Enablers and Barriers to Registered Nurses Expanding Their Scope of Practice in Australia: A Cross-Sectional Study

Abstract

A number of resources exist to assist registered nurses in Australia to determine their scope of practice; however, the ability of a professional nurse to expand his or her practice is highly context dependent. This article reports on barriers and enablers to expanding scope of practice, as identified by registered nurses across Australia. A cross-sectional survey administered online in 2016 returned 1,205 useable submissions. Results indicated that nurses wishing to expand their practice felt supported to do so by nursing colleagues and were aware of professional and regulatory documents relating to expanding scope of practice. Less support for this process was evident from other health professionals or employers. Respondents also indicated that they were motivated to expand their scope by professional satisfaction, potential for career advancement, and the desire to meet health service user's needs. The majority of respondents identified barriers to expanding scope of practice, including lack of remuneration and the absence of supportive guidelines. Respondents in the early stage of their careers were more likely to perceive organizational support for expanding their scope of practice. When required to expand their role, the majority of respondents indicated that they had undertaken additional training or accessed various resources to guide them in this process. Barriers to expanding nursing scope of practice can result in underutilization of the one of the greatest resources in the health care system. This article identifies a number of strategies that can facilitate role expansion to ensure that nursing continues to make a significant contribution to positive health service outcomes in Australia.

Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK

“…While the factors leading to endorsement and specialist registration by a National Board are generally straightforward, the expression of these expanded scope of practice is often shaped by federal, state, and territory legislation around funding and prescription drugs that can form a barrier to practicing to full scope [66][67][68]. This has been found in particular in relation to nurse practitioner scope of practice where jurisdiction and clinical context continues to be a major influence on defining scope of practice [66,67]. Further, employers or professional associations may develop their own lists of skill sets that define scope of practice within specific settings or may use credentialing to verify the ability of practitioners to provide specialized practice within specific organizational environments [69].…”

Implementing pelvic floor muscle training for women with pelvic organ prolapse: a realist evaluation of different delivery models

“…For instance, resistance has been reported among several professional groups to creation of new roles (e.g. 'generic healthcare worker' [27] or 'independent nurse practitioner' [28] or 'nursing role expansion' [29,30] and professional conflict has been reported in the context of overlapping roles (e.g. primary healthcare teams [31]; physiotherapy and occupational therapy [32]).…”

Nursing and Midwifery Education: Historical Perspectives

“…In the United States (USA), advanced practice nurses are recognized as Advanced Practice Registered Nurses (APRN) with titles such as clinical specialist, certified nurse-midwife, nurseanesthetist, and nurse-practitioner (Parker and Hill 2017). Nurses in Australia can secure specialized practice endorsement in two areas: Nurse Practitioner and Endorsement for Scheduled Medicines Registered Nurses (Rural and Isolated Practice) (Birks et al 2019), these being the only advanced practice roles regulated in Australia. New Zealand has two established advanced practice rolesnurse practitioners who are regulated and have defined scope of practice and clinical nurse specialists whose role is not regulated nor definedboth roles are expected to be masters-level educated (Carryer et al 2018).…”

“…Education and professional development are natural enablers of expanded scope of practice (Birks et al 2019); however, lack of organized and available education can act as barriers to advanced nursing practice (McKenna et al 2015). Ongoing health workforce reform will be required to meet needs from chronic and complex conditions in ageing populations, amid existing workforce shortages, to enable health professionals to work at optimum scope of practice (McKittrick and McKenzie 2018).…”