UNIT 3: SCOPE OF PRACTICE IN HEALTHCARE PROFESSIONALS
Key Unit competence:Demonstrate understanding of scope of practice of healthcare professionals.
3.0 Introductory activity
Mr T. is admitted in the unit for patient with tuberculosis where a registered
nurse receives him for assessment. He is coughing, with chest pain and present
transpiration on his front. The vital signs are temperature of 38.80C, Blood
pressure of 102/64 mmHg, heart rate of 112beats/min and respiration of 20
cycles /min. The oxygen saturation is 92%. The health care professionals in that
service include nurses, physicians, epidemiologists, dieticians, radiologists and
pharmacist.How the nurse will give intervention for Mr T.’s treatment?
3.1. Introduction and definitions of associate nurse
Learning activity 3.1
Referring to the above case, the registered nurse and associate nurse are goingto intervene for patient care. T.
1. How will an associate nurse intervene to care for Mr. T.?
Associate Nurse: A nursing associate is a member of the nursing team in England
that helps bridge the gap between health and care assistants and registered
nurses. Nursing associates work with people of all ages, in a variety of settings in
health and social care. The role contributes to the core work of nursing, freeing up
registered nurses to focus on more complex clinical care. It’s a stand-alone role thatalso provides a progression route into graduate level nursing.
Scope of practice: Scope of practice describes the services that a qualified health
professional is deemed competent to perform, and permitted to undertake in
keeping with the terms of their professional license.is used by national agencies and
regulatory authorities to define the parameters of a professional’s activities, those
include procedures, actions and associated processes that a licenced individual ispermitted to perform.
The rationale for such scope of practice definitions for health care professionals
include protection of the public, a general societal understanding of the role and
functions of the practitioner, and the need for role clarity to ensure that practitioners
can practice to the full extent of their capabilities and thereby optimise their
contribution to the provision of an effective and safe public health service.
A Profession is a range of roles, functions, responsibilities, activities and
professional accountability for which a nurse, or midwife is educated, competent,
and has the authority to perform within limits of a particular sphere of practice.
A competence is the ability of the nurse or midwife to practice safely and effectively
to fulfil her/his professional responsibility within one’s own scope of practice.
Nursing activities
According to the International Council of Nurses (ICN 2010): Nursing encompasses
autonomous and collaborative care of individuals of all ages, families, groups
and communities, sick or well and in all settings. Nursing includes the promotion
of health, prevention of illness, and the care of ill, disabled and dying people.
Advocacy, promotion of a safe environment, research, participation in shaping
health policy and in patient and health systems management, and education arealso key nursing roles.
The key factors in nursing and midwifery profession determining factors that must
be taken into account in deciding on the scope of practice of nursing and midwifery
shall be the following: competence, accountability autonomy, and continuing
professional development. Nursing activities that the nurse shall perform amongothers, will include the following:
• Reception and registration of patients/client
• Health education to the client/patient, family and community;
• Provision of safe client/patient care;
• Follow-up of client/patient ;
• Prompt reporting of client/patient information on condition as necessary
• Management of working environment;
• Leadership and management of resources;
• Collaboration with multidisciplinary teams;• General safety of patients/clients, staff and working environment.
According to the scope of practice for the nurse as defined by ministerial order
of Rwanda, the registered nurse shall plan, lead, supervise and evaluate health
promotional activities, preventative care, curative, rehabilitative and palliative
services, managerial educational, training and research roles,
An associate nurse will
• Carry out home visits for delivery of health services to individuals, families and
community including follow-up, education, monitoring of nutrition, hygiene
and sanitation in conjunction with multidisciplinary teams
• Use communication skills for behavioural change of an individual, family and
community
• Communicates appropriate information for effective behaviour change and
maintenance of sound health. More details on the roles of the associate nurseare described in unit one on characteristics of the associate nurse.
Self-assessment 3.1
Define these concepts
1. Scope of practice
2. Clarify the importance of the scope of practice
3. Mr. H is an associate nurse and is working in health centre to provide
care to mothers who bring their children coming for measurement of
weight, height and brachial perimeter, assessment for nutritional status,
receiving food supplements like vitamin A, therapeutic milk and injections
for vaccination. He works with Mrs J. who is a registered nurse who is
in charge of vaccination service. Administers vaccinations to children,
give health education to their mothers about hygiene, breast feeding, and
proper nutrition, she registers the children vaccinated and their weight,
height and brachial perimeter, she observes the availability and safety of
the vaccines, and she do a weekly report to the health centre manager.
a. What activities will be done by Mr H.?b. What are the activities done by Mrs J. ?
3.2. Roles of associate nurse
Learning activity 3.2
Mr B. is allocated in the health centre where Mrs C. a registered nurse works
with him. There are many clients and today is for immunization and they profit
that occasion to provide health education to the mothers who bring their children
for immunization.
