Considerations in determining scope: expanded practice and emergency situations

‘Expanded practice’ is understood as a change in the role of an individual nurse or midwife to include areas of practice that have not previously been within their scope of practice, but are within the overall scope of practice of the nursing and midwifery professions. This can involve taking on new roles or delegating roles and responsibilities.

Expanded practice can occur within any nursing or midwifery role. Research indicates that expanded nursing and midwifery practice results in better patient outcomes, enhanced outcomes for healthcare staff and improved service quality and development.

Expanded practice should occur in the context of quality person-centred safe care, service needs and national policy. There is no specific stage in the nurse’s or midwife’s clinical career at which expansion of practice occurs. The individual nurse or midwife’s educational preparation and professional competence, and not the nature or degree of difficulty of the task, should determine role expansion. Nurses and midwives have demonstrated their willingness to expand their practice through continuing professional development, and through specialist and advanced roles.

Examples of expanded practice in Ireland have included but are not limited to intravenous cannulation, nurse and midwife prescribing of medicines and ionising radiation, behaviour management, nurse and midwifery-led clinics in acute and community settings. There are also the defined expanded roles of: clinical nurse specialist; clinical midwife specialist; advanced nurse practitioner; and advanced midwife practitioner.

The expanded scope of practice associated with advanced practitioner roles incorporates the interpretation and application of advanced nursing or midwifery theory and research, higher-level decision-making and autonomy in practice, which are congruent with their education level and clinical experience.

Nurses and midwives who expand their roles must assume the associated responsibility. In addition, managers and employers share the responsibility to facilitate role expansion; including access to further education, allocation of necessary resources, policy development and assessment of competence.

Emergency situations

The guidance presented in this document supports a nurse or midwife taking appropriate action in emergency and / or life-threatening situations. At all times, the overall benefit to the patient must be served in these situations.
 

Scope of Nursing and Midwifery Practice Framework

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