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Reply by authors Baker and Williams to Brake on Overview and Summary: Elimination of Barriers to RN Scope of Practice

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April 18, 2017

Reply by Authors to Carolyn Brake on Overview and Summary: Elimination of Barriers to RN Scope of Practice Opportunities and Challenges by Kathy Baker and Tracy E Williams (September 30, 2016).

Dear Carolyn,

The thoughtful response to the article, “Overview and Summary: Elimination of Barriers to RN Scope of Practice Opportunities and Challenges,” (Baker & Williams, 2016) is respected and appreciated. Some of the assertions detailed in this letter to the editor were supported by the results of a recent qualitative case study examining the barriers to RNs practicing to the their full Scope of Practice that were reported in a presentation at the ANA annual conference in Tampa recently (Baker & Lewis, 2017). In this study, workplace disruptions including staffing issues and increased patient acuity, were reported as major barriers to practicing to the full Scope of Practice. The recommendations of the study challenged nursing administrators to optimize the work environment as well as improve the efficiency of care delivery models in order to support the practice of the bedside nurse. In addition, the study recommendations also referenced the American Nurse’s Association recent Avalere White Paper on staffing as an excellent resource to guide nurses in developing flexible staffing and scheduling models to support the demands of care delivery at the bedside.

In regards to the health care reimbursement system’s focus on patient satisfaction data, HCAPs are certainly a component of the financial equation and optimizing patient satisfaction is definitely complex.  HCAPs however, represent only one component of a major shift in our reimbursement system to paying for value instead of volume. A health care reimbursement system that is focused on value elevates the role of the bedside nurse. Optimized nursing care can decrease patient length of stay, improve patient safety, and minimize patient complications as well as improve patient satisfaction. These contributions that are specific to bedside nurse will not only improve the wellbeing of patients but will improve the financial margin of hospitals in the new health care reimbursement environment.  

One of the most important goals of the “Overview and Summary: Elimination of Barrier to RN Scope of Practice Opportunities and Challenges” (Baker & Williams, 2016) was to encourage interest in promoting exemplary nursing practice. The response to our article in this letter to the editor is exactly the type of interest and dialogue that we hope will continue throughout the nursing profession.

Kathy Baker
Tracy E Williams


Baker, K., & Lewis, E.J. (2017). Factors that promote frontline RNs’ ability to practice to the fullest extent of their education and scope of practice. Presented at the American Nurses Association Annual Conference, Translating Quality into Practice, Tampa, FL.

Baker, K., & Williams, T.E., (2016). Overview and summary: Elimination of barriers to RN scope of practice: Opportunities and challenges. OJIN: The Online Journal of Issues in Nursing, 21(3). doi:10.3912/OJIN.Vol21No03ManOS. Retrieved from: