Registered Nurses’ Lived Experience Working to Scope of Practice in Pediatric Ambulatory Medical Care Clinics

Abstract

In today’s financial climate, the entire health care system, including nurses, has to ensure that care delivered is evidenced based, has positive outcomes, and is provided it in the most fiscally responsible way possible. The literature highlights the fact that nurses, in general, are not working to the full scope of what they are authorized and educated to provide. A qualitative methodology grounded in interpretative phenomenology (Hermeneutic) was used to uncover how pediatric ambulatory care nurses live out their role, scope of practice, and the meaning they give to the experience of working to full scope of nursing practice in pediatric ambulatory medical care. Eight pediatric ambulatory medical care nurses from an Atlantic Canadian healthcare facility took part in focus groups to share their experiences about working to full scope of practice in their ambulatory nursing roles. Interpretation of focus group session transcripts identified an over-arching central theme of “we are the mothers of our clinic areas” that reflected the lived experiences of this ambulatory nursing group. Three other sub-themes wove through the main theme; (a) What we do on a daily basis is our full scope of practice, (b) Ambulatory nursing: a different sort of busyness; and (c) Feeling under the gun: lack of resources and time. These nurses saw themselves as the “mothers” of their ambulatory clinic areas. They not only supported their patients and provided for their needs, but they also supported and coordinated their multidisciplinary team members to ensuring best possible care. Pieces of their work utilized their specialized nursing knowledge and skills, but they were also spending enormous amounts of time on tasks that did not make use of this. The nurses saw all of this work, both nursing and non-nursing, as work that fell within their scope of practice. What was also uncovered was the extensive knowledge and skill these registered nurses possess. Yet, using this knowledge to provide meaningful nursing interventions often came second to the nurses’ perceived role as clinic “mother”, where ensuring all team members had what they needed took priority. Nurses took on this work, as there was often no one else available or willing to do it. Disturbingly, this seemed to be the expectation of their colleagues and their administrators. This study highlights the fact that there is much work to be done by both administrators and nurses to improve this situation and allow the pediatric ambulatory medical care nursing group to work to full scope of practice and deliver best nursing care to the families they serve. This work provides administrators with a starting point to address identified barriers and facilitators to create an environment where registered nurses are empowered to provide nursing care that best meets the needs of the patients and families they serve. This will involve clearly defining a role that fully utilizes their knowledge and skills to positively influence health care outcomes.