SCOPE OF NURSING PRACTICE

I cannot begin to recount the numbers of times that I encounter nurses who reflect frustration with unjustified restrictions they experience on their nursing practice. It was this very frustration that led me to pursue a master's degree in nursing early in my career, hoping that by earning this advanced degree, I would be able to practice the kind of nursing that I learned about in my undergraduate program at the University of Hawaii. Indeed, my master's degree opened a number of doors, but the restraints on my practice only morphed into new forms.

One particular absurdity stands out in my career. Not long after earning my doctoral degree and beginning my teaching career, I was supervising graduate students enrolled in a maternal-child nursing master's program. The students' clinical experience was on an obstetrics unit of a prominent medical center. Not long after the start of the semester, I received a call from the dean of the School of Nursing, asking me to appear at a meeting with the chief physician on the unit, who was extremely upset with the students I was supervising. When I arrived at the meeting, the physician was clearly agitated; his face was red and veins were protruding from his neck as he angrily regaled against the fact that the students were teaching postpartum women how to manually express breast milk-without his permission. Furthermore, he made it clear that if I had requested his permission, it would be promptly denied.

Admittedly, this may be an extreme example, but it is by far not the only example of undue restraints on my own nursing practice over the years, nor is it unlike many of the accounts I have learned about from other nurses. So when the Future of Nursing1 report was published in October 2010, I was delighted to see that the first of the 4 recommendations read: Nurses should practice to the full extent of their education and training.

Clearly, the factors that constrain and restrain nurses' practice are complex and extend well beyond those imposed by physicians. Even nurse practice acts in many states impose restrictions that are inconsistent with many of the possibilities that are envisioned for nursing, and that are included in our educational preparation.

The topic of this issue of Advances in Nursing Science (ANS) was planned soon after the report was published, with the hope that nursing scholars who have explored issues related to the complex factors that interfere with nurses practicing to the full extent of their education and training. This issue includes 7 excellent articles that address these issues and offer significant evidence that can be called upon to create changes that are needed to realize the goal of the "Future of Nursing" recommendation. Each of these articles will be featured on the ANS Web site as an "Editor's Pick" article, and our ANS blog will feature messages from each of the authors over the first 3 months of 2013. Visit the blog and add your comments and responses to the articles as they appear!

-Peggy L. Chinn, PhD, RN, FAAN

Editor

REFERENCE