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Nurses’ Scope of Practice and the Implication for Quality Nursing Care


  • J.C. (Irene) Lubbe PhD, RN, RM,

    Corresponding author
    1. Tau Lambda-at-Large, Senior Lecturer, Health Studies, University of South Africa (Unisa), South Africa
    • Correspondence

      Dr. J.C. (Irene) Lubbe, PO Box 392, University of South Africa (Unisa), 0003, South Africa.


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  • Lizeth Roets PhD, RN, RM

    1. Tau Lambda-at-Large, Associate Professor, Health Studies, University of South Africa (Unisa), South Africa
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This article provides an overview of the implications for patients’ health status and care needs when assessments are performed by nurses not licensed or competent to perform this task. The Waterlow™ scale (Judy Waterlow, The Nook, Stroke Road, Henlade, TAUNTON, TA3 5LX) scenario is used as a practice example to illustrate this case.

Organizational Construct

The international nursing regulatory bodies, in South Africa called the South African Nursing Council, set the scope of practice wherein nurses are allowed to practice. Different categories of nurses are allowed to practice according to specified competencies, in alignment with their scope of practice.


A retrospective quantitative study was utilized. A checklist was used to perform an audit on a random sample of 157 out of an accessible population of 849 patient files. Data were gathered in May 2012, and the analysis was done using frequencies and percentages for categorical data. Reliability and validity were ensured, and all ethical principles were adhered to.


Eighty percent of risk assessments were performed by nurses not licensed or enrolled to perform this task unsupervised. Areas such as tissue malnutrition, neurological deficits, and medication were inaccurately scored, resulting in 50% of the Waterlow™ risk-assessment scales, as an example, being incorrectly interpreted. This has implications for quality nursing care and might put the patient and the institution at risk.


Lower-category nurses and student nurses should be allowed to perform only tasks within their scope of practice for which they are licensed or enrolled. Nurses with limited formal theoretical training are not adequately prepared to perform tasks unsupervised, even in the current global nursing shortage scenario.

Clinical Relevance

To optimize and ensure safe and quality patient care, risk assessments should be done by a registered professional nurse, who will then coordinate the nursing care of the patient with the assistance of the lower category of nurses.