ANA OJIN is a peer-reviewed, online publication that addresses current topics affecting nursing practice, research, education, and the wider health care sector.

Find Out More...

Letter to the Editor

  • A critical element of preparing competent nursing students, not mentioned in "Crisis in Competency: A Defining Moment in Nursing Education", is the need to eliminate barriers to recruiting and retaining nurse educators still engaging in clinical practice.

  • Continue Reading...
    View all Letters...

Registered Nurses as Professionals, Advocates, Innovators, and Collaborative Leaders: Executive Summary

m Bookmark and Share

Tracy E. Williams DNP, RN, FNAP
Kathy Baker, PhD, RN, NE-BC
Leda Evans, BSN, RN, OCN
Michelle A. Lucatorto DNP, RN, FNP-C
Edtrina Moss, MSN, RN-BC, NE-BC
Ann O’Sullivan, MSN, RN, NE-BC, CNE, ANEF
Patricia C. Seifert, MSN, RN, CNOR, FAAN
Terry Siek, MSN, RN, NEA-BC
Timothy W. Thomas, BSN, RN
Barbara Zittel, PhD, RN


This article concludes a series that described work completed by the American Nurses Association (ANA) Barriers to RN Scope of Practice Professional Issues Panel (Panel). The Panel has summarized the roles of the registered nurse (RN) as professional, advocate, innovator, and collaborative leader. As professionals, RNs are accountable for their own educational development, growth of their own practice, and execution of their own professional role. As advocates, RNs provide direct and indirect care focused on the achievement of optimal health. As innovators, RNs act as agents of change in driving processes and policy and leveraging technology. As collaborative leaders, RNs lead within the professional practice setting with state-specific nurse practice acts, a defined scope of practice, and nurse-led initiatives. In this article, Panel members describe their methodology, offer role definitions and recommendations, and provide individual recommendations for RNs to remove barriers and practice to the full extent of their scope of practice. We conclude with some future considerations.

Citation: Williams, T. E., Baker, K., Evans, L., Lucatorto, M. A., Moss, E., O’Sullivan, A., Seifert, P. C., Siek, T., Thomas, T. W., Zittel, B. (September 30, 2016) "Registered Nurses as Professionals, Advocates, Innovators, and Collaborative Leaders: Executive Summary" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3, Manuscript 5.

DOI: 10.3912/OJIN.Vol21No03Man05

Key Words: Barriers, scope of practice, RN, professional, caregiver, advocate, innovator, leader, collaborative partner, nurse-led initiatives

...authors started this series of articles with a guided imagery exercise [to envision] the preferred future for registered nurses (RNs) and how this future could be realized. This OJIN topic considers barriers to RN scope of practice, and disseminates in several articles the work of the American Nurses Association (ANA) Professional Issues Panel (Panel), Barriers to RN Scope of Practice, to identify, analyze, and consider both opportunities and challenges to eliminate these barriers. Panel member authors started this series of articles with a guided imagery exercise during which we envisioned the preferred future for registered nurses (RNs) and how this future could be realized. Several articles individual consider individual RN roles in the health care delivery system that were identified throughout the work of the Panel RN as professional, RN as advocate, RN as innovator, and RN as collaborative leader.

In this article, we summarize this series with additional questions for all nurses: What is the preferred future for RNs? How are we going to effectively work to achieve, articulate, and demonstrate our value? We must define the optimal state for RNs and determine how they can practice to the full extent of their education, training, and license. Achieving these goals is essential to meet the recommendations articulated in the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health (Future of Nursing Report) (IOM, 2011), and reiterated in the 2015 follow-up report (IOM, 2015).

If we neglect our responsibility to determine and control the scope of nursing practice, assuredly others will. This exercise pushes nurses as individuals and as professionals to envision what we, as RNs, could and should be. It forces us to consider: What impact could and should nurses have on those we serve? It engages us to determine: What value could and should we create? It demands accountability by asking: How will we articulate and demonstrate our value as RNs? These are difficult questions both to ask and answer. Nurses must do both. Our individual and collective professional future resides in the answers to these questions. If we neglect our responsibility to determine and control the scope of nursing practice, assuredly others will. It is every nurses’ individual and professional responsibility to prevent that from happening.

