Letter to the Editor by Carolyn Brake to Overview and Summary: Elimination of Barriers to RN Scope of Practice Opportunities and Challenges

Elimination of Barriers to RN Scope of Practice: Opportunities and Challenges

April 17, 2017

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

With Reply from Author

Dear Editor:

I am writing in response to, “Overview and Summary: Elimination of Barriers to RN Scope of Practice Opportunities and Challenges” (Baker & Williams, 2016). As a new graduate registered nurse (RN), this article piqued my attention immediately because we come out of school wide-eyed and ready to take the profession by storm. Being able to practice to the full extent of my scope is exactly what I am looking to do. While I believe the topics discussed are completely on point with what the profession needs, I feel that it overlooks some realities that the RN currently faces. 

As is widely known, we have a shortage of individuals in the nursing profession. This means larger patient loads with higher acuity patients, as well as picking up additional shifts to meet the current demands of patient population. This does not allow much time for a nurse to engage in educational opportunities or lobby legislators. Meanwhile, timelines are in place for educational and certification goals that must be met. These demands can lead to additional stress for the professional nurse.

The current reimbursement system based on customer satisfaction increases the burden on nurses to cater to patient wants and not necessarily to provide the best care. This also requires administrators to focus on the best possible financial return for the hospital when their time and energy could be used to help ease the staffing shortages, facilitate town hall meetings to get feedback from nurses, and develop retention and incentive programs for those who have become overwhelmed facing daily demands.

In conclusion, the efforts of the think tank have provided groundwork to reduce barriers and allow nurses to practice to their full scope. This will certainly lead to a more efficient healthcare system in the future. However, before these ideas can be fully translated into programs and policies, I believe that we need to find ways to reduce the current staffing shortages and advocate for patient outcome-based reimbursement policies (as opposed to the current basis of patient satisfaction). In my opinion, these changes would promote greater work satisfaction for nurses; support improved workplace efficiency; and create more appropriate reimbursement within healthcare systems. Resolution of these barriers would be helpful in the effort to allow RNs to achieve full scope of practice.


Carolyn D. Brake, RN


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: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/OS-Elimination-of-Barriers-to-RN-Scope-of-Practice.html