Public Nursing Policy Meeting Assignment Essay

Public Nursing Policy Meeting Assignment Essay

Public Nursing Policy Meeting Assignment Essay

Submit a 4 page summary paper on the public policy meeting. Include headings in your paper that address these components:

The purpose of the meeting, key participants, key agenda items, and meeting logistics
Background information and a description about the committee
One specific topic that was discussed at the meeting and an explanation of the committee process
An analysis of the key stakeholder positions related to the topic discussed
Key interactions that occurred at the meeting
Outcomes of the meeting including the specific topic focus Public Nursing Policy Meeting Assignment Essay

The first six bullet points above should be your headings.
References should not be older than 2015
The link to the meeting .

An effective public health system that can assure the nation’s health requires the collaborative efforts of a complex network of people and organizations in the public and private sectors, as well as an alignment of policy and practice of governmental public health agencies at the national, state, and local levels. In the United States, governments at all levels (federal, state, and local) have a specific responsibility to strive to create the conditions in which people can be as healthy as possible. For governments to play their role within the public health system, policy makers must provide the political and financial support needed for strong and effective governmental public health agencies.


Weaknesses in the nation’s governmental public health infrastructure were clearly demonstrated in the fall of 2001, when the once-hypothetical threat of bioterrorism became all too real with the discovery that many people had been exposed to anthrax from letters sent through the mail. Communication among federal, state, and local health officials and with political leaders, public safety personnel, and the public was often cumbersome, uncoordinated, incomplete, and sometimes inaccurate. Laboratories were overwhelmed with testing of samples, both real and false. Many of these systemic weaknesses were well known to public health professionals, but resources to address them had been insufficient. A strong and effective governmental public health infrastructure is essential not only to respond to crises such as these but also to address ongoing challenges such as preventing or managing chronic illnesses, controlling infectious diseases, and monitoring the safety of food and water. Public Nursing Policy Meeting Assignment Essay

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Suggested Citation:”3. The Governmental Public Health Infrastructure.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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The fragmentation of the governmental public health infrastructure is in part a direct result of the way in which governmental roles and responsibilities at the federal, state, and local levels have evolved over U.S. history. This history also explains why the nation lacks a comprehensive national health policy that could be used to align health-sector investment, governmental public health agency structure and function, and incentives for the private sector to work more effectively as part of a broader public health system. In this chapter, the committee reviews the organization of governmental public health agencies in the United States. The chapter then examines some of the most critical shortcomings in the public health infrastructure at the federal, state, and local levels: the preparation of the public health workforce, inadequate information systems and public health laboratories, and organizational impediments to effective management of public health activities. The committee recommends steps that must be taken to respond to these challenges so that governmental public health agencies can meet their obligations within the public health system to protect and improve the population’s health. Public Nursing Policy Meeting Assignment Essay

The committee believes that the federal and state governments share a responsibility for assuring the public’s health. From a historical and constitutional perspective, public health is largely a local and state function. The role of the states and localities is a primary and important one. The federal government, however, has the resources, expertise, and the obligation to assess the health of the nation and to make recommendations for its improvement. Ensuring a sound public health infrastructure is an urgent matter, and the committee urges the federal government to engage in planning for national and regional funding to accomplish this.

In 1988, The Future of Public Health (IOM, 1988) reported that the American public health system, particularly its governmental components, was in disarray. In that report, the responsible committee sought to clarify the nature and scope of public health activities and to focus specifically on the roles and responsibilities of governmental agencies. Aiming to provide a set of directions for public health that could attract the support of the broader society, the committee produced findings and made recommendations dealing with three basic issues: Public Nursing Policy Meeting Assignment Essay