The goal of our panel was to create our best determination of an “optimal state” of RN scope of practice. We then needed to discern the current state through an assessment. This assessment was the work of the panel and helped to frame our focus and determine what barriers exist that interfere with nurses’ ability to act and practice to the fullest scope possible. Once these barriers were determined, we created an actionable strategy with tactics to eliminate or minimize their impact on nursing practice. This was an overwhelming, but achievable, task. In this summary article, Panel members describe their methodology, offer role definitions and recommendations, and provide individual recommendations for RNs to remove barriers and practice to the full extent of their scope of practice. We conclude with some future considerations.


... the panel focused specifically on the role of the RN. In September 2014, ANA issued a call for interested nurses to serve on a panel focused on the barriers to scope of practice, emphasizing that the focus would be RN scope of practice, rather than advanced practice registered nurse (APRN) concerns. While some issues and barriers would overlap, there would be distinct additional differences and concerns to consider. Therefore, the panel focused specifically on the role of the RN. ANA and other organizations remain committed to removing barriers to APRN practice and care as well. Individuals seeking additional information on the topic of APRN scope of practice may visit the ANA APRN page, Advanced Practice Nurses (ANA, 2016a).

Expert nurses from a variety of disciplines were selected to serve on either the steering committee or on an advisory panel. The work of the Panel subcommittees began in early 2015. The Panel’s charge concerning the elimination of barriers of RN scope of practice was to discern and quantify what those issues were and to make recommendations about pathways to eliminate or mitigate those issues.

In APRN practice, regulations governing scope of practice have been documented as the most significant barrier to achieving the fullest extent of practice reflecting education and training (Gutchell et al., 2014; Ward, 2015). In contrast, the extent to which regulations governing scope of practice serve to inhibit RN practice at the top of licensure is not well documented. It is likely that the individual nurse’s understanding of their state nurse practice act (NPA) may play an important role. Also, literature described in the future of nursing report (IOM, 2011) has suggested that barriers imposed by organizations or by complexities of the work environment may be the most significant limitation to full scope of practice for bedside RNs.

The Panel was established as a think tank to create an environment for RNs to consider and identify some of the barriers to RN practice... The Panel was established as a think tank to create an environment for RNs to consider and identify some of the barriers to RN practice at the full extent of education, experience, and scope of practice. Using a theoretical framework from the organizational behavior literature (Thompson, 1967), the team developed a model, validated by contemporary research in nursing administration (Kendall-Gallagher et al., 2010), to guide their exploration of this construct.

The model considered both individual and organizational perspectives. The Panel started with an attempt to define and envision what we perceived as the optimal future state for nursing practice from our collective view. The model considered both individual and organizational perspectives. Concepts from the model for study that likely influence the ability of nurses to practice to the full extent of their education and scope included:

  • Individual Factors: These were factors that related to the individual nurse including, but not limited to, educational preparation and ongoing commitment to professional development.
  • Work-Related Factors: Some factors related to work environment and context of the work, such as relationships and communication with members of the interdisciplinary healthcare team.
  • Organizational Factors: Examples of factors related to organizational and professional support included organizational policies and practices, the healthcare reimbursement structure, and the ability to quantify and demonstrate the value of nurse contributions.

The ultimate goal of the subcommittees was to develop summary recommendations to remove identified barriers to RN practice. Priorities for consideration among all identified concepts were established, based on consensus voting within the steering committee. Subcommittees were formed to explore each prioritized concept using an evidence-based practice approach. Subcommittees were led by the steering committee members. Advisory committee members participated by gathering data to validate recommendations brought forward by the steering committee. The ultimate goal of the subcommittees was to develop summary recommendations to remove identified barriers to RN practice.

Following review and synthesis of the literature, clear, actionable themes emerged from the data generated from the subcommittee work. The themes identified produce a vision for expanded roles for nurses that will provide a basis to elevate the value of the RN contribution to the healthcare team. The action items associated with each nursing role provide a roadmap for nurses at all levels to accelerate this transformation.

The Panel findings revealed that some of this end-state vision is already underway. For example, we identified several existing ANA initiatives that already reflect portions of it including,

  • Professional Issues Panel on Workplace Violence and Incivility (ANA, 2016d)
  • ANA Code of Ethics (ANA, 2016b)
  • Healthy Nurse, Healthy Nation™ (ANA, 2016c)
  • ANA’s Healthy Nurse Health Risk Appraisal ([HRA], n.d.)

