1. Section Editor(s): Powers, Jan PhD, RN, CCNS, CCRN, CNRN, FCCM

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The Institute of Medicine Future of Nursing report made several recommendations for advancing nursing practice and promoting professionalism to provide optimal outcomes. Frontline nurses play a vital role in helping realize the goals of healthcare reform, so it's imperative that we lead change. However, to reach our full potential, we must be allowed to practice to the complete extent of our education and training. Nurses should have the ability to work to the full scope of their practice, whether in an advanced practice role or as direct care nurses.

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The term scope of practice is used to define nursing actions and procedures that are permitted by law based on specific experience and educational qualifications. The RN scope of practice is independent and comprehensive in all steps of the nursing process. RN practice doesn't require assignment or supervision by a higher level healthcare provider. The RN uses his or her skills, knowledge, and professional judgment to determine appropriate action based on the scope of practice, standards of practice, nurse practice acts from state boards of nursing, and legal regulations.


Nurses must be empowered to make autonomous patient care decisions at the point of care and fully practice as professionals. The concept of nurse empowerment isn't new; however, for our profession to maintain its unique scope of practice and advance, empowerment must be promoted and embraced. To promote empowerment in nursing practice, it must be understood that nursing has an autonomous scope of practice. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities-sick or well, in all settings.


For nurses to practice to their full potential, we must be empowered to implement care within our autonomous scope of practice, determine the best care plan for the patient, and then advocate for the needs of that patient. We must be allowed to independently practice our nursing skills, as well as mobilize other resources to provide safe, high-quality patient care. We need to be included in decision making at an organizational level through involvement in policy decisions, shared governance councils, and clinical practice councils. And we must have access to information and resources, as well as support for job responsibilities and decision making. In addition, we should be afforded the opportunity for advancement or involvement in activities beyond our job description.


If nurses aren't allowed to practice to their full potential or if work environments are oppressive, patients and the entire organization will suffer as a result. Research has demonstrated that the outcomes of disempowerment are feelings of frustration, dissatisfaction, and burnout. The result? Increased turnover.


Nurses are the key to the future of healthcare, so we must work to create environments that encourage and empower us to make decisions that will contribute to the well-being of our patients, our hospitals, and our communities. Empowered nurses working together with other disciplines and healthcare agencies will play a fundamental role in the transformation of the healthcare system, ensuring quality care that leads to improved health outcomes.