Evaluating the Scope of Nursing Practice Decision Making Framework. An Australian experience

In 1995 the Queensland Nursing Council introduced the Scope of Nursing Practice Framework to guide nurses in delegation, assessment of competence and supervision. Two evaluations of the Framework implementation have been conducted but neither explored the Framework’s use by nurses in the workplace. The purpose of this study was to evaluate the implementation of the Framework in the daily practice of a sample of the state’s 57,000 nurses and midwives across various contexts of practice. Evaluation methodology was used because of the ascending approach to evaluating policy. Nurses (N = 88) and midwives (N = 10) were recruited from metropolitan, regional and rural public and private hospitals, community and aged care centres. Using focus groups, participants’ views on the utility of the Framework were explored. Triangulation was achieved through observation studies and document analysis. Transcripts of focus groups were analysed to identify data-rich themes. Observation data was subjected to theoretical analysis and documents were coded and analysed using content analysis and quasi-statistical methods. The data produced 12 significant outcomes including the overt and covert pressure on nurses to work outside of their scope of practice, usually from upper to middle management in most environments. At some sites, institutions policies limited the scope of practice of the registered nurse while expanding the scope of the enrolled nurse and unlicensed carer resulting in worker and workplace tension. The recommendations highlight the need for further education at all levels of nursing to strengthen the overall understanding of the principles of the Framework