The upcoming ANA Healthy Nurse, Healthy Nation Grand Challenge™ will also complement the vision for full scope of RN practice. This ongoing work will address important topics concerning self-care and self-promotion. The issues included in these initiatives are essential to the elimination of barriers to RN scope of practice, particularly with regard to the role of the RN as a professional. However, to avoid duplicating these ongoing initiatives, these topics were not a central focus of this Panel’s work.

Our panel ultimately envisioned an individual RN who was knowledgeable about and accountable for the applicable standards and scope of practice; educated and committed to engaging in a journey of lifelong education, learning, and discovery; and accountable for and able to articulate his or her professional value. We envisioned systems and organizations in an optimal state as providing a supportive and engaging environment that enhanced RN education and professional development; fostered autonomy of practice; engaged RNs in innovative change; and valued, quantified, and allocated resources based upon RN contribution to care.

Role Definitions and Panel Recommendations

With a visionary framework in place for guidance, the Panel began the core work. Many of our findings have been disseminated in greater detail within the individual RN role articles concurrently published in this OJIN topic. Lessons learned from the work of the Panel have resulted in several core conclusions. As we answered our first question, What is the envisioned future role of an RN?, we structured our findings around four core tenets, or roles for RNs, in the health care system. In Table 1, we propose definitions, followed by recommendations specific to each of these RN roles.

Table 1. Definitions for Four Key RN Roles


Panel Definition

RN as Professional

As professionals, all RNs are accountable for their own educational development, growth of their own practice, and execution of their own professional role.

RN as Advocate

As advocates, all RNs are engaged as speak and act on behalf of patients, families, and communities they serve to positively influence the systems which provide care.

RN as Innovator

As innovators, all RNs act as agents of change to drive processes and leverage technology that impact both care delivery and those who deliver care.

RN as Collaborative Leader

As collaborative leaders, all RNs are invested as interprofessional collaborative partners in the creation of outcomes of value for patients, families, and communities.

The Panel then considered an answer to the second question, How are we, as RNs, going to effectively demonstrate our value? Those conclusions were based in part upon our discovery of existing barriers to RNs in the execution of the four core roles. As Panel members explored perceived and actual existing barriers, they created recommendations and tactics to either eliminate them or mitigate their impact. The Panel organized the ideas by the RN roles described above. The key themes, conclusions, and recommendations determined by the Panel members are briefly summarized here, with additional detail available in the appropriate role perspective articles in this OJIN topic. We also include recommendations at the individual level for all registered nurses.

Full Scope of Practice: Role-Targeted Panel Recommendations

RNs as Professionals. As professionals, RNs are accountable for their own educational development and execution of their individual professional role. Recommendations related to this role considered standardized minimum recommended educational level for practice, seamless academic progression, mentoring, and specialty certification. Panel recommendations are adapted from Zittel, Moss, O’Sullivan, and Siek (2016).

Panel Recommendations:

  • Prospective/potential applicants to the nursing profession must commit to a goal of life-long learning with the attainment of a BSN as the minimum educational preparation for continued practice.
  • Individuals, organizations, state boards for nurses, and educators must make policy decisions to develop a standardized educational preparation that permits new RNs to be licensed with a diploma or associate degree, but requires earning a BSN degree within a certain timeframe after licensure.
  • Seamless academic progression models must be created and implemented to support RN educational advancement to the BSN degree level or higher.
  • Mentoring/guidance in academic and practice venues must be provided to assist RNs to continue their education.
  • Certification is most valuable when it is accompanied by a BSN, thus attainment of specialty certification should be prefaced by completion of a bachelor’s degree in nursing.

As caregivers, RNs are engaged as advocates on behalf of the patients, families, and communities they serve... RNs as Advocates. As caregivers, RNs are engaged as advocates on behalf of the patients, families, and communities they serve to positively influence the systems in which care is provided. Recommendations related to the caregiver role consider collaboration to achieve full scope of RN practice, accountability as team members in healthcare delivery, and accountability to provide value driven and effective nursing care. Panel recommendations are adapted from Lucatorto, Thomas, and Siek, (2016).