The mission of public health

The government’s role in fulfilling this mission and

The responsibilities unique to each level of government

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Suggested Citation:”3. The Governmental Public Health Infrastructure.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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The mission of public health was specified as “fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM, 1988:7). The government’s role in fulfilling this mission was described in terms of three core functions of public health practice: assessment of health status and health needs, policy development, and assurance that necessary services are provided. States were considered to have primary public responsibility for health, but it was considered essential that residents of every community have access to public health protections through a local component of the public health system. The public health obligations of the federal government included informing the nation about public health policy issues, aiding states and localities in carrying out their public health functions in a coordinated manner, and setting national health goals and standards. The report also contained recommendations for a review of the statutory basis for public health, the establishment of the governmental public health infrastructure as the clear organizational hub for public health activities, better linkages to other government agencies with health-related responsibilities, and strategies to strengthen the capacities of public health agencies to perform the core functions. A complete listing of the recommendations from that report can be found in Appendix C. Public Nursing Policy Meeting Assignment Essay

Responding to Disarray
The Future of Public Health provided the public health community with a common language and a focus for reform, and progress has been made. In Washington, Illinois, and Michigan, for example, revisions of the state public health codes resulted in the inclusion of mandatory provisions for funding and the distribution of services to all communities “no matter how small or remote,” as recommended by the Institute of Medicine (IOM) (1988). In 1994, the Public Health Functions Working Group, a committee convened by the Department of Health and Human Services (DHHS) with representatives from all major public health constituencies, agreed on a list of the essential services of public health. This list of services translates the three core functions into a more concrete set of activities, called the 10 Essential Public Health Services (see Box 3–1). These essential services provide the foundation for the nation’s public health strategy, including the Healthy People 2010 objectives concerning the public health infrastructure (DHHS, 2000) (see Appendix D) and the development of National Public Health Performance Standards (CDC, 1998) for state and local public health systems. Public Nursing Policy Meeting Assignment Essay

At least four subsequent National Academies reports have made a strong case for sustained federal action both domestically and internationally to strengthen the public health infrastructure (IOM, 1992, 1997a, 1997b; NRC, 2002). The federal government has yet to take the initiative to develop a comprehensive, long-term plan to build and sustain the financ-

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Suggested Citation:”3. The Governmental Public Health Infrastructure.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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BOX 3–1 The 10 Essential Public Health Services


Monitor health status to identify community health problems

Diagnose and investigate health problems and health hazards in the community

Policy Development

Inform, educate, and empower people about health issues

Mobilize community partnerships to identify and solve health problems

Develop policies and plans that support individual and community health efforts


Enforce laws and regulations that protect health and ensure safety

Link people to needed personal health services and assure the provision of health care when otherwise unavailable

Assure a competent public health and personal health care workforce

Evaluate effectiveness, accessibility, and quality of personal and population-based health services

Serving All Functions

Research for new insights and innovative solutions to health problems Public Nursing Policy Meeting Assignment Essay

ing for this infrastructure at the state and local levels to ensure the availability of the essential health services to all people, and this is a critical concern. The federal government has, however, developed and funded various new programs and organizational units, which, if effectively coordinated, could serve as important components of a more systematic program. The Centers for Disease Control and Prevention (CDC) established (in 1989) the Public Health Practice Program Office and strengthened university-based Centers for Prevention Research (initiated in 1983). CDC also developed Public Health Leadership Institutes (initiated in 1992) at the national and regional levels and the National Public Health Training Network (initiated in 1993). Both programs respond to recommendations to improve the overall leadership competencies of public health practitioners. In 1993, CDC began discussions of a modern and uniform approach to public health surveillance, and it has moved forward with the development of a National Electronic Disease Surveillance Network. More recently, CDC has worked with states to establish the Health Alert Network (initiated in 1999) to improve infor-

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Suggested Citation:”3. The Governmental Public Health Infrastructure.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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mation and communication systems for both routine and emergency use and the Centers for Public Health Preparedness (launched in 2000) to improve linkages between local health agencies and academic centers. These programs provided important services in the aftermath of September 11, 2001.

