Scope of Practice
Scope of Practice
This domain tests what a registered nurse or midwife may lawfully do, and where the boundary lies between competence, delegation and authorisation. Scope is set by the register category and Council guidelines, not by the employer’s job description or a doctor’s instruction.
- Cadre boundaries. An enrolled nurse, registered nurse and registered midwife each have a defined scope. Midwifery includes antenatal, intrapartum and postnatal care within the midwife’s competence; it does not make every nurse a midwife.
- Competence and authorisation. A task may be within the broad scope but outside the individual’s competence, or require additional authorisation (for example, certain expanded or specialist roles).
- Delegation. The delegator remains accountable. Tasks cannot be delegated to an unregistered person, and supervision must be real, not nominal.
- Emergency exception. In an emergency, a practitioner may act to preserve life and safety, then document and escalate.
Worked example
An enrolled nurse is asked by a doctor to give a first dose of intravenous chemotherapy because the ward is short-staffed. Reasoning: the instruction does not enlarge the enrolled nurse’s scope. Chemotherapy administration is a specialist, high-risk activity requiring specific preparation and authorisation. The correct response is to decline, escalate to the registered nurse in charge and document the request and the action taken.
Traps
Believing a doctor’s order overrides scope. Treating “I was trained once” as authorisation. Delegating to a student or aide without supervision. Assuming a change of setting (clinic, theatre, community) changes the scope. Ignoring documentation after an emergency act.