Panel Recommendations: Collaboration and Scope of RN Practice
  • Healthcare organizations should formally declare, through policy and conduct, that nurses are actively engaged in decisions regarding nursing care in all aspects of the organization and hold the ultimate authority for deciding what constitutes nursing practice. This recommendation requires that organizations include nurses in policymaking groups that currently have no nursing representation. Organizational leadership structures may need modification to place nurses in upper-level decision-making positions with final authority related to nursing care.
  • Healthcare and organizational policy will need to adopt language recognizing that healthcare professions have a shared scientific body of knowledge and acknowledging overlaps that may exist between professions for some aspects of care. Where overlap exists, based upon each profession’s interpretation of scope of practice, organizations will respect that there may be more than one profession with a valid scope of practice for a service.
  • Healthcare organizations will need to restructure the existing nursing hierarchy to reflect principles of shared governance. Embracing principles of shared governance may require restructuring resources or positions to provide increased support for practicing nurses.
Associated organizational policy should support and encourage nurses to use their judgment to perform care rather than completing task-based actions. 

Panel Recommendations: Accountability as Team Members in Healthcare Delivery

  • Healthcare organizations must develop nursing practice boards that have the ultimate authority to grant privileges or approve individual nurse skill competencies. This step will increase nurse accountability and allow nurses to practice to the fullest extent of their level of competency, yet within their professional scope of practice and relevant nurse practice acts. Nursing practice boards must include nurses with appropriate education and experience to evaluate competencies.
  • Healthcare organizations must create an environment to attract, recruit, and retain highly skilled nurses by developing a team-based practice and culture that uses terminology respectful to all team members. An example of this terminology is using the word “treatment” or “prescription” rather than “order.” Associated organizational policy should support and encourage nurses to use their judgment to perform care rather than completing task-based actions.

Panel Recommendations: Accountability for Value-Based and Effective Nursing Care

  • Leaders in the profession of nursing must develop and implement standardized coded terminology or the use of coded data that serve as a measure of intensity of the nursing service provided, the type of care provided, and who provided the care. This coding can be mandated through collaboration with meaningful-use partners and be tied to reimbursement or quality bonuses in the way that similar terminology has been previously implemented (ANA, 2013; ANA Care Coordination Taskforce, 2015).
  • Nursing leaders must collaborate with accrediting bodies to mandate public reporting of nursing work and outcomes related to nursing care. Ongoing organizational accreditation will require public reporting of measures for accreditation.

RNs as Innovators.
As innovators, RNs act as agents of change in driving processes and policy and leveraging technology that impact both care delivery and those who deliver care. Consistent with the ANA Scope and Standards of Practice, nurses in all roles and settings lead innovative change to protect, promote, optimize, and advocate for the health of individuals, families, groups, communities, and populations (ANA, 2015). This change includes development of nurse led innovations, policy to support innovations, and input in the innovation process. Panel recommendations are adapted from Thomas, Seifert, and Joyner (2016).

Panel Recommendations: Nurse Innovation

  • Nurses develop leadership skills (financial, self-awareness, critical thinking) and skills in interprofessional collaboration and strategic reasoning to promote innovation on all aspects of healthcare delivery.
  • Researchers work to identify key characteristics and attributes of successful nurse innovators.
  • Nurses achieve positions of influence on national committees and workgroups that are designing and implementing innovative changes to federal initiatives such as the National Quality Strategy, payment methodology, quality measures, and other healthcare initiatives.
  • Employers invest in the development of environments that foster nurse innovation.
  • Nurses share and promote best practices developed through innovative initiatives.

Panel Recommendations: Policy

  • Nurses lead development of innovations in health policies by applying nursing knowledge to advocate for patients, consumers, and the nursing profession.
  • Educators develop and implement curricula and continuing education that reflects an active role in health policy.
  • Nurse leaders mentor new nurses about how to get involved in health policy development.
  • Nurses achieve leadership positions throughout the healthcare system (e.g., organizational, local, state, and federal levels) to design and implement innovative changes to health policy.
  • Nursing organizations monitor health policy regulations to ensure they are supportive of patient care and nursing practice.

Panel Recommendations: Innovation Process

  • Nurses lead, leverage, and advance innovations and technology from inception and development through implementation and evaluation.
  • Nurses advocate for nursing input to identify the value of nursing services and impact on quality.
  • Nurses integrate informatics and technology into nursing education (including continuing education).
  • Nurse educators develop and implement curricula and continuing education reflecting contemporary practice.

RNs are invested as interprofessional collaborative partners in the creation of outcomes of value... RNs as Collaborative Leaders. As leaders, RNs are invested as interprofessional collaborative partners in the creation of outcomes of value for the patients, families, and communities they serve. Recommendations to support collaborative leadership are offered in the areas of transition to practice, culturally competent care, and interprofessional environment. Panel recommendations are adapted from Moss, Seifert, and O’Sullivan (2016).