1. What activities you think that will be done by Mr B. and Mrs C.?
2. During health education, what topics may be used by Mr B. and Mrs C.?
Associates Nurses alike nurses and other healthcare professionals, can expand
their knowledge and skills with the right training and governance. However, the
intention is for nursing associates to support, not substitute, registered nurses.
They follow the standards for nursing and nursing associate programs.
1. Being an accountable professional: associates nurses act in the best
interests of people, putting them first and providing nursing care that is
person-centered, safe and compassionate. They act professionally at all
times and use their knowledge and experiences to make evidence based
decisions and solve problems. They recognize and work within the limits of
their competence and are responsible for their actions.
2. Promoting health and preventing ill health: associates nurses play a
role in supporting people to improve and maintain their mental, physical,
behavioural health and wellbeing. They are actively involved in the prevention
of and protection against disease and ill health, and engage in public health,
community development, and in the reduction of health inequalities
3. Provide and monitor care: associates nurses provide compassionate,
safe and effective care and support to people in a range of care settings.
They monitor the condition and health needs of people within their care on
a continual basis in partnership with people, families, and caregivers. They
contribute to ongoing assessment and can recognize when it is necessary
to refer to others for reassessment.
4. Working in teams: associates nurses play an active role as members of
interdisciplinary teams, collaborating and communicating effectively with
nurses, a range of other health and care professionals and lay caregivers.
5. Improving safety and quality of care: associates nurses improve the quality
of care by contributing to the continuous monitoring of people’s experience
of care. They identify risks to safety or experience and take appropriateaction, putting the best interests, needs and preferences of people first.
6. Contributing to integrated care: associates nurses contribute to the
provision of care for people, including those with complex needs. They
understand the roles of a range of professionals and carers from other
organizations and settings who may be participating in the care of a person
and their family, and their responsibilities in relation to communication andcollaboration.
Self-assessment 3.2
1. Use examples to illustrate four roles of an associate nurse
2. How does an associate nurse improve safety and quality of care whileproviding nursing care?
3.3. Scope of nursing associate
Learning activity 3.3
Mr P. a 50 year old patient is admitted in Internal Medicine service for a long
lasting gastritis. Mr U. an associate nurse working in that service receives the
patient and took vital signs. The registered nurse came to assess the patient and
calls the medical doctor. The Doctor came and ordered to take samples for labinvestigations and prescribed oral medications to reduce the pain.
1) Which activity will be carried out by an associate nurse in caring this client?
2) Which activity is not in the competence of an associate nurse?3) What a AN will do ?
Introduction
In order to meet the proficiency outcomes outlined in the main body of this document,
nursing associates must be able to carry out the procedures in health and caresetting.
Procedures to be undertaken by the nursing associate
At the point of registration, the nursing associate will be able to safely demonstratethe following procedures:
1. Procedures to enable effective monitoring of a person’s condition
• Accurately measure weight and height, calculate body mass index and
recognize
• Use manual techniques and devices to take, record and interpret vital
signs including temperature, pulse, respiration (TPR), blood pressure
(BP) and pulse oximetry (SO2)in order to identify signs of improvement,
deterioration or concern
• Measure and interpret blood glucose levels
• Collect and observe sputum, urine, stool and vomit specimens, interpreting
findings and reporting as appropriate
• Recognize emergency situations and administer basic physical first aid,including basic life support.
2. Procedures for provision of person-centered nursing care provide
support in meeting the needs of people in relation to rest, sleep, comfort and
the maintenance of dignity:
• Use appropriate bed-making techniques, including those required for
people who are unconscious or who have limited mobility
• use appropriate positioning and pressure relieving techniques
• Take appropriate action to ensure privacy and dignity at all times
• appropriate action to reduce or minimize pain or discomfort
• Support people to reduce fatigue, minimize insomnia and take appropriate rest.
3. Provide care and support with hygiene and the maintenance of skin integrity:
• Observe and reassess skin and hygiene status using contemporary
approaches to
• Determine the need for support and ongoing intervention.
• Identify the need for and provide appropriate assistance with washing,
bathing, shaving and dressing
• Monitor wounds and undertake simple wound care using appropriate
evidence-based techniques.
4. Provide support with nutrition and hydration:
• Assist with feeding and drinking and use appropriate feeding and drinking aids
• Record fluid intake and output to identify signs of dehydration or fluid
retention and escalate as necessary• Support the delivery of artificial nutrition using NGT
5. Provide support with maintaining bladder and bowel health:
• Observe and monitor the level of urinary and bowel continence to
determine the
• Need for ongoing support and intervention
• Assist with toileting, maintaining dignity and privacy and use appropriate
continence products• Care for and manage catheters for all genders
6. Provide support with mobility and safety:
• Use appropriate assessment tools to determine, manage and escalate
the ongoing risk of falls
• Use a range of contemporary moving and handling techniques and
mobility aids
• Use appropriate moving and handling equipment to support people with• Impaired mobility.
