Scope of Practice: Can You vs Should You Perform a Task

Scope of practice defines the boundaries of what a nurse can do within their role. It is not a fixed list of tasks, but a combination of education, competence, policies, and the clinical situation. Understanding scope of practice helps guide safe decision-making and ensures that care is delivered appropriately. It also supports knowing when to act independently and when to seek support or escalate. Scope of practice can expand and contract, depending on the clinical environment and level of training.

What you need to know

Scope of practice refers to the range of activities a nurse is educated, competent, and authorised to perform. It is influenced by professional standards, workplace policies, and the clinical context.

In practice, this means:

• working within your level of knowledge, skill, and experience

• recognising when something is outside your scope

• seeking guidance or escalating when required

Scope of practice is not the same for every nurse. It develops over time with experience, training, and exposure to different clinical settings. What is appropriate for one nurse may not be appropriate for another, even within the same role.

Working outside of scope, or failing to act within scope, can both lead to unsafe care and disciplinary actions. Nurses are accountable for recognising these boundaries and making appropriate decisions.

Beyond the basics

Determining whether a task is within your scope is not always straightforward. It often requires clinical reasoning and critical thinking. A useful way to approach this is to ask yourself the following questions:

1. Have I had training and do I feel competent to perform the task?
   Competence involves both knowledge and skill. You should have been trained in the task and understand how to perform it safely, why it is being done, and what risks are involved. Feeling unsure can indicate that further support or supervision is needed. Acting without competence increases the risk of harm, even if the task is commonly performed by others.

2. Is there a policy that supports me performing the task?
   Workplace policies and guidelines outline what is permitted within a specific setting. Even if you have the skill, the task must be supported by organisational policy. Policies provide consistency and help ensure care is delivered in an approved and safe way. If a task is not covered by policy, it may require clarification or escalation before proceeding.

3. Is there adequate support and supervision if required?
   Some tasks may be appropriate within your scope but still require support, particularly if you are developing a skill or the situation is more complex. Knowing who is available to assist, supervise, or step in if needed is part of safe practice. Lack of support can increase risk and should be considered before proceeding.

4. Is the patient or situation appropriate for me to perform the task?
   Scope of practice is not just about the task itself, but also the context. A patient who is unstable, has multiple comorbidities, or is deteriorating may require a higher level of clinical expertise. Even familiar tasks can fall outside your scope in more complex or high-risk situations.

5. Would a reasonable and competent nurse perform the task in this situation?
   This question helps guide decision-making using a professional standard. It considers what is generally accepted as safe and appropriate practice. If the decision feels uncertain, this question can help prompt further reflection or discussion with a senior nurse.

6. Am I prepared to accept accountability for this task?
   Accountability means being able to justify your actions and decisions. Before proceeding, consider whether you can explain why the task was appropriate, how it was performed safely, and how it aligns with your role and standards of practice. If not, it may be outside your scope.

These questions support decision-making by linking competence, context, and accountability. They help ensure that care is delivered safely and within appropriate boundaries. If you answer no to any of these question, it would be appropriate to pause, seek further advice and consider your options before proceeding.

In practice

In clinical settings, scope of practice is applied through ongoing assessment and decision-making. It is not something you check once, but something you consider each time you perform a task.

For example, a nurse may be competent in performing a procedure but recognise that a deteriorating patient requires escalation instead. In another situation, a nurse may be asked to perform a task they have not been trained in, requiring them to seek guidance or decline until appropriate support is available.

In practice, working within scope involves:

• recognising personal limits and acting within them

• seeking support when unsure or when a task is unfamiliar

• adapting decisions based on patient condition and complexity

• escalating when a situation exceeds your level of competence

Scope of practice is not about limiting what you can do, it is about ensuring that what you do is safe, appropriate, and supported.

Case Study

Nurse A is a newly graduated Registered Nurse. During her training, she has performed nasogastric tube (NGT) insertions on multiple occasions in both adult and paediatric patients. She feels competent in performing this skill, and it is supported by hospital policy.

A patient under Nurse A’s care has a significantly low platelet count, increasing the risk of bleeding. There is an order to insert a NGT. Although the task itself is within her usual scope, Nurse A recognises that the patient’s condition introduces additional risk.

She determines that this situation is no longer appropriate for her to perform the procedure independently. Nurse A escalates to the medical officer, explaining her concerns regarding the bleeding risk. The medical officer reviews the patient and agrees that the situation requires further consideration and management and confirms that Nurse A made the right decision to pause and seek advice.

This demonstrates that scope of practice is not defined by the task alone, but also by the clinical context.