Panel Recommendations: Transition to Practice

  • Establish a shared commitment for evidence-based programs that are sustainable and cost effective via the collaborative development, implementation, and evaluation of residency programs (AONE, 2012).
  • Hold employers accountable to develop and evaluate transition programs in collaboration with academic partners.
  • Support investment by employers and academic partners in research about transition program designs, to include measurement of return on investment.

Panel Recommendations: Culturally Competent Care

  • RNs create an environment and practice in a manner congruent with cultural diversity and inclusion principles.
  • Leaders in academia work to recruit diverse students to achieve a multicultural workforce and develop curricula to promote cultural competence.
  • RNs promote policies and organizational culture that ensures that cultural, religious, and racial preferences of patients, families and RNs are respected and incorporated into the plan of care.
  • Employers of nurses should invest in the development of a workforce that reflects the community they serve.

Panel Recommendations: Interprofessional Environments

  • Leaders in academia and practice should develop and test effective interprofessional practice collaborative models.
  • Nurses should drive and engage in research to develop and test interprofessional practice and academic collaborative models.
  • Establish a shared commitment to create infrastructures to collect and analyze data on current and future needs of the RN workforce (AONE, 2012).
  • Identify useful workforce data and consider joint collection and analysis of workforce and education data.
  • Solicit funding for BSN education.

Full Scope of Practice Individual Level Panel Recommendations
As the Panel reviewed key conclusions, we determined that there were additional recommendations that must be part of any dialogue or study moving forward. These recommendations are today actionable by each of us as RNs. Some of them are directly actionable and others offer a philosophical basis for daily practice as a registered nurse. We present these 10 Panel recommendations in Table 2.

Table 2. Full Scope of Practice: 10 Panel Recommendations for Individual RNs

Action: To achieve the full scope of practice, each RN must:


Know our scope of practice and own it.

We, as professional RN’s have accountability morally, ethically and legally for practicing within our defined scope of practice. If we do not understand and articulate what that practice is, we cannot execute within our defined frame. In addition, if we do not understand, we cannot extend ourselves to practice at the top of that licensure and scope. Finally, if we are unable to articulate our practice, those we serve and those with whom we practice will not be able to distinguish those unique attributes and contributions that our profession makes.

Recognize the need for change and engage in the process.

Change must focus on us, our practice, our employers/systems/organizations, our boards, and our national professional organizations. Change must be advocated for, defined, and implemented by us, as RNs. To do less is to abdicate our professional responsibility. We must learn to adapt, abandon, and overcome processes, policies, practices, and programs that do not serve nor add value to the patients within our care or to our profession. We must be willing to ask and answer the questions and be accountable for the answers. We do this in order to embrace the power of our potential and drive the need for change to add value to our healthcare practice.

Understand that as good as we are, we can be better.

We must understand that, as knowledgeable as we are, we can know more. We must understand that as much as we do, we can do more. The patients, families, and communities we serve deserve that commitment and that action from each of us as individuals and from our collective as professionals.

Articulate our value as RNs.

The healthcare delivery system in the United States is evolving rapidly. We, as professionals, must become comfortable with articulating what our role brings to the table in terms of quality, safety, service, and outcomes.

Find and use our professional voice.

Our voice as individuals is focused in service of the individual patients and families within our care. We think nothing of advocating for the care needed, even when faced with a differing or conflicting opinion. We utilize our knowledge to create a voice that, in turn, creates action. We must use that voice in broader discussions at the organizational, state, and/or national level to advocate both for those we serve and for our own profession.

Challenge our assumptions and status quo.

Often, we use excuses to maintain what is, rather than to embrace what should be. Our rationale of “that’s the way it has always been” is no longer acceptable professional practice. Instead, we should be driving ourselves and our practice to “that’s the way it should be.” Our patients and our profession deserve no less.

Create new pathways to deliver care through innovation and transformation.

It is not easy to discover new methodologies for care. By using research and engaging in an evidence-based practice, we can innovate. Our mastery rather than condemnation of technology enables us to drive transformation at the bedside.

Be proactive. Lead from the front, not the rear.

We have the professional responsibility to insert our knowledge into the national conversation. We have the expertise and the knowledge to be effective advocates for those we serve. Our leadership is inherent in our role as RNs. We must acknowledge and own the mantle.

Engage and become involved.

