession of nursing. We need to examine our role within the organization and within nursing. Our actions are part of what the public perceives nursing to be. We need to ensure that the perceived “blurred boundaries” of care become clear to every nurse, patient, physician, administrator, and consumer. Individual accountability and professional accountability must be addressed before we are no longer considered a profession. Each nursing task we delegate to a nonnurse reinforces to the administrators, physicians, patients, and the general public that anyone can perform the duties of a registered nurse.

References
American Nurses’ Association (ANA). (2003). Definition of professional nursing. ANA’s Nursing’s Policy Statement (2nd ed.). Washington, DC: Author.

Additional Readings
Bruser, S., & Whittaker, S. (1998). Diluting nurses’ scope of practice. American Journal of Nursing. Retrieved October 11, 2005, from http://www.nursingworld.org

Spilsbury, K., & Meyer, J. (2004). Use, misuse and non-use of health care assistants: Understanding the work of the health care assistant in a hospital setting. [Electronic version] Journal of Nursing Management, 12(6), 411-418.

Trossman, S. (2005). The battle over RN replacement. American Journal of Nursing, 105 (11), 73-77.