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  1. Buck, Jacalyn PhD, RN, NEA-BC
  2. Loversidge, Jacqueline PhD, RNC-AWHC
  3. Chipps, Esther PhD, RN, NEA-BC
  4. Gallagher-Ford, Lynn PhD, RN, NE-BC DPFNAP, FAAN
  5. Genter, Lynne MS, RN, CRRN
  6. Yen, Po-Yin PhD, RN


OBJECTIVE: The aims of this study were to describe nurses' perceptions of nursing activities and analyze for consistency with top-of-license (TOL) practice.


BACKGROUND: The Advisory Board Company expert panel proposed 8 TOL core nursing responsibilities representing practice at its potential. Thus far, no empirical work has examined nursing practices relative to TOL, from staff nurses' points of view.


METHODS: This qualitative study used focus groups to explore perceptions of typical nursing activities. We analyzed activities for themes that described nurses' work during typical shifts.


RESULTS: Nurses' full scope of work included TOL-consistent categories, as well as categories that did not exemplify TOL practice, such as nonnursing care. A proposed model was developed, which depicts nurses' total scope of work, inclusive of all activity categories. In addition, hindrances to TOL practice were also identified.


CONCLUSIONS: Findings from this study can inform leadership imperatives and the development of innovative, sustainable nursing practice models that support nursing practice at TOL.