Nurses' Scope of Practice and the Implication for Quality Nursing Care

Monday, 28 July 2014: 7:20 AM

Lizeth Roets, PhD, MSocSc (Hons), BSocSc
Department of health studies, University of South Africa, Pretoria, South Africa
Johanna Catharina (Irene) Lubbe, PhD, MSocSc (CritCrNsg), AdvDipEducMgmt, BSocSc
Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa


The purpose of this presentation is to give an overview of the implications for patients’ health status and care needs when assessments are performed by nurses not licensed or competent to perform this task. The “Waterlow™ scale” scenario is used as a practice example to illustrate this case.


A retrospective quantitative study was utilised. A checklist was used to perform an audit on a random sample of 157 out of an accessible population of 849 patient files. Data was gathered in May 2012 and the analysis was done using frequencies and percentages for categorical data. Reliability and validity were ensured and all ethical principles were adhered to.  


Eighty percent of risk assessments were performed by nurses not licensed/enrolled to perform this task unsupervised. Areas such as tissue malnutrition, neurological deficits and medication were inaccurately scored, resulting in fifty percent of the Waterlow™ risk-assessment scales, as an example, being incorrectly interpreted. This has implications for quality nursing care and might put the patient and the institution at risk.


Lower-category nurses and student nurses should be allowed to perform only tasks within their scope of practice for which they are licensed or enrolled. Nurses with limited formal theoretical training are not adequately prepared to perform tasks unsupervised, even in the current global nursing shortage scenario.

To optimise and ensure safe and quality patient care, risk assessments should be done by a registered professional nurse, who will then coordinate the nursing care of the patient with the assistance of the lower category of nurses.