Thompson, M. (1997)
Borders, boundaries and balloons: Conceptual and professional issues in defining the scope of practice.
Royal College of Nursing, Australia, 4(1), 32-36.

• Reviewed by Nan Turner

As the abstract indicates, this paper explores relevant conceptual and professional issues to assist nurses to address the important issue of articulating the scope of practice for nursing. They discuss the issues in terms of boundaries limiting practice, borders being extended and balloons being flexible and shaped by forces and events internal and external to them.

The paper addresses the fact that nursing is struggling with the definition of their scope of practice. Many outside factors have affected the practice: rising healthcare costs, specialization of nursing, non-licensed professionals replacing nurses, and nurses leaving the profession.

Two important questions that are raised in the paper are: 1) What range of responsibilities are beginning practitioners prepared for? And 2) Who determines the range of responsibilities: educators, employers, individual nurses, professional nursing organizations, and other professions?
The purpose of the Scope of Practice Project currently being undertaken by the Queensland Nursing Council is to develop a policy framework that will encompass nursing practice wherever it is undertaken and practiced.

The paper warns that an occupation which is characterized by a list of activities is in danger of being limited in its practice and having its growth stifled as other occupations are developed to carry out specific activities. Examples are given of how nursing’s scope of practice changes based upon the situation. It is clear, however, that there are limits on what nurses can competently do based upon their education.

The approach the paper suggests is to identify what different areas of nursing practice have in common, and what are the essential differences, will facilitate the transition of nurses from one area of practice to another, maintain acceptable standards of practice and assist in the development of cost-effective educational programs (seems a similar approach to EMS makes sense).

The author feels that there are three important characteristics of a statement of scope of practice: (1) a strong client-based focus; (2) acknowledgement of the diversity of nursing practice; and (3) accommodation of the dynamic nature of nursing and the provision of healthcare. She also suggests that the framework of nursing’s scope of practice be responsive to change but that the profession manages this responsiveness. It is also essential that this statement articulate nurse’s practice wherever and whenever it occurs.