Engagement is not a passive exercise. It is active and requires courage of convictions and the understanding of issues and circumstances with the passion to improve. If the nursing profession does not own, drive, and advocate for nursing practice, someone else will determine its future. We cannot abdicate our professional responsibility.

Be accountable for your practice.

Our accountability has to focus on ourselves and on our individual practice. Before we can hold others accountable, we must be willing to hold ourselves individually and collectively answerable to those we serve and to colleagues with whom we serve daily. We are our outcomes.

Each of these 10 recommendations is directly or indirectly actionable by us, as RNs, today and every day. Each requires commitment and tenacity, throughout one’s career, to achieve. Each can contribute to the basis for all RNs to achieve the fullest scope of nursing practice.

Conclusion: Future Considerations

The Panel discussed additional ideas and opportunities for consideration as we addressed elimination of barriers to scope of RN practice. Members of the Panel believe there are still many possibilities to explore. While the Panel focus was on the nursing profession as a whole, to continue the dialogue and build our work, we conclude by proposing several potential areas of future study for state and national level consideration:

  1. Create a call to action for seamless academic progression and development of academic/practice partnerships. Academic/practice partnerships should engage beyond collaboration. There should be mutual focus on driving both nursing care and nursing practice. Neither side can do this in the absence of the other. As a goal, create stackable credentials among and between academic programs (i.e., a sequence of credentials that can be accumulated over time by an individual to develop various qualifications).
  2. Require that nursing review and privilege all nursing professionals within systems or organizations rather than through other mechanisms or other professions. Only nursing has the professional responsibility and understanding to evaluate the practice of a nursing professional. This should include APRN practice in addition to RN practice.
  3. Create a valid and reliable value contribution metric to quantify and demonstrate the value that the nursing professional contributes toward achieving quality patient outcomes. Use this metric to inform the appropriate distribution of resources for RNs. The creation of value will be a balanced equation that quantifies the contribution that nurses individually and the nursing department as a whole deliver to individual patients and to patient populations. This balanced equation will quantify the delivery of quality, safety, service, and process and outcome metrics by RNs.
  4. Create a standardized national interpretation of scope of practice in all states. The legal interpretation of scope of practice currently varies from state to state. It is incumbent on our profession to strive for a uniform, standardized methodology to evaluate practice. Building upon the work done by the National Council of State Boards of Nursing (NCSBN, 2009) in the development of the Nurse Licensure Compact may be one pathway to achieve action.
  5. Propose and successfully advocate for changes in regulation and policy to ensure that the voice of nurses, to represent the nursing profession, is included at the organizational level. For example, the Centers for Medicare & Medicaid Services “Condition of Participation” regulations require a hospital board to “consult directly with the individual assigned the responsibility for the organization and conduct of the hospital’s medical staff, or his or her designee” (CMS, 2014, 42 CFR § 482.12(a)(10)). These regulations do not address the need for a nursing voice. As one of a hospital’s largest constituent/employee bases, nurses should have, and deserve to have, nurse leaders at the table to represent and voice the perspective from the profession of nursing.

While these considerations may seem ambitious, Panel members are convinced that the process of addressing and eliminating barriers to the full practice of RNs can be accelerated. We encourage everyone reading this article, and this OJIN topic, to join us in envisioning the future scope of practice and keep the dialogue alive.

We can no longer accept barriers as blockades to action. As the topic articles demonstrate, RNs have both significant opportunities and challenges. The authors have presented options and rationale to address these challenges that are both evolutionary and revolutionary. To fully answer the questions, What is the preferred future for RNs? and How are we going to effectively work to achieve, articulate, and demonstrate our value?, is to begin with the definitions of our roles. RNs are professionals, advocates, innovators, and collaborative leaders. We can no longer accept barriers as blockades to action. We must stand as individuals and as a collective profession to face our internal and external challenges. It is no longer realistic to do nothing. As caregivers, we are professional advocates who, through innovation, collaboratively lead. Let us commit to execute our roles to the fullest scope of RN practice. Let us not accept limits. Let us instead be limitless within our thinking to support our scope. It is time.


Portions of the research for this article were performed by an American Nurses Association (ANA) Professional Issues Panel entitled “Barriers to RN Scope of Practice.” The panel was composed of volunteers from a variety of nursing backgrounds who contributed through participation on the Panel’s Steering Committee and Advisory Committee. While the articles were generated by authors participating in a Professional Issues Panel convened by ANA, the conclusions and recommendations articulated by any author do not necessarily reflect those of the Association.