Many units within CDC have contributed to strengthening the public health infrastructure. The National Center for Chronic Disease Prevention and Health Promotion, for example, has led the effort to develop statewide population-based cancer registries, a tracking system for cardiovascular disease, and a program for the early detection of breast and cervical cancer (CDC, 2002). The National Center for Environmental Health also contributed to the improvement of public health monitoring and assessment functions when it developed a biomonitoring program to measure people’s exposures to 27 different chemicals by analyzing human blood and urine samples. Public Nursing Policy Meeting Assignment Essay This program offers the first national assessment of people’s exposure to 24 chemicals for which exposures were not previously assessed and 3 for which exposures were previously assessed. In 2002, the center began developing a nationwide environmental public health tracking network in response to a Pew Environmental Health Commission report entitled America’s Environmental Health Gap: Why the Country Needs A National Health Tracking Network (Pew Environmental Health Commission, 2000; Among CDC initiatives are the development of immunization registries and a guide to community preventive services (

Limited Progress
Despite this progress, the committee found that in many important ways, the public health system that was in disarray in 1988 remains in disarray today. Many of the recommendations from The Future of Public Health have not been put into action. There has been no fundamental reform of the statutory framework for public health in most of the nation. Funding for the public health infrastructure has recently increased to support the infrastructure that relates to bioterrorism and emergency preparedness but may still be insufficient. Furthermore, governmental and nongovernmental support (both political and financial) and advocacy for the report’s recommendations have been limited. Progress is mixed in strengthening public health agencies’ capacities to address environmental health problems, in building linkages with the mental health field, and in meeting the health care needs of the medically indigent. In addition, new information and technological challenges face the system today. In a recent review of the nation’s public health infrastructure for the U.S. Senate Appropriations Committee, Public Nursing Policy Meeting Assignment Essay

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Suggested Citation:”3. The Governmental Public Health Infrastructure.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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address gaps in workforce capacity and competency, information and data systems, and the organizational capacities of state and local health departments and laboratories.

Finding continued disarray in the public health system is especially disturbing because the nation faces increasingly diverse threats and challenges. The early detection of and the response to these threats will depend on capacity and expertise within the public health system at every level. The gaps in the system warrant urgent remediation. Many of these basic reforms also require actions from agencies that are outside the direct control of governmental public health agencies but whose policies and programs can have important health consequences, such as the Environmental Protection Agency (EPA) (environment) and the Departments of Agriculture (nutrition and food safety), Labor (working conditions), and Treasury (economic development). This support has not been forthcoming from elected or appointed government officials (including those in control of budgets), and stakeholders in the broader public health system—who should have been partners in the vision of creating a healthier nation—have yet to be effectively mobilized in this effort. Public Nursing Policy Meeting Assignment Essay

In the next section, the committee provides an overview of the special role of governmental public health agencies (at the federal, tribal, state, and local levels). The section addresses the legal framework for governmental responsibility and its authorities for protecting the health of the people as well as the organization of the governmental public health infrastructure.

