The nursing scope of practice is a complex system of rules, regulations, and recommendations that govern nursing. Each action taken by a nurse must fall within that scope of practice. In 2006, the American Nurses Association (ANA) created a model to describe how different stakeholders help determine the nursing scope of practice: the Model of Professional Nursing Practice Regulation (American Nurses Association [ANA], 2015, p. 33). In this post I’ll describe how a routine nursing task, foley catheter insertion, fits within this model of nursing practice regulation.
The Model of Professional Nursing Practice Regulation is a pyramid, with the ANA’s Nursing: Scope and Standards of Practice as well as the Code of Ethics for Nurses making up the foundation of the pyramid (ANA, 2015, p. 35). Foley catheter insertion, while not explicitly mentioned in the Scope and Standards of Practice, fits best within Standard 5, Implementation (ANA, 2015, p. 61). The nurse collaborates with the health care consumer and health care provider to implement the plan of foley catheter insertion in order to accurately measure hourly urine output in the critically ill patient, and utilizes evidence-based strategies to do so safely and minimize risk of infection (ANA, 2015, p. 61). The participants at this level of the model are the ANA and other professional organizations, nurses, health care consumers, and educational organizations (ANA, 2015, p. 35).
The next level up on the pyramid of Professional Nursing Practice Regulation is Nurse Practice Act, and rules and regulations for the state in which a nurse is licensed (ANA, 2015, p. 35). The Nurse Practice Act for the state of Virginia also does not explicitly mention foley catheter insertion as a part of nursing practice (Code of Virginia, 2019). However, the Virginia Board of Nursing does recommend the use of their Decision-Making Model for Determining RN/LPN Scope of Practice when the Nurse Practice Act does not explicitly prohibit or allow an action (2018). When the Nurse Practice Act is unclear, a nurse should consider the standards of professional nursing organizations, the policies of the nurse’s employer, current literature, and the behaviors of a prudent nurse in a similar situation (Virginia Board of Nursing, 2018). I will elaborate about the policies and procedures at VCU Health when discussing the next level on the pyramid. However, current literature indicates that foley catheter insertion by a registered nurse is appropriate. The Centers for Disease Control and Prevention recommend that foley catheters be placed by “health care personnel, family members, or patients themselves” as long as they are “properly trained” (Centers for Disease Control and Prevention, 2015). A prudent nurse who has been trained in foley catheter insertion would place the catheter. The participants at this level on the pyramid are the Virginia Board of Nursing, legislators, lobbyists, the National Council of State Boards of Nursing, voters, and nurses (ANA, 2015, p. 35).
The next level on the pyramid consists of the policies and procedures of the institution where the nurse is working (ANA, 2015, p. 35). VCU Health has policies in place which allow registered nurses to insert foley catheters. For example, foley catheter insertion is listed under nursing procedures in the Lippincott procedure manual on the VCU Health Intranet (Wolters Kluwer, 2021). The participants at this level on the pyramid are VCU Health, hospital administration including nurse managers, and nurses (ANA, 2015, p. 35).
Finally, the peak of the pyramid for the Model of Professional Nursing Practice Regulation is self-determination by the nurse performing the action (ANA, 2015, p. 35). At this point in nursing practice regulation, the nurse uses her own clinical judgment to ensure that her actions are safe, prudent, and are evidence-based (ANA, 2015, p. 35). For the example of foley catheter insertion, a nurse would assess her training and education to ensure that she has the skills and knowledge to safely place the foley. At this level of the pyramid, the participants are the nurses themselves (ANA, 2015, p. 35).
Using this Model of Professional Nursing Practice Regulation can help professional nurses self-determine their unique circumstances as it relates to the nursing scope of practice, because varying state laws, organizational policies, and education all influence a nurse’s practice (ANA, 2015, p. 36). The model also helps identify the stakeholders involved at each level of nursing practice regulation (ANA, 2015, p. 35). Diligent use of the Model of Professional Nursing Practice Regulation helps nurses promote “safe, quality, evidence-based nursing practice decisions” that lead to positive patient outcomes (ANA, 2015, p. 36)
American Nurses Association. (2015). Nursing : Scope and Standards of Practice: Vol. 3rd
edition. American Nurses Association.
Centers for Disease Control and Prevention. (2015). Summary of Recommendations. Infection Control.
Code of Virginia, Chapter 30, § 54.1-3000 et seq. (2019).
Virginia Board of Nursing. (2018). Decision-Making Model for Determining RN/LPN Scope of Practice.
Wolters Kluwer. (2021). Lippincott Procedures and Skills. Virginia Commonwealth University Intranet.