Tracy E. Williams DNP, RN, FNAP

Tracy Williams has served as Senior Vice President and System Chief Nursing Officer with Norton Healthcare since 2005. Williams received a BSN from Old Dominion University in Norfolk, VA; an MS in nursing from Medical College of Virginia/Virginia Commonwealth University; and earned a DNP in Executive Leadership from Rush University in Chicago, IL. Williams is the Executive Associate Dean for the Norton Academic Practice Partnership and Professor with the University of Kentucky College of Nursing and is an Assistant Professor, (Adjunct), at Rush University, College of Nursing.

Kathy Baker, PhD, RN, NE-BC

Kathy Baker currently holds a Nursing Director position at the Virginia Commonwealth University Health System (VCUHS) in Emergency Services, Critical Care Transport, Resource Management and Patient Care Support. She is also a Nurse Scientist at VCUHS with a research focus in work environments and patient safety. Her clinical background includes Critical Care, Cardiovascular and Emergency Nursing with experience in both adult and pediatric populations. Dr. Baker also holds an affiliate faculty position at the VCU School of Nursing where she teaches in the Graduate Nursing Leadership program.

Leda Evans, BSN, RN, OCN

Leda Evans received her BSN from Grand Valley State University (GVSU) in 2006. She currently works as a Registered Nurse on an inpatient medical/surgical oncology unit at Mercy Health St. Mary’s. Leda is a recent graduate of GVSU’s Doctor of Nursing Practice program, with a focus on the Adult/Older Adult population. She was awarded the Graduate Dean’s Citation for Academic Excellence for Service to the Community or Profession. Leda is a Jonas IV Veterans Healthcare Scholar, with an interest in HIV/AIDS prevention in vulnerable populations.

Michelle A. Lucatorto DNP, RN, FNP-C

Michelle Lucatorto is the Clinical Program Manager for Specialty Care Nursing and a Nurse Practitioner in Primary Care in the Veterans Health Administration with a Doctor of Nursing Practice Degree. Dr. Lucatorto has held multiple faculty positions and is currently a Clinical Facility Advisor at Georgetown University in the Family Health Nurse Practitioner Program. Dr. Lucatorto has published multiple peer reviewed journal articles, and written chapters in several books.

Edtrina Moss, MSN, RN-BC, NE-BC

Edtrina Moss has expertise in dialysis, transplant, critical care, ambulatory care, nursing education, care coordination, utilization management, and leadership. She has served in the roles of nurse educator, transplant coordinator, nurse manager and program director. She is a member of the Texas Nurses’ Association Policy Council and serves as content expert reviewer for the American Academy of Ambulatory Care Nursing’s Care Coordination & Transition Management curriculum and certification. She is also a student at Texas Woman’s University – Houston Campus, where she has completed all course work for a PhD in Nursing.

Ann O’Sullivan, MSN, RN, NE-BC, CNE, ANEF

Ann O’Sullivan currently serves as Assistant Dean for Support Services at Blessing-Rieman College of Nursing and Health Sciences. Ann has served in many roles in the American Nurses Association, including state Board of Directors and President, chair of Health Policy, and chair of Assembly Nursing Practice. She is currently Vice-President of ANA-Illinois and chairs the Illinois Expert Panel of Scope of Practice. At the national level, Ann served as chair of the Reference Committee, member and vice-chair of the Congress of Nursing Practice and Economics. Ann chaired the workgroup that revised the 2010 ANA Scope and Standards of Practice and was co-editor of Essential Guide to Nursing Practice (2012).

Patricia C. Seifert, MSN, RN, CNOR, FAAN

Patricia C. Seifert has more than 25 years of experience as a perioperative nurse. Seifert is a past president of the Association of periOperative Registered Nurses (AORN), past Lead Coordinator of the Nursing Organizations Alliance, a member of Sigma Theta Tau. She is a Fellow in the American Academy of Nursing. Seifert is the author of six books and numerous articles and chapters; she was a member of the writing group for the 2013 American Heart Association Scientific Statement: Patient Safety in the Cardiac Operating Room: Human Factors and Teamwork.

Terry Siek, MSN, RN, NEA-BC

Terry Siek, Vice President of Patient Care and Chief Nursing Officer at Hays Medical Center, graduated from Fort Hays State University in 1991 with a BSN and in 2002 with an MSN. Mr. Siek is responsible for the practice of all nursing staff at the 200-bed tertiary care center in rural Kansas. He has also served as the State President of the Kansas Organization of Nurse Leaders and is currently Secretary for the Kansas State Nurses Association.

