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Six-Step Decision-Making Model for Determining Nursing Scope of Practice
This decision-making flowchart was developed by Board of Nursing (BON) staff to assist nurses in making good professional judgments about the nursing tasks or procedures they choose to undertake. It references parts of the NPA and Rules, and asks the nurse to apply other questions to his/her specific practice situation. These same sections of the nursing laws and targeted questions are tools board staff utilize when nurses call and ask “Is this task/procedure in my scope of practice?”
A nurse always has a duty to his/her clients/patients to assure that they are safe. One of the most important actions a nurse can take toward that goal is making sure that he/she only accepts those assignments for which the nurse has the education, training, and skill competency. Physical and emotional ability can also impact a nurse’s ability to maintain client safety when accepting an assignment.
The BON does not maintain that this is the only model a nurse may use for assistance in determining his/her scope of practice in a given situation; however, all nurses practicing in Texas must comply with the Nursing Practice Act and Board Rules as they apply to LVNs, RNs, and\or RNs with advanced practice authorization in a given role and specialty.
Step One: Is the act consistent with the Texas Nursing Practice Act (NPA)? Do the Board’s rules or positions statements address this specific act? ( This may be all the information you need to make your decision. If not, continue to the next step.
The following Information available on the BON’s web page may be of assistance: a. NPA, Ch. 301.002(2), Definition of Professional Nursing & Ch. 301.002(5), Definition of Vocational Nursing. b. Standards of Professional Nursing Practice (BON Rule 217.11) c. Unprofessional Conduct Rule (BON Rule 217.12) d. Delegation Rules for RN Delegation to Unlicensed Assistive Personnel (224 & 225) e. Documents listed under “Scope of Practice” in the Nursing Practice Section on the BON web site. f. BON Position Statements, Guidelines, & Frequently Asked Questions (FAQ’s)
If NO, the act is NOT within your scope of practice; If YES, continue to the next step.
Step Two: Is the activity appropriately authorized by a valid order when necessary, and in accordance with current policies and procedures? Clarification of the orders(s) should be sought as needed [Rule 217.11(1) (N)].
If NO, the act is NOT within your scope of practice; If YES, continue to the next step.
Step Three: Is the act supported by positive and conclusive data from nursing literature, nursing research, and/or research from a health related field (such as evidence based practice standards)? Has a national nursing organization issued a position statement, guideline, or standard supporting LVNs, RNs, or both engaging in this practice?
If NO, the act is NOT within your scope of practice; if YES, continue to the next step.
Step Four: Do you personally possess current clinical competence to perform the task safely from knowledge acquired in a basic nursing education program, post-basic program, or continuing education program? Documentation to validate competency should be maintained in accordance with agency/facility policy and procedure. Each nurse is also encouraged to maintain his/her own copies of competency forms.
If NO, the act is NOT within your scope of practice; if YES, continue to the next step.
Step Five: Is the performance of the act within the accepted “standard of care” which would be provided in similar circumstances by reasonable and prudent nurses who have similar training and experience? An additional related question to ask is: If an untoward event/reaction occurs as a result of your nursing actions, can the untoward consequences/reaction be resolved through nursing intervention alone?
Rule 217.11(1)(A) states that the nurse (LVN, RN or RN with advanced practice authorization) shall:“Know and conform to the Texas Nursing Practice Act and the board’s rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse’s current area of nursing practice.”
Review of the applicable rules in their entirety is recommended for the nurse in this step of the six-step model. In addition, human, material, and equipment resources can vary greatly across the spectrum of possible practice settings, and may contribute to the nurse’s decision in a given circumstance.
If NO, the act is NOT within your scope of practice; if YES, continue to the next step.
5. Would a reasonable and prudent nurse perform this activity in this setting?
Yes → Continue No → STOP
6. Are you prepared to assume accountability for the provision of safe care and the outcome of the care rendered?
Yes → Perform the No → STOP Activity