Nursing Practice
The scope of nursing practice is defined as the range of roles, functions, responsibilities, and activities which
registered nurses are educated and authorized to perform.
The broad scope of nursing practice reflects all of the roles and activities undertaken by registered nurses to
address the full range of human experiences and responses to health and illness. This includes: health promotion,
health protection, health maintenance, health restoration, rehabilitation, and palliation.
Nursing practice is directed towards the goal of assisting clients to achieve and maintain optimal health in order to
maximize quality of life across the lifespan (ARNNL, 1995; CNA, 2002). Client, referring also to patient and
resident, is defined as an individual, a family, a group of individuals, a community, or a population. Nursing
practice is accomplished through:
 Utilization of nursing knowledge through the application of critical thinking, judgment and skill. It is grounded
in the principles of nursing, medicine, social and public health sciences and expressed as the art of nursing.
 Adoption of a holistic approach to care, addressing the biological, psychological, social, and spiritual needs
of clients. Public Nursing Policy Meeting Assignment Essay
 Promotion of client self-reliance and self-determination by actively involving the client as a partner in all aspects of care.
 Use of nursing theories to define and organize practice and the nursing process to comprehensively assess,
diagnose, plan, implement, evaluate, and document client care.
 Application of the model of nursing care delivery adopted within the agency or practice setting.
 Collaboration with other members of the health care team and partnering with diverse sectors of the
 Advocating for and/or creating quality health care systems, population health, and healthy public policy.
 Adherence to relevant legislation, professional guidelines, including the Standards for Nursing Practice in
Newfoundland and Labrador (ARNNL, 1995) and the Code of Ethics for Registered Nurses (CNA, 2002),
and in accordance with applicable employer policies.
To be responsive to the evolving health-related needs of the public, the boundaries of the scope of nursing practice
must be flexible. Nursing practice takes place in the context of continuing change and development resulting from
advances in research and technology, the introduction of new approaches to care delivery, and a greater variety of
practitioners sharing more areas of common ability. The dynamic nature of the health care environment requires
that nurses respond to client’s needs by continually expanding their knowledge and skills and making judgments
about the limits of their practice.
The overall scope of nursing practice refers to the outer limits or boundaries for the profession and everything
therein. The actual scope of practice of individual nurses is always narrower than that of the scope of the nursing
profession as a whole. The scope of practice of the individual nurse is influenced by the nurses’ knowledge,
practice setting, employer requirements, and client needs (CNA, 2002c). It is often described in job descriptions
and/or illustrated in practice settings as competencies. Public Nursing Policy Meeting Assignment Essay
Scope of Nursing Practice: Definition, Decision-Making and Delegation
55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 | ARNNL.CA
Advanced Nursing Practice (ANP)
ANP roles have evolved in response to the changing needs of clients and society, and trends in the delivery of
health care. Advanced nursing practice is within the regulated scope of nursing practice, however, advanced
practice nurses constantly challenge and extend the boundaries of nursing practice.
At a national level, the Canadian Nurses Association (CNA) and jurisdictional members, including ARNNL, have
approved concepts put forth in Advanced Nursing Practice – A National Framework (2002). This document defines
Advanced Nursing Practice and identifies nine characteristics of ANP that must be consistently evident for a
practice to be considered advanced. In this way the CNA ANP framework contributes to defining the boundaries
of the scope of nursing practice.
Some advanced nursing practice competencies include activities that, in the past, were exclusive to the scope of
another health care profession (e.g. prescriptive authority). Nurse practitioner (NP) roles are in this category. In
Newfoundland and Labrador, NP roles are the most prominent ANP roles. Nurses in NP roles have moved along
the continuum of experience and education and have acquired new competencies that are incorporated into their
practice. These roles are examples of how the scope of nursing practice changes over time. ARNNL, through the
