Social Policy Statement/Scope of Practice

Summary of Nurse Practitioner (NP) Scope of Practice

The American Academy of Nurse Practitioners (1993)developed standards for practice that specify activities within the NP scope of practice and govern the services provided. The standards cover qualifications, the process of care, environment, collaborative responsibilities, documentation, client advocacy, quality assurance, supporting roles, and research. NPs provide primary health care services to individuals, families, groups of clients, and communities. In general, NP care is characterized by an emphasis on health promotion and disease prevention and, in addition, involves the diagnosis and management of common acute illnesses/injuries and stable chronic diseases. In the provision of these services, NPs may order, conduct, and interpret appropriate diagnostic and laboratory tests and prescribe pharmacologic agents, treatments, and nonpharmacologic therapies. Educating and counseling individuals and their families regarding healthy lifestyle behaviors are key components of NP care. Data in the following table lists services which may be performed by any NP, regardless of specialty. The general scope of services provided by NPs has three main categories: assessment of health status, diagnosis, and case management. Specific services are listed for each category. 

Some NPs choose to seek additional training and experience to be able to perform additional advanced clinical procedures to further expand the scope of practice. These procedures which can be completed by NPs with additional training depending upon prior experience and practice restrictions of individual state Nurse Practice Acts. 

 
  • Doppler exam of carotid and peripheral arteries 
  • Simple biopsy 
  • Incision and drainage of cysts 
  • Lumbar puncture 
  • Wound debridement 
  • Suturing 
  • Insertion of invasive intravenous and arterial lines 
  • Intubation 
  • Bedside urodynamics 
  • Setting of simple fractures 
  • Bone marrow aspiration 
    		•

    While the role of NP was first envisioned for practice based in the rural under-served community, NPs have worked in a wide variety of settings. Traditionally, most NPs practiced in either community- or hospital-based ambulatory care. Today, new roles are expanding opportunities for NPs to practice in such acute settings as hospital inpatient specialty units and emergency departments. 

     
     
     
    Scope of Services Provided by Nurse Practitioners in Primary Care 
    Type of Care Specific Activity 
    Assessment of Health Status Obtain a relevant health and medical history 

    Perform a physical examination, based on age and history 

    Conduct preventive screening procedures based on age and history (e.g., hearing, vision, dental, cancer) 

    Identify medical and health risks and needs 

    Order appropriate diagnostic tests 

    Developmental assess and evaluation and referral
    Diagnosis Order appropriate diagnostic tests

    Formulate appropriate differential diagnosis based on history, physical examination and clinical findings
    Case Management  Identify needs of the individual, family or community, based on evaluation of data collected

    Identify, implement and evaluate appropriate plan of care, including pharmacologic and non-pharmacologic interventions 

    Provide relevant patient/family education 

    Refer to other health professionals and community agencies 

    Reassess and modify plan of care as necessary to achieve medical and health goals 

      Reference: 
    The Internet Journal of Advanced Nursing Practice
    http://www.ispub.com/journals/IJANP/Vol1N2/scope.htm

    American Academy of Nurse Practitioners. (1993). Standards of practice. Washington, DC: Author.

    U. S. Congress, Office of Technology Assessment (1986). Nurse practitioners, physician assistants, and certified nurse-midwives: A policy analysis. Washington, DC: U. S. Government Printing Office.

    Pearson, L. J. (1997). Annual update of how each state stands on legislative issues affecting advanced nursing practice. The Nurse Practitioner: The American Journal of Primary Health Care, 19(1), 11-53.

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