7. Provide support with respiratory care: take and be able to identify normalSO2 and oximetry measurements
8. Preventing and managing infection:
• Observe and respond rapidly to potential infection risks using best
practice guidelines
• Use standard precautions protocols
• Use aseptic, non-touch techniques
• Use appropriate personal protection equipment
• Implement isolation procedures
• Use hand hygiene techniques
• Safely decontaminate equipment and environment• Safely handle waste, laundry and sharps.
9. Meeting needs for care and support at the end of life:
• Recognise and take immediate steps to respond appropriately to
uncontrolled symptoms and signs of distress including pain, nausea,
thirst, constipation, restlessness, agitation, anxiety and depression
• Review preferences and care priorities of the dying person and their
family and carers, and ensure changes are communicated as appropriate
• Provide care for the deceased person and the bereaved, respectingcultural requirements and protocols.
10. Procedural competencies required for administering medicines safely:
• Continually assess people receiving care and their ongoing ability to self
administer
• Their own medications. Know when and how to escalate any concerns
• Undertake accurate drug calculations for a range of medications
• Exercise professional accountability in ensuring the safe administration of
• Medicines to those receiving care
• Administer medication via oral, topical routes
• Administer injections using subcutaneous and intramuscular routes and
manage injection equipment
• Administer and monitor medications using enteral equipment
• Administer enemas and suppositories
• Manage and monitor effectiveness of symptom relief medication
• Recognize and respond to adverse or abnormal reactions to medications,
and when and how to escalate any concerns
• Undertake safe storage, transportation and disposal of medicinalproducts.
Self-assessment 3.3
1. Describe five procedures in the scope of practice of an associate nurse2. Which procedures included in preventing and managing infection?
3.4. End Unit Assessment
End unit assessment
Section 1 : Multiple choice questions
Read the following options and choose the right answer
1) Among the following activities which one is not performed by an associate nurse?
a. Vaccination
b. Health education on breast feeding is a health promotional activity
c. Provide oral analgesic drugsd. Provide oxygen therapy
2) Among the following activities which one is in competence of an associate nurse?
a. Give drug for malaria
b. Perform urinary catheter
c. Plan care for the patient in post-operative cared. Evaluate performance of the staff
3) Among the following activities which one is managerial activity?
a. Vaccination
b. Give drug for malaria
c. Give report on numbers of patientd. Evaluate performance of the staff
4) Among the following activities which one is an educational activity?
a. Evaluate performance of the staff
b. Teach nursing student during internship
c. Give drug for diabetesd. Give supplement food to children
Section 2: Read the following statement and answer by T if the
statement is true or F if the statement is False
1. The associate nurse in the unit is not responsible of good utilization of
materials in allocated services
2. The associate nurse carries out home visits for delivery of health services
to individuals, families and community
3. The scope of practice describes the services that a qualified healthprofessional is allowed and competent to perform
Section 3: Case study
Each health institution offers many services to the public and among these
services we have admission of the client in hospitalization unit, or being
cared in outpatient consultation and each client. Receive required care. To
ensure the promotion of the client health and well-being a collaboration of the
multidisciplinary team is very important in caring the client. A client suffering
for a long-lasting gastritis was admitted after road accident and has left an arm
fracture which needs surgical intervention for better management. The client
needs medication to reduce pain, a picture of the fracture and to be prepared forsurgical intervention
According to the scope practice and activities to be carried out in caring this
1. Enumerate activities to be carried out by an associate nurse
2. Clarify how the scope of practice protects the patient as well as thenurse?
SECTION 4. ADDITIONAL ACTIVITIES
4. 1 . Remedial activities
All of you have already been in health institution and observe different activities
carried out by the nurse
a) Identify any 5 activities to be carried out by an associate nurse without
supervision
b) If as an associate nurse you are assigned a task that is not in yourcompetences what are you going to do?
4. 2. Consolidation activities
1) Identify any 4 roles of associate nurse2) By using 4 examples, explain scope of an associate nurse
4. 3. Extended activities
A 20 years old female have been in the health centre as he has headache ,
fever and loss of appetite. The nurse starts by taking vital signs as the client
was looking tired, the client has temperature of 400 Celsius. The nurse decides
to withdraw a blood sample for laboratory investigation then give medication to
reduce body temperature while waiting the result of blood examination . After
having blood results, the client was suffering for Malaria
According to the scope of practice of a nurse:
1. Is the nurse the competence to give treatment to this client? Why?
2. If the client receives appropriate treatment against malaria, what the
nurse should do to prevent the complication and relapse of Malaria?
3. If the client has manifested signs of anemia (insufficient blood in the
body), which health professional is competent to treat adequately thisclient?