Registered Nurses Act and Regulations, recognizes and licenses NPs – Primary Health Care and NPs – Specialist.
The NP license is a regulatory safeguard that addresses public protection and authorizes NP practice in the new
competency areas of health assessment, diagnosis, treatment, and health care management. NPs are also
authorized to perform activities approved through delegation of function, provided the appropriate criteria are met
as outlined in this document. Public Nursing Policy Meeting Assignment Essay
For further information on advanced practice competencies see the most recent version of the ARNNL’s, The Professional Regulatory Framework for Nurse Practitioners Province of Newfoundland and Labrador.
Competencies are defined as the integrated knowledge, skills, attitudes, and judgment required to safely and
effectively practice nursing. Competencies are more specific than scope of practice statements and reflect what is
required of the registered nurse to function in a specific role or practice setting. The term competency, versus the
word skill, reflects the level of critical thinking and knowledge involved in nursing interventions.
Nursing competencies are classified into four categories:
 Entry to Practice Nursing Competencies are identified as the knowledge, attitudes, judgment, critical
thinking, communication, and psychomotor interventions, expected of the entry-level registered nurse. These
competencies are acquired through a basic nursing education program and are in accordance with the
Requirements outlined in the current version of the ARNNL document, Competencies in the Context of
Entry-Level Registered Nurse Practice.
Examples: wound care, counseling, and health assessment.
 Specialty Nursing Competencies are identified as activities currently practiced and new/emerging interventions that involve a higher level of complexity then entry level competencies in application and/or critical
thinking. The concepts underlying these competencies may have been introduced in a basic nursing
education program but further learning and/or experience must be obtained through continuing education
before these competencies can be implemented in clinical practice.
Examples: removal of chest tubes, administering chemotherapy, changing established outer tracheotomy tubes,
counseling clients with acute mental illness, community development, and competencies used in emerging roles
such as complementary therapy (e.g. healing touch), esthetic services (e.g. collagen therapy), and select skills
needed for roles involving advanced technology such as telehealth. Public Nursing Policy Meeting Assignment Essay
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Association of Registered Nurses of Newfoundland and Labrador
In keeping with the direction of the Canadian Nurses Association, the label advanced is reserved for advanced
practice roles e.g. Clinical Nurse Specialist or Nurse Practitioner. Nursing competencies that had been classified
as advanced nursing and/or medical nursing shared skills, as well as new and emerging interventions, are
re-named as specialty competencies.
 Shared Competencies are identified as health related client interventions that are determined to be within
the scope of practice of more than one health care profession. These competencies may be shared between
nursing and other disciplines such as medicine or allied health professionals. Shared competencies may be
performed by either professional(s) competent in the skill and authorized to do so through agency policy.
Examples: Medication administration is a shared competency of Registered Nurses and Licensed Practical Nurses.
Maintenance of airways is a shared competency with Respiratory Therapists. Immunization is a shared competency with Physicians. Counseling is a shared competency with Social Workers.
 Non-Delegated Competencies are identified as activities that are articulated in legislation, or directives arising out of legislation e.g. regulations and/or agency by-laws, to be the exclusive domain of a particular profession or professions. Authority to perform competencies in this category by members of another discipline
requires a change in the related legislation or delegation of function. Collaboration with the ARNNL and other
relevant professional regulatory authorities (e.g. CPSNL) is required before a nurse can perform
competencies identified to be non-delegated. (See page 11 for more information).
Examples: prescriptive authority, examination of individuals detained under the Mental Health Act. Public Nursing Policy Meeting Assignment Essay
Portability refers to the ability of a nurse, who is competent in a particular intervention, to safely perform the
competency with a different client population or in another practice setting. The decision to perform a competency
in a different area of practice must reflect best practices, self-assessment of competency, and be supported by
agency policy. If these criteria are not met, the competency should not be considered portable. Before a nurse
performs any competency, he/she must be familiar with the policies and guidelines for performing the competency
within the specific setting and seek required information and support if he/she has not obtained proficiency in the
relevant competency.
Examples: If a nurse obtains proficiency in the competency of venipuncture or irrigation of a nephrostomy tube
while employed in an institution, he/she can continue to perform these skills in the community, if the practice is
supported as a nursing intervention in the new setting. Likewise, the nurse moving from community health into an
institution may be able to continue to provide immunizations. The skill of removing central venous catheter lines
may be deemed to be portable for a nurse transferring from ICU to a medical unit, if he/she maintains competency
and the practice is supporting by agency policy. Public Nursing Policy Meeting Assignment Essay
A provincial ARNNL list of specialty, shared or non-delegated competencies is no longer collected or published.
The ARNNL document, Advanced Nursing and Medical Nursing Shared Skills, which included a list of advanced
and medical nursing shared skills has been rescinded. RNs are expected to be aware of the competencies for
which they are proficient and are approved for nursing in their area of practice. Agencies are expected to keep a
record of the competencies that are approved to be within the scope of practice for nurses within their own health
Non-delegated competencies are identified within the numerous pieces of legislation, regulations, and by-laws for
the various disciplines and health related organizations in our province. There is no consolidated provincial listing
of non-delegated competencies. ARNNL consultants are available to any agency wishing assistance in
determining if a particular competency may be restricted to another discipline and/or if a competency is appropriate
to consider for nursing. ARNNL will continue to develop and identify competencies required for initial RN and NP
licensure purposes, in collaboration with the schools of nursing and other stakeholders.
Scope of Nursing Practice: Definition, Decision-Making and Delegation
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Role Preparation
Nurses obtain the competencies required to practice nursing through basic and continuing education, including
formal and informal learning opportunities. Basic nursing education programs prepare generalists, rather than
specialists, to engage in beginning nursing practice. Basic nursing education includes academic content in
nursing, the humanities, and the physical and social sciences. This knowledge is utilized in providing
evidence-based or best-practice nursing care to clients in various practice settings throughout the basic nursing
program. These programs enable students to acquire the knowledge, skills, and attitudes required for entry-level
practice and to pursue life-long learning. For more information see the current version of the ARNNL document,
Competencies in the Context of Entry-Level Registered Nurse Practice and/or contact one of the provincial schools
of nursing. Public Nursing Policy Meeting Assignment Essay
Nursing practice ranges on a continuum from novice to expert (Benner, 1984). Beginning practitioners enter
nursing practice at the novice level. Nurses develop along this continuum through experience and continuing
formal and informal education. Informal education includes active involvement in such activities as: self-directed
reading/study; unit level presentations; case study analysis; attendance at workshops, seminars, in-services,
nursing rounds; and membership in special interest groups. Formal continuing education programs include postbasic courses and certificate and degree programs.
Nurses are accountable to obtain and maintain continuing competency within their defined roles through a
commitment to life-long learning. It is also the responsibility of the RN to assess his/her own competence to
perform required nursing functions and to make judgments about any limitations of their practice. When aspects of
care are beyond their level of competence, he/she must seek additional education or experience (ARNNL,
Standards for Nursing Practice).
Examples: Nurses may be taught the fundamentals of caring for a client requiring pertineonal dialysis, to initiate an
IV, or to administer immunizations in their basic education program. However, before they are deemedcompetent
to perform the skill in practice, they may require additional education and practice, which includes both theoretical
education and supervised practice. (see Appendix F for more information).

