Unlocking the potential of nurses through scope of practice reforms

Australia’s healthcare system is under immense pressure, with workforce shortages, increasing patient demands, and a growing burden on existing resources. As the backbone of health care, nurses play a critical role in addressing these challenges. Their extensive education, expertise, and the trust they hold with patients position them uniquely to deliver timely, high-quality care across a variety of settings.

However, despite their capabilities, nurses are often held back by outdated regulations, inconsistent policies, and organisational restrictions that limit their scope of practice. These barriers prevent them from working to their full potential, creating delays in care and adding unnecessary strain to an already overburdened system.

Unlocking the full potential of nurses by supporting them to work to their full scope of practice is not just a matter of professional growth—it’s essential for building a more efficient and accessible healthcare system. By optimising how nurses contribute to patient care, Australia can take significant strides toward meeting current and future healthcare demands.

What is scope of practice, and why is it important in health care?

Scope of practice refers to the specific activities and responsibilities that nurses are educated, trained, and legally authorised to perform. These activities are shaped by a nurse’s qualifications, registration type, education, relevant regulations, competence, and confidence, ensuring they align with their skills and expertise.

A clearly defined scope of practice is fundamental to safe and efficient health care. It ensures that patients receive high-quality care from the most appropriately qualified professional while maximising the use of healthcare resources.

Additionally, a well-defined scope of practice fosters public trust, as it guarantees that care is delivered by competent and skilled professionals. It also minimises the risk of errors, enhances collaboration within multidisciplinary teams, and streamlines the healthcare process.

To address Australia’s increasing healthcare demands, it is critical to enable nurses to work to their full scope of practice. By doing so, the system can unlock their potential to deliver faster, safer, and more effective care across all settings, ensuring better outcomes for patients and the broader community.

How does scope of practice differ across nursing roles and jurisdictions in Australia?

The scope of practice for nurses is influenced by several factors:

• Qualifications, education and registration: A nurse’s scope of practice depends on their qualifications, registration type (e.g., registered nurse, enrolled nurse, nurse practitioner), and level of education, including postgraduate studies and advanced clinical skills.
• Jurisdictional variations: While the Nursing and Midwifery Board of Australia (NMBA) sets national standards, state-specific legislation can create inconsistencies, for example in prescribing formularies for Nurse Practitioners.
• Organisational policies: Many healthcare organisations impose additional restrictions beyond legal requirements, further limiting nurses’ ability to carry out tasks within their training.

Examples of restricted tasks within a nurse’s expertise

Nurses are often prevented from performing tasks they are fully trained for, such as:

• inserting catheters
• ordering diagnostic tests
• administering certain medication, e.g. cytotoxics

For instance, a registered nurse in an emergency department could assess a patient with a urinary tract infection (UTI), arrange urine specimen collection and testing, initiate analgesia, and insert an IV cannula if clinically indicated. These actions would reduce waiting times, expedite treatment, and allow doctors to focus on more complex cases. Yet, in many settings, nurses are unable to perform these tasks without approval, creating delays in care.

Barriers to full scope of practice

Several factors have historically restricted nurses’ scope of practice:

• Outdated legislation: Regulations often fail to reflect modern nursing education and skills.
• Cautious workplace policies: Organisations may limit nurses’ roles due to liability concerns and medical governance models.
• Resistance to change: Concerns about overlapping roles and boundary-blurring within healthcare teams can slow progress toward reforms.

The impact of restrictive regulations
Restrictive regulations and policies not only delay care but also disproportionately affect rural and underserved communities. In these areas, nurses could play a pivotal role in improving access to care, but they are often unable to act without a doctor’s approval, adding unnecessary steps to the patient journey.

The benefits of nurses working to their full scope of practice

Allowing nurses to work to their full scope of practice would have far-reaching benefits:

• Patients would receive faster access to care, particularly in remote areas.
• Doctors could focus on complex cases, easing pressure on the system.
• Nurses would experience greater job satisfaction, improving retention.
• Nurse-led models, such as Nurse Practitioner Clinics, could expand, offering cost-effective care.

Lessons from other countries

International examples, such as Canada, highlight the transformative benefits of fully utilising nurses in the healthcare system. In Canada, Nurse Practitioners (NPs) play a critical role in delivering primary care, particularly in underserved and remote areas where access to health care is often limited. By working to their full scope of practice, NPs provide a wide range of services, including diagnosing conditions, prescribing medications, ordering diagnostic tests, and managing chronic illnesses.

This approach not only improves access to care but also enhances the quality of care. Patients in remote regions benefit from timely interventions, reducing the need to travel long distances for basic healthcare needs. The expanded role of NPs also relieves pressure on physicians, allowing them to focus on more complex cases.

These international practices serve as a powerful example of what could be achieved in Australia by enabling nurses and nurse practitioners to work to their full potential, addressing workforce shortages and enhancing healthcare equity across the country.

Nurse-led models of care in Australia

In Australia, nurse-led models of care have demonstrated the transformative power of leveraging nurses’ expertise to address healthcare challenges. These innovative approaches highlight the pivotal role nurses play in improving health outcomes, particularly for vulnerable and underserved populations.

During the COVID-19 pandemic, nurses led vaccination efforts, independently administering vaccines in both urban and remote settings. This not only eased the burden on other healthcare professionals but also highlighted nurses’ ability to deliver safe, efficient, and large-scale public health interventions.

Beyond the pandemic, leaders like Sonia Martin MACN, Chair of ACN’s Street Health Faculty, exemplify how nurse-led care can fill critical gaps in the system. By providing essential services such as wound care, chronic disease management, and mental health support to people experiencing homelessness, these models address complex health needs while reducing hospital admissions.

Nurse-led Clinics offer another example of success. Operating in various settings, including aged care facilities and community health centres, these clinics provide accessible, cost-effective care by managing chronic conditions, prescribing medications, and coordinating multidisciplinary treatment plans.

These examples underscore the value of nurse-led models of care in addressing Australia’s healthcare challenges, from improving access to reducing system-wide inefficiencies. Expanding these models could be pivotal in meeting the nation’s future health demands.

What needs to change?

Reforming nurses’ scope of practice will require a collective effort to:

• Update legislation to align with modern nursing education and skills.
• Revise organisational policies to remove unnecessary restrictions.
• Implement the recommendations of the Cormack Report to standardise scope of practice across Australia.
• Support ongoing education and mentorship to enhance nurses’ skills and confidence.