What is Scope of Practice?
Professional scope of practice refers to a set of parameters placed into state law to define what acts a licensed healthcare provider may, or in some cases, may not perform.
As a result, the law does not limit what medical acts a physician may perform. The North Carolina Medical Board provides oversight to physician practice, ensuring the public is protected from any potentially harmful behavior.
Non-physician health care providers have a legislated scope of practice that places limitations on their practice. This may appear in one of many ways.
- As a definition in statute. For example 90-143 defines Chiropractic as “the science of adjusting the cause of disease by realigning the spine, releasing pressure on nerves radiating from the spine to all parts of the body, and allowing the nerves to carry their full quota of health current (nerve energy) from the brain to all parts of the body.” As a result activities outside of this defined scope are prohibited without legislative authority.
- As a specified list of permitted activities. For example 90-722 lists 5 categories of practice that a polysomnographic technologist may engage in. This list if further broken down into a very specified list of tests that may be performed by these practitioners.
- In the form of physician supervision. Physician assistants and advanced practice nurses are not limited by a definition of practice or list of tasks. However, each must practice with a supervising physician’s approval.
How is Scope of Practice Determined?
In North Carolina the legislature specifies the scope of practice of various healthcare providers within Chapter 90 of the General Statutes. These decisions are often based on the level of training of the healthcare provider, balanced with the potential for harm to patients.
Can a Licensing Board Make Changes to Scope of Practice?
Not in North Carolina. Statute often allows licensing boards to write rules to clarify acceptable practice guidelines. For example, the Medical Board and Board of Nursing have rules in place to determine what information must be included in a supervisory agreement between the two providers. However, a licensing board cannot allow its licensees to practice outside of the legislated scope of practice or eliminate the requirement for physician supervision.
Why Do Providers Need a Scope of Practice?
It is important that these permissions, and in some instances limitations, are specified within state law in order to protect patients from harm. Just as state law describes who can operate motor vehicles, it is also tasked with determining who is qualified to provide medical care.