Physicians, interprofessional care team members, and even nurses themselves often don't fully understand the full scope of nursing practice, which can prevent nurses from providing care they're qualified to deliver. These three strategies will help expand perceptions of the work nurses can and should perform, and help achieve top-of-license nursing practice across different care settings.

Healthcare professionals often have misperceptions of each other's roles, and many caregivers feel more supported by colleagues in their own departments than those in others. When there is less collaboration between different team care members, there is a greater risk of negative patient outcomes.

To ensure nurses have the interprofessional understanding and support they need to practice to the full extent of their training and skills, you can implement these five practices:

Interpersonal communication pledge

Although some organizations have developed formal standards for interprofessional communication, few have fully integrated these standards into their organizational culture. By consistently reinforcing standards through various methods — including pledges, visual reminders, and performance goals — leaders can ensure all employees understand the importance of interprofessional teamwork.

Unit-based clinical leaders

Oftentimes, nurse, medical, and quality leaders work in siloes, meaning leaders in one discipline may not fully understand other's goals and may fail to support them. By collaboratively identifying unit goals and working together to achieve them as an interdisciplinary leadership triad, nursing, medical, and quality leaders develop a better understanding of each other's roles.

Nurse-medical student pairs

Because medical students receive most of their education from physicians, they often don't understand the full scope of nursing practice. By shadowing nurses as part of their education, medical students will gain a better understanding of nurses' roles.

Interprofessional student teams

Students from different disciplines also rarely learn or work together. This means they may not fully understand the roles of other disciplines on the care team. By allowing nursing, medical, pharmacy, and social work students to learn and work together, they can develop a deeper understanding of each other's roles, as well as how to work together as an interprofessional team.

APRN privilege database

Many healthcare leaders are unfamiliar with the full scope of advanced practice registered nurse (APRN) practice, which can lead to limited APRN privileges. By comparing your organization's APRN privileges to those at similar organizations, you can use benchmarks to educate stakeholders about appropriate APRN practice.

Bottlenecks often prevent patients from accessing care in a variety of settings, including the ED or primary care. Although nurses are often in the best position to alleviate these bottlenecks, three challenges prevent nurses from making the clinical decisions required to provide timely care:

1. Nurses lack information from other care team members, resulting in care delays
2. State regulations or organizational policies require nurses to request and receive physician order before providing care
3. Organizational policies do not reflect new technology that enables nurses to provide care that was formerly out of their scope of practice

To address these challenges and allow nurses to appropriately expand their clinical decision making, you can implement these three practices:

Unified care plan development

Because caregivers often follow discipline-specific care plans, there may be miscommunication and unnecessary delays in care. Collaborating with physicians and pharmacists to create a coordinated care plan at the time of admission will provide nurses with a complete picture of patient needs and help them proactively manage a patient toward discharge.

Nurse-driven protocol starter list

Although some organizational policies may require a physician's order for specific elements of care, obtaining one takes time, which can then lead to unnecessary patient care delays and lost nursing time. By implementing appropriate nurse-driven protocols, nurses can provide timely patient care and avoid unnecessary delays.

Technology-enabled nursing practice expansion

New applications of existing technology can allow nurses to deliver certain elements of care previously provided by physicians. By incorporating technology into nursing practice appropriately, nurses will be able to provide care more efficiently in the moment.

Patients with complex needs frequently experience care gaps as they transition from one care setting to another. To bridge these gaps, nurses must work to the full extent of their skills and training not only within individual care settings but also between settings. Because nurses have a unique combination of clinical expertise and care coordination skills, they are well-positioned to facilitate seamless patient transitions across the care continuum.

To broaden nursing's focus on core responsibilities beyond a single care setting, you can implement these two practices:

SNF transfer expert

Avoidable readmissions often occur because patients are transferred to facilities unequipped to meet their needs or because key information is lost along the way. A nurse with skilled nursing facility expertise can help identify appropriate post-acute care placement and facilitate handoffs for complex patients, which leads to more seamless transitions and prevents unnecessary readmissions.

Nurse-led interim care

Patients often have gaps in care because they do not have timely access to primary care or mental health providers. This can lead their condition to deteriorate, which can then result in hospitalization. By providing patients with short-term primary or behavioral care through home visits, while simultaneously coordinating longer-term care, nurses can reduce preventable complications and bridge care gaps.

Achieving top-of-license nursing practice can be a difficult task, but these and other strategies will help move your organization one step closer to making it a reality. To gain more insights into top-of-license nursing practice and the best practices to achieve it, download Advisory Board's executive briefing "Achieving Top-of-License Nursing Practice."