Student Scope of Practice- Requirements and Restrictions

In the health disciplines, students are identified as learners by the various regulating bodies.

So let’s take a moment to consider ‘what is learning’ and how teachers contribute to learning.

“Learning is an active, personal process. The student is the one who experiences the learning. Teachers cannot provide the experience, they can provide only the opportunity for the experience. The teacher’s role is to provide activities that facilitate learning.” (Gaberson & Oermann, 1999, p. 3). It is the responsibility of the student to become aware of their practice requirements and restrictions in collaboration with their teachers/educational institutions/regulatory bodies.

Here are some familiar phrases for students regarding scope of practice responsibilities…..

“In consultation with your clinical instructor, you are responsible for your own practice in the clinical setting”

“All students should be familiar with the Standards of Nursing Practice developed by the College of Nurses”

“All students are responsible to review the Best Practice Guidelines on the RNAO website”

“Students have a responsibility to familiarize themselves with the academic regulations in the Faculty of Health Sciences Undergraduate Studies at:

Failure to follow Academic regulations may result in failure of the course. If students find themselves having difficulty meeting course requirements, they are responsible to contact the professor”.

Take a moment and consider the term “responsible” and what it means in terms of student’s scope of practice.

The term ‘responsible’ is often used synonymously with the term accountable. Being responsible or accountable is the acknowledgement and assumption of responsibility for actions and decisions including the implementation of scope of role or employment position. (Wikipedia, 2010).

Some of the issues identified by students in regards to scope of practice:

In round table discussions with 12 nursing students from the University of Ottawa, Algonquin and St Lawrence College it became evident that students feel that there is a lack of defined scope of practice when entering the clinical environment.  They also feel confused by differing scope of practice responsibilities and restrictions instituted by various institutions.

Students referred to this example of Learning Outcomes from a clinical course:

Within the context of acute care, the student will:

1. apply theorectical and evidence based concepts to provide nursing care for children with acute and chronic illnesses and their families

2. demonstrate professional conduct

3. demonstrate accountability and responsibility for clinical decisions

4. practice within the ethical and legal guidelines of the College of Nurses

5. demonstrate accountability and responsibility for personal learning

6. demonstrate ability to utilize a range of communication strategies to meet the diverse needs of children and their families

These outcomes are broad. Is it possible to make student scope of practice more defined?

CNO highlights nursing student scope of practice responsibilities and restrictions in this link from Sick Kids’ Hospital in Toronto.

http://www.sickkids.ca/Nursing/Education-and-learning/Nursing-Student-Orientation/nursing-student-roles-and-responsibilities/index.html

The Children’s Hospital of Eastern Ontario has similar guidelines in regards to student scope of practice.  In addition to the above statements this institution clearly outlines restrictions to student scope of practice in this pediatric setting.  For example, students may not perform IV direct administration of medications- such as Ancef.

Another example, students may perform Q hourly assessments of patients on epidural, PCA or continuous opiod infusions. However, the assessments must be co-signed by the Clinical instructor or most responsible nurse caring for the patient (CHEO, 2009).

Why does scope of practice vary? Why place restrictions?

Nursing programs differ significantly, so student’s scope of practice will vary depending on where they are enrolled. Scope of practice provides a framework that guides clinical learning and the nursing activities that students can participate in. It is not meant to unnecessarily limit student learning but provide a clear outline of the types of activities that students should focus on (Levett-Jones & Bourgeois, 2006). Scope of practice will develop as the student progresses through the nursing program, as their level of competence increases and may vary depending on the context of the placement.

Restrictions are placed for the safety of patients and students need to understand their scope of practice, articulate it to staff members and work within that scope.

A clear outline of scope of practice specific to each year of the nursing program may benefit students, clinical professors and nurses to better understand, support and challenge students based on a collaborative understanding of expectations –responsibilities and restrictions.