Understanding your Scope of Practice as a Graduate Nurse

Why is this topic important?

Starting your career as a Graduate Nurse is such an exciting time and most of you will be nervous about the transition. As a student it was clear what you were able to do under supervision, but one of the challenges as you transition to a professional practitioner is uncertainty about what you can now be accountable for.

This Guide will help you to understand why there is no magic recipe, or list, of what is in or out of your scope of practice. You will begin your careers in many different contexts and will be what is described as work-ready, having completed all mandatory requirements for registration with the Nursing and Midwifery Board of Australia (NMBA).

Why can’t I just have a list of what I can and cannot do as a Graduate Nurse?

Your Education Provider, along with participating health services and other settings where you have completed clinical placements, have assessed that you are competent and have the foundational knowledge to practice as a Nurse. In addition, the Nursing and Midwifery Board of Australia (NMBA) have verified that you are fit to be registered.

The truth is that your scope of practice as a graduate nurse is dependent on a number of factors, and will be very much influenced by where you are practicing. For example, your scope of practice may be very different between an intensive care unit and an aged care setting, but it will still be a beginner scope of practice.

Other factors to consider are your level of competence, your confidence and the individual health service or setting policy requirements, as well as the needs of their patient population.

Over time, your graduate scope of practice will change as you become more confident, become more competent in certain skills, and work in different specialty areas.

The Nursing and Midwifery Board of Australia have published a Fact Sheet to describe the Scope of Practice of Nurses.

It is not prescriptive but is a very useful guide which takes into account the following:

1. The NMBA Registration Standards
2. The Standards for Practice for Registered Nurses
3. The Standards for Practice for Enrolled Nurses

The Fact Sheet describes both the educational approaches and outcomes that lead to both Registered and Enrolled Nurse qualifications and a subsequent scope of practice based on the differing preparation. It also describes the principles by which Registered and Enrolled Nurses practice, without describing the exact levels of competence required - however we can assume that, on a scale of novice to expert, a graduate nurse is a novice/beginner.

What does the NMBA say about the Scope of Practice for Registered Nurses?

All Registered Nurses (including a Graduate Registered Nurse) are accountable for the care they give, guided by the Registered Nurse Standards for Practice.

They use critical thinking to provide safe and responsive nursing practice, as well as enabling people to make decisions about themselves through education.

Importantly, Registered Nurses supervise, and delegate care, to Enrolled Nurses, student nurses and, for example, Registered undergraduate Students of Nursing or Health Assistants.

Examples of activities within the Registered Nurse Scope of Practice are included in the Fact Sheet but are context-specific - too much focus on these inclusions often leads to questioning what is excluded which is where scope of practice discussion becomes difficult.

What does the NMBA say about the Scope of Practice for Enrolled Nurses?

Enrolled Nurses contribute to nursing care as part of a team, and are always under the supervision of a Registered Nurse. They are accountable for the care that is delegated to them and are unable to delegate to other healthcare workers.

Conclusion

Whether you are a newly graduated Registered Nurse (completing a graduate program) or Enrolled Nurse (completing a transition program), you will not find a defined list of duties that you can and cannot perform, although some health service policies may indicate who can perform certain tasks.

Whatever context you are working in, you will be a beginner, providing care at a level expected of you as newly qualified nurses.

Duties will be delegated to you with full knowledge of the beginning nature of your practice and will be dependent on your level of competence, your confidence, and any individual health service policy requirements.

Over time, your scope of practice will change as you develop more confidence and even higher levels of competence.

Who wrote this Guide?

Tony McGillion | RMIT

Tony McGillion is a Registered Nurse with over three decades of experience across various roles. He began his career in the UK, also working in Saudi Arabia, before transitioning to leadership and educational roles in Australia, including positions at Epworth Hospital, Cabrini Health, Austin Health, and as a policy advisor to the Victorian Government. Currently, he holds the positions of Adjunct Professor (RMIT University) and Clinical Associate Professor (The University of Melbourne). Tony spent 5 years at La Trobe University as an Associate Professor and held multiple directorships. Tony holds a Bachelor of Education and a Master of Health Administration and he currently focuses on leadership development in nursing, served as Chair for the Australian College of Nursing in Victoria and Melbourne, and mentors early and mid-career nurse leaders. He also volunteers as a Scholarships/Grants Assessor for the Australian College of Nursing and, in his spare time, is an Athletics Australia Recreational Running Coach.