Timothy W. Thomas, BSN, RN

Timothy W. Thomas has worked as a registered nurse for 15 years, and started his career in the U.S. Army at the original Walter Reed Army Medical Center (WRAMC). In the USPHS, he has been detailed to the Federal Bureau of Prisons (BOP) and has moved up from a clinical nurse, to the Improving Organization Performance/ Infectious Disease Coordinator (IOP/IDC), to his current position as Regional Nurse Consultant/ Medical Asset Support Team RN for the Southeast Region.

Barbara Zittel, PhD, RN

Barbara Zittel is the immediate past Executive Secretary to the New York State Board for Nursing where she was responsible for the scope of practice determination, discipline and licensure of 320,000 licensed practical nurses, registered nurses, and nurse practitioners. Currently she serves as Co-Director of the Robert Wood Johnson Foundation/AARP Academic Progression in Nursing grant in New York and as a Trustee to Ellis Medicine.


American Nurses Association. (2016a). Advanced practice nursing. Retrieved from

American Nurses Association. (2016b). Code of ethics. Retrieved from

American Nurses Association. (2016c). Healthy Nurse, Healthy Nation™. Retrieved from

American Nurses Association. (2016d). Incivility, bullying, and workplace violence. Retrieved from

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

American Nurses Association, Care Coordination Task Force. (2015). Policy agenda for nurse-led care coordination. Retrieved from

American Nurses Association. (2013, March). ANA offers guidance on new Medicare billing codes. Retrieved from

American Nurses Association. (n.d.). Welcome to ANA’s Healthy Nurse® health risk appraisal (HRA). Retrieved from

American Organization of Nurse Executives. (2012). AONE guiding principles. Retrieved from

Centers for Medicare & Medicaid Services, Conditions of Participation for Hospitals, 42 C.F.R. Part 482, § 482.12(a)(10) (2014)

Gutchell, V., Idzik, S., & Lazear, J. (2014). An evidence-based path to removing APRN practice barriers. Journal for Nurse Practitioners, 10(4), 255. doi:10.1016/j.nurpra.2014.02.005

Institute of Medicine. (2011). Future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. Retrieved from

Institute of Medicine. (2015). Assessing progress on the Institute of Medicine report: The future of nursing. Washington, DC: National Academies Press. Retrieved from

Kendall-Gallagher D., Aiken L.H., Sloane, D.M., Dimiotti, J.P. (2010). Nurse specialty certification, inpatient mortality, and failure to rescue. Journal of Nursing Scholarship, 43(2), 88094. doi: 10.1111/j.1547-5069.2011.01391.x. Epub 2011 Apr 1.

Lucatorto, M.A., Thomas, T.W., & Siek, T. (2016). Registered nurses as caregivers: Influencing the system as patient advocates. OJIN: The Online Journal of Issues in Nursing, 21(3). doi:10.3912/OJIN.Vol21No03Man02

Moss, E., Seifert, P. C. & O’Sullivan, A. (2016). Registered nurses as interprofessional collaborative partners: Creating value-based outcomes. OJIN: The Online Journal of Issues in Nursing, 21(3). doi:10.3912/OJIN.Vol21No03Man04

National Council of State Boards of Nursing. (2009). Changes in healthcare professions’ scope of practice: Legislative considerations. Retrieved from

Thomas, T. W., Seifert, P. C. & Joyner, J. C. (2016). Registered nurses leading innovative changes. OJIN: The Online Journal of Issues in Nursing, 21(3). doi:10.3912/OJIN.Vol21No03Man03

Thompson, J. D. (1967). Organization in Action. New York: McGraw-Hill.

Ward, Cynthia W, DNP, RNBC,C.M.S.R.N., A.C.N.S.B.C. (2015). It's time to recognize APRN practice nationally. Medsurg Nursing, 24(4), 210-211.

Zittel, B., Moss, E., O’Sullivan, A., & Siek, T. (2016). Registered nurses as professionals: Accountability for education and practice. OJIN: The Online Journal of Issues in Nursing, 21(3). doi:10.3912/OJIN.Vol21No03Man01

© 2016 OJIN: The Online Journal of Issues in Nursing
Article published September 30, 2016

Related Articles