Professional, peer-reviewed journal articles on topics such as scope of practice and clinical application of nursing theory are particularly valuable to nursing students, ancillary medicine students, and professionals in both fields. “Nurses’ Scope of Practice and the Implication for Quality Nursing Care” by Irene Lubbe and Lizeth Roets is one such article; it chronicles a summary of what can occur to the health of a patient when a nursing needs assessment is conducted by unlicensed or incompetent individuals.
The two authors had adequate credentials to take on the research of these topics, as both hold RN licenses and doctorates in nursing. The problem the researchers researched was the possibility of patient care being impacted by unqualified or untrained nurses participating in needs analyses. The purpose of the study was to reveal if, in fact, there was an impact in patient care caused by unqualified or untrained nurses, and if so, what recommendations could be made to lessen this impact. The authors stated their hypothesis as follows: “The health and safety of patients can be threatened, however, when nurses are permitted to perform patient care duties that are not commensurate with their education and scope of practice” (Lubbe & Roets, 2013, pp. 58-59).
This hypothesis, while clearly stated, was in an unusual location within the introductory section, landing quite near the beginning of the article and amongst the references to other similar studies. It did not reside after the introduction of similar research where it would have been more clear to the reader how it was differentiated from the other similar studies. The authors attributed this hypothesis, in part, to the complicated scope of practice divisions amongst different classifications of nurses. This issue was not stressed in their hypothesis, but it did constitute a great deal of the analysis and their findings, recommendations, and conclusions, however.
Another troublesome aspect of this research article was the brevity and placement of the literature review. There are a few references to other similar studies, as mentioned above, scattered in the first three paragraphs of the introduction, but there is no formal literature review and very little correlation with other research in this area. This would indicate to a reader that the study at hand is either completely novel and there is nothing to compare it to, hence, no literature review, or, the authors purposely chose not to conduct a close reading of relevant research. The latter is likely the case, which immediately diminishes the authors’ credibility. This causes everything else in the article to become suspect.
The descriptive, quantitative research by these authors was certainly of significance to warrant a formal research effort. Any time a reduced quality of patient care is suspected, it is worthy of study. Conducted in a private hospital in South Africa, the formal data collection consisted of random sampling of 157 of 849 patients’ files which were analyzed retrospectively by way of a chart audit on frequency and were categorized. However, the frequency of what is not revealed anywhere in the article, and how the categorization was conducted or even the categories is also not revealed to the reader. The authors also indicated that standard validity testing was conducted on the data as was reliability testing, but no mention of how this was accomplished appeared in the article.
For the actual data collection, the chart audits were conducted by two PRNs. There is no mention of how the two separate PRNs normed their analyses, nor was there information on how the patient charts were randomized for selection. There was only the statement that the audit was conducted using a “self-generated audit instrument” from a “literature available the Waterlow™ scale” (Lubbe & Roets, 2013, pp. 61.) The scale is not explained at all. Likely the most problematic issue with the research article is the fact that where, as just discussed, the authors state that “Two PRNs, qualified as nurse educators, did the audit” (Lubbe & Roets, 2013, pp. 61, but three paragraphs later, the authors state that “only 30 files were audited by PRNs, 30 by ENs, 46 by the enrolled nursing auxiliary, and 46 by student nurses” (Lubbe & Roets, 2013, pp. 61). These two statements are in direct contradiction with each other. Overall, the methods section of this article is lacking detail, specificity, and the depth needed for the reader to embrace the reliability of the data. The study was approved by a university’s higher degree committee for ethicality, so the issue of ethics does not appear to be a factor.
After sampling and analyses were completed, the authors reported that “eighty percent of risk assessments were performed by nurses not licensed or enrolled to perform this task unsupervised” (Lubbe & Roets, 2013, pp. 58), and they assessed that this statistic does, in fact, have effects on the care a patient receives as well as the liability of the institution where the patient is receiving care. The authors concluded that “nurses should be allowed to perform only tasks within their scope of practice for which they are licensed or enrolled” (Lubbe & Roets, 2013, pp. 58) and nurses with inadequate training in nursing theory should not be allowed to work unsupervised at all.
A detailed chart providing information on the nursing categories in South Africa, Australia, the United States, and the United Kingdom is included in this article, but it really has little relevance to the hypothesis or the recommendations. The inclusion of this information tells the reader that the authors were perhaps not clear about their goal for the research, or that the authors were reaching to fill space with what looked like, but was not, relevant information.
This study would not be a good model to follow in conducting further research; however, the research question is an important one, and more information on how needs assessments are conducted and by whom in the nursing profession could be of great benefit to patients and hospitals.
