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July 2016
Scope of Nursing Practice Decision-Making Framework
Introduction
In early 2015, the Tri-Council for Nursing, consisting of the American Association of Colleges of Nursing (AACN), the
American Nurses Association (ANA), the American Organization of Nurse Executives (AONE) and the National League
for Nursing (NLN), in collaboration with the National Council of State Boards of Nursing (NCSBN
®
), determined that a
uniform tool (scope of practice decision-tree) was needed. The tool would be adopted by boards of nursing (BONs),
used by facilities, and help a nurse determine whether specific activities, interventions or roles are permitted under the
nurse’s level of education, licensure and competence; and meet the standards established by the Nurse Practice Act
and rules/regulations of each state/jurisdiction.
Representatives from the ANA, NLN, BONs, along with NCSBN staff methodically reviewed the literature and
existing decision-making algorithms and used their expertise to develop a uniform tool that could be used across
states/jurisdictions.
Purpose
Recognizing that nursing practice is continually evolving, this document serves to provide a standardized, decision-
making framework for all licensed nurses in all settings with respect to their education, role, function and accountability
within the scope of nursing practice. It will assist nurses, including direct care nurses, in navigating current nursing
practice with all of its challenges. As practice transforms, licensed nurses need to communicate any ongoing issues/
concerns to their BON so regulators can evaluate whether changes to the Nurse Practice Act, rules/regulations, or
standards need to be considered.
Targeted Population
All licensed nurses (LPN/VN, RN and APRN) at all experience levels (novice to expert), in all practice settings, and in
all roles such as:
Direct care nurses
Nurse managers
Nurse administrators
Nurse educators
Nurse researchers
Nurse regulators
Nurse policymakers
Context for Use
To promote safety of patients, nurses would use this framework to:
Determine individual accountability for practice decisions;
Communicate with other health care professionals regarding the scope of nursing practice and the nurse’s
accountability;
Inform health care and other employing organizations about the scope of nursing practice and nursing
accountability;
Educate nursing students about their accountability for practice decisions; and
Guide professional nursing organizations, credentialing and regulatory agencies in the formulation of scope and
standards of practice, policy and position statements.
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Key Definitions
Accountability: “To be answerable to oneself and others for one’s own choices, decisions and actions as measured
against a standard such as that established by the Code of Ethics for Nurses with Interpretive Statements.”
(American Nurses Association [ANA], 2015a, page 41)
“To be accountable, nurses follow a code of ethical conduct that includes moral principles such as fidelity,
loyalty, veracity, beneficence, and respect for the dignity, worth, and self-determination of patients, as
well as adhering to the scope and standards of nursing practice. Nurses in all roles are accountable for
decisions made and actions taken in the course of nursing practice. Systems and technologies that assist in
clinical practice are adjunct to, not replacements for, the nurse’s knowledge and skill. Therefore, nurses are
accountable for their practice even in instances of system or technology failure.” (ANA, 2015a, page 15-16)
Appropriate resources: Human and material support to perform the activity, intervention or role safely, including
any necessary emergency management.
Education: Refers to basic nursing education, advanced nursing education or professional development to support
in the activity, intervention or role
Professional nursing standards: A set of standards for the practice of safe and effective nursing care such as
Nursing: Scope and Standards of Practice, Third Edition (ANA, 2015b) and Nursing Practice Standards for the
Licensed Practical/Vocational Nurse (National Association of Licensed Practical Nurses, 2003).
Reasonable and prudent nurse: A nurse that uses good judgment in providing nursing care according to accepted
standards and that another nurse with similar education and experience in similar circumstances would provide.
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Scope of Nursing Practice Decision-Making Framework
Identify, describe or clarify the activity, intervention or role under consideration.
Is the activity, intervention or role prohibited by the
Nurse Practice Act and rules/regulations or any other
applicable laws, rules/regulations or accreditation
standards or professional nursing
scope and standards?
Is performing the activity, intervention or role consistent
with evidence-based nursing and health care literature?
Are there practice setting policies and procedures in
place to support performing the activity,
intervention or role?
Has the nurse completed the necessary education to
safely perform the activity, intervention or role?
Is there documented evidence of the nurse’s current
competence (knowledge, skills, abilities, and
judgments) to safely perform the activity,
intervention or role?
Does the nurse have the appropriate resources to
perform the activity, intervention or role in the
practice setting?
YES
NO
YES
NO
YES
YES
YES
YES
Would a reasonable and prudent nurse perform the
activity, intervention or role in this setting?
YES
Is the nurse prepared to accept accountability for the
activity, intervention or role and for the
related outcomes?
YES
NO
NO
NO
NO
NO
NO
The nurse may perform the activity, intervention or role to acceptable and prevailing
standards of safe nursing care.
These decision-making framework guidelines are for educational purposes only. The guidelines do not purport to establish a standard of care or
advise a course of action for patient care in any particular situation.
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111 E. Wacker Drive, Ste. 2900
Chicago, IL 60601
Main 312.525.3600
Fax 312.279.1032
www.ncsbn.org
©2016 Tri-Council for Nursing, consisting of the American Association of Colleges of Nursing (AACN), the
American Nurses Association (ANA), the American Organization of Nurse Executives (AONE) and the National
League for Nursing (NLN), in collaboration with the National Council of State Boards of Nursing (NCSBN
®
).
References
American Nurses Association. (2015a). Code of ethics for nurses with interpretive statements.
Silver Spring, Maryland: Author.
American Nurses Association. (2015b). Nursing: Scope and standards of practice, Third Edition. Silver Spring,
Maryland: Author.
National Association of Licensed Practical Nurses. (2003). NFLPN Practice Standards for the Licensed Practical/
Vocational Nurse.
Advisory Panel
Karen Ballard, MA, RN, FAAN
Deb Haagenson, BSN, RN
Linda Christiansen, EdD, JD, MSN, RN
Gloria Damgaard, MS, RN, FRE
Judith A. Halstead, PhD, RN, FAAN, ANEF
Ruby R. Jason, MSN, RN, NEA-BC
Jane Clare Joyner, MSN, RN, JD
Ann M. O’Sullivan, MSN, RN, CNE, NE-BC, ANEF
Josephine Silvestre, MSN, RN
Maureen Cahill, MSN, RN, APN-CNS
Beth Radtke, MS
Maryann Alexander, PhD, RN, FAAN
One Dupont Circle, NW Suite 530
Washington, DC 20036
Main 202.463.6930
Fax 202.785.8320
www.aacn.org
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Silver Spring, MD 20910
Main 1.800.274.4ANA
www.nursingworld.org
155 N. Wacker Drive, Ste. 400
Chicago, IL 60606
Executive Office:
800 10th Street, NW, Two City Center
Ste. 400, Washington, D.C.
Phone 312.422.2800 | 202.626.2240
Fax 312.422.4503 | 202.638.5499
www.aone.org
2600 Virginia Avenue, NW
Eight Floor
Washington, D.C. 20037
Phone 800.669.1656
www.nln.org
