Scope of Practice and Licensure

Medical Law and Ethics

Scope of Practice

• Based in state licensing laws and rules• Sets legal framework for service delivery by a specific

health profession in a state• Defines parameters of practice for a profession • Limits practice to people who successfully

complete specified education and/or training • Restricts use of title and/or credential to license

holders in the professiono Designed to provide consumer protection

Scope of Practice

• “One hallmark of a professional is to know the

limits of one’s own professional knowledge.”

• Legal and Ethical Perspectives in Health Care

Texas Scope of Practice Issues

• http://www.amednews.com/article/20090309/profession/303099970/2/

• http://www.acfas.org/uploadedFiles/Physicians/Research_and_Publications/Update_Newsletter/v17n6.pdf

From the Texas Nursing Board http://www.bon.texas.gov/practice/apn-scopeofpractice.html

The following questions may help to clarify whether a new activity/procedure can be incorporated into an individual's scope of practice:

• Is it consistent with one's professional scope of practice?

• Is it consistent with statutory or regulatory laws?• Is it consistent with one's education in the role and

specialty?

From the Texas Nursing Board http://www.bon.texas.gov/practice/apn-scopeofpractice.html

• Is it consistent with the scope of one's recognized title or does it evolve into another advanced practice title recognized by the board requiring additional formal education and legal recognition?

• Is it consistent with the Standards of Nursing Practice outlined in Board Rule 217.11?

• Is it consistent with evidence-based care?• Is it consistent with reasonable and prudent practice?• Are you willing to accept accountability and liability for

the activity and outcomes?

Licensure• Defined as - “A mandatory credentialing

process established by law, usually at the state level, that grants the right to practice certain skills and endeavors.”

• Each state offers its own examination for licensure for physicians. Some allied health professions have national licensure/certification exams.

To apply for a license:• Provide proof of education and training• Provide detailed work history• Pass an examination designed to assess

knowledge and their ability to apply that knowledge and other concepts and principles important to ensure safe and effective patient care

• Reveal information about past medical history (including alcohol and drug abuse), arrests, and convictions

Loss of license through:List 4 ways in which a medical professional might

lose their license to practice.• Physical abuse of a patient• Inadequate record keeping• Failure to recognize or act on common symptoms• The prescription of drugs in excessive amounts or

without legitimate reason• Impaired ability to practice due to addiction, or

physical or mental illness

• Failure to meet continuing education requirements

• Performance of duties beyond the scope of a license

• Dishonesty• Conviction of a felony• Delegation of practice of medicine to an

unlicensed individual

Certification• Defined as – “A voluntary credentialing

process whereby applicants who meet specific requirements may receive a certificate.”

• Certification by a professional organization, usually through an examination, signifies that an applicant has attained a certain level of knowledge and skill.

Registration

• Defined as – “A credentialing procedure whereby one’s name is listed on a register as having paid a fee and/or met certain criteria within a profession.

Accreditation• Defined as – “Official authorization or approval for

conforming to a specified standard.”• Example – Joint Commission on Accreditation of

Healthcare Organizations (JCAHO) accredits health care organizations that meet certain standards.

• Give me 3 examples of organizations that require accrediation. Hospitals of any type, HMOs, PPOs, Home Health services, Medical Equipment Supply companies, Nursing homes, Mental health facilities, any outpatient treatment facilities, laboratories including blood donation organizations, etc.

• http://usnews.nbcnews.com/_news/2013/03/03/17167379-nurse-refuses-to-perform-cpr-despite-911-dispatchers-plea?lite