Practice Settings
Nursing is practiced in a variety of settings and in diverse roles, for example: direct care provider, educator,
manager, researcher, community developer, counselor, consultant, and public policy developer. Nurses may be
employers, employees, private practitioners, and/or volunteers. Public Nursing Policy Meeting Assignment Essay
The practice of nursing involves working with individuals, families, groups, communities, and populations. Nursing
practice may range from one-on-one interventions, up to and including policy development to meet the needs of an
entire population. Services range from episodic illness-focused care to health promotion across the lifespan based
on the principles of primary health care.
Continuity of Nursing Care
Continuity of care refers to consistent quality nursing services across settings and/or within settings. Continuity of
nursing services across settings refers to the provision of consistent client care practices between agencies for
example, the hospital and community. Continuity of nursing services within settings promotes consistent client
care practices among nurses in the same setting, for example, between ICU and a medical unit, between nurses in
two different community health districts or two long term care facilities.
There may however be significant differences in the availability of resources and expertise to support safe and
competent performance of a particular competency by nurses in different settings. When scope of practice
decisions are made in one setting or area of practice, consideration must be given to the ability of nursing staff to
meet the client’s ongoing nursing needs across and/or within the continuum of care. Public Nursing Policy Meeting Assignment Essay
Examples: A client has an abdominal drainage system inserted while in hospital but is a permanent resident of a
rural long-term care facility. Education on the required nursing care and relevant policy information is shared with
the nursing staff in the long term care facility in advance of the client’s transfer or, a client with diabetes who is
managing his own insulin requirements at home, is supported to continue self care while in hospital.
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Association of Registered Nurses of Newfoundland and Labrador
Scope of Nursing Practice:
Decision-Making Process
In the past ARNNL approved all scope of nursing practice changes. This process was extensive, time consuming,
and often requiring the approval of other relevant disciplines thus resulting in delayed implementation. Nursing
skills approved through this process were identified in an ARNNL centralized list. The list was neither exhaustive
nor exclusive and did not capture the complexity or holistic philosophy of nursing practice. The legislation
governing the practice of nursing in our province does not mandate this level of detail or approach to determining
the scope of nursing practice. Consequently, ARNNL has introduced a more flexible framework to address scope
of practice requests. The new decision-making framework recognizes:
 ARNNL’s responsibility to set the parameters for scope of practice decision making to promote safe,
competent and ethical nursing practice
 Registered Nurses’ professional accountability for their own practice, and
 Agencies/health authorities responsibility to provide quality health care services in response to client needs,
available resources, and internal quality initiatives (see Appendix B for more details). Public Nursing Policy Meeting Assignment Essay
ARNNL’s new framework outlines the process whereby decision-making authority within the categories of specialty
and shared competencies moves from the ARNNL, the College of Physicians and Surgeons of Newfoundland and
Labrador, and any other applicable health professional regulatory association, to the agency(s) and registered
nurses involved in incorporating the particular competency into nursing practice. Scope of practice decisions made
within the health care agency must involve collaboration between the management/leadership team and registered
nurse(s), as well as other relevant health care professional(s). As appropriate, communication may also be
required between health care professionals across the continuum (e.g. between different agencies/departments/
programs if client care is to be provided in different settings).
A collaborative agency-nursing based approach to determining specialty and shared nursing competencies
supports and recognizes:
 efficient and timely resolution of practice requests;
 diversity of client care needs and resources available within different health care agencies;
 autonomy in decision making based upon best practices and professional accountability recognizing the
clinical expertise at the agency level;
 agency specific identification of required competencies, in keeping with its own client population needs and
quality initiatives;
 efficient use of healthcare resources, and the contribution of all health care professionals and;
 ARNNL’s mandate to set the standards which govern nursing practice and agencies’ mandate to determine
appropriate clinical competencies required for the practice of their nursing staff. Public Nursing Policy Meeting Assignment Essay
Decision-making regarding performance of non-delegated competencies identified in provincial legislation cannot
be made at the agency level. ARNNL and other relevant professional associations must continue to be involved in
such scope of practice changes. The decision-making processes in this section also do not apply to the
introduction of new and emerging nursing roles, such as nurse practitioner, First Assist, or Clinical Nurse
Specialist. Agencies wishing to explore role changes must continue to seek input from ARNNL and any other
pertinent professional regulatory bodies. Self-employed nurses are also required to seek counsel from ARNNL.
Scope of Nursing Practice: Definition, Decision-Making and Delegation
55 Military Road | St. John’s | NL | Canada | A1C2C5 | Tel: (709) 753-6040 | 1 (800) 563-3200 | Fax: (709) 753-4940 | ARNNL.CA
Principles for Decision-Making
The determination of the most appropriate practitioner to provide a specific health service or to perform an
intervention will depend upon client needs, competency of available professionals, and the context of practice.
Agency decisions regarding specialty and shared competencies for nurses must reflect safe and competent care,
the best interest of the client, and be supported by all applicable legislation, standards, guidelines, and policies.
The decision making process utilized to assign a competency to a discipline must recognize the unique and shared
competencies of all professionals and promote optimal use of resources. Scope of practice decisions at the
agency level should be time constant and not based solely upon convenience for various health care professionals
(American Nurses Association, 2003; Canadian Medical Association, 2001; CNA, 2002b). The Scope of Practice
principles are outlined in Table 1.
Table 1: Scope of Practice Principles
ARNNL supports RNs performing specialty and/or shared competencies when the
following Principles are met:
1. Adherence to Legislation and Standards – Scope of practice decisions must reflect ARNNL’s public protection
mandate and adhere to relevant legislation and provincial and applicable national practice standards. Public Nursing Policy Meeting Assignment Essay
2. Support for Client Needs/ Benefits – There is an identified client need; the nursing and client advantages of
introducing the practice into nursing scope of practice are validated.
3. Evidence-Based – The decision is supported by research and/or clinical evidence.
4. Involves Collaboration – Input and participation in decision-making is sought from all those impacted by the
decision; decisions promote, and not detract from, a spirit of co-operation and teamwork among care
providers (ARNNL, 1994; 2000).
5. Supported by Education and Authorized by Agency – Nurses obtain/maintain the necessary competency and
have agency authorization to perform the competency.
6. Includes an Evaluation Component – The impact of the decision in relation to quality care and nursing services is evaluated on an ongoing basis.
Process for Decision Making
Agencies must develop or adopt a standard review process for their organization that reflects adherence to the
ARNNL principles outlined above, as a means of ensuring a consistent, comprehensive, and professional review of
all scope of nursing practice requests. This includes the identification of the agency authority and procedure
whereby scope of practice requests are submitted, reviewed, and approved. Figure 1 depicts the process to be
followed. A sample of the procedure or review criteria used by ARNNL is provided in Appendix C. The agency’s
process must be established before any new decisions about performance of specialty nursing competencies are
reviewed. The established agency process should be supported through nursing policy and readily available within