Although there is widespread support for top-of-license nursing practice, many organizations struggle to achieve — or even clearly define— this goal. This expert insight explains the main barriers to achieving top-of-license nursing practice, and highlights ways to overcome them.

With patients requiring increasingly complex care, it's important for healthcare organizations to effectively leverage the skills of frontline nurses.

According to CDC, 60% of U.S. adults have at least one chronic disease, and 40% have two or more. These chronic diseases are quite expensive to treat, totaling $4.1 trillion in annual healthcare costs.

Although healthcare organizations have historically increased nursing hours to keep up with rising care complexity, higher nurse salaries, workforce shortages, and growing margin pressure mean this strategy is no longer sustainable.

To care for increasingly complex patients with currently available staffing resources, healthcare leaders need to maximize the value of each nursing hour and help nurses practice at the top of their licenses. Doing so will allow organizations to provider higher-quality care more efficiently.

Regardless of care setting, two common barriers often prevent nurses from focusing on their core responsibilities:

1. Nurses as the "last line of defense"

Because nurses are often viewed as the "last line of defense" to ensure safe patient care, they frequently spend time providing elements of care that could be automated or safely performed by another member of the care team with less training.

2. Pervasive misconceptions about nurses' scope of practice

Physicians, interprofessional care team members, and even nurses themselves often don't fully understand the full scope of nursing practice. This prevents nurses from providing care they are qualified to deliver.

To address issues preventing nurses from practicing at the top of their licenses, as well as to improve patient care, leaders can take two broad actions:

1. Protect nurses from avoidable time sinks

Across care settings, many nurses spend a significant portion of their time on "non-value-added" work that could either be automated or completed by another member of the care team.

Some examples of non-value-added work include:

• Asking patients redundant questions in screening forms
• Waiting for a physician's order to administer pain medication
• Transferring patients to different departments in the hospital
• Driving to a home health agency's office to document care in an electronic record

Streamlining documentation, normalizing workflows for support staff, and cultivating nurse willingness to delegate responsibilities are three ways to protect nurses' time and allow them to practice at the top of their licenses. 

2. Remove interprofessional barriers to full scope of nursing practice

Interprofessional colleagues often have a difficult time understanding each other's roles and supporting one another effectively, which can lead to negative patient outcomes. The four root causes of these misunderstandings are:

• Professional culture: A distinct professional culture may not always emphasize the roles of other care team members and reinforce staff perceptions of hierarchy among different disciplines.
• Siloed goals and reporting relationships: Being siloed in their work can prevent members in one discipline from knowing the priorities and goals of other disciplines.
• Profession-specific education: Because students in each profession are educated separately, they rarely get to learn about other disciplines or have the opportunity to work on interprofessional teams.
• Misperceptions about the legal scope of practice: Staff may mistakenly assume that certain elements of care are outside the scope of practice for certain disciplines.

By addressing these root causes, nurse leaders will be equipped with strategies to increase interprofessional understanding of their role, as well as more fully understand the roles of other disciplines. 

To ensure that you're able to achieve top-of-license nursing practice, Advisory Board offers several strategies to streamline documentation, expand support staff workflows, enhance interprofessional understanding, and more.