Can you use that new piece of equipment at work? Can you undertake that new task your employer is asking you to do? What about outside of work – are you allowed to use your professional skills?
Our guidance says you should use your “professional judgement” to come to decisions about these kinds of questions – decisions about what is and is not within your scope of practice (the limit of your skills, knowledge and experience). But what does this “professional judgement” look like in practice?
“Some professionals don’t have the confidence to make that decision for themselves, and need to talk through their situation,” says Anne Keen, Professional Adviser from the Royal College of Occupational Therapists. “The HCPC has a broad definition of scope of practice, which is great – but this can make it difficult for a professional to decide if an activity is within their scope of practice. There are no black and white answers.”
Will it help and can you do it?
Anne shared the following story about Jenny*, an occupational therapist who was asked to lead a yoga class on her ward:
Jenny wanted to conduct the yoga class, yet wasn’t sure whether she could do so within her scope of practice as an occupational therapist.
I encouraged Jenny to think about two factors: the individual service users and her own professional skills, knowledge and experience.
Firstly, was the yoga going to benefit the service users? By practising yoga, would their engagement in their activities improve? Would the relaxation techniques they learned through yoga help them to engage with activities they want or need to do such as shopping or travelling on public transport?
Secondly, was Jenny professionally competent to lead the yoga class – either through education, training or experience?
Once Jenny clarified that the yoga would help the service users engage with their activities, and that she was professionally competent to deliver yoga as an intervention, she was able to go off and lead the class.
Applying that two-step test – checking the therapeutic benefit to the service user, and her own professional competence – allowed Jenny to make that decision.
“This test can be applied to many scope of practice questions for occupational therapists,” Anne adds. “If you can demonstrate that your professional rationale for any intervention is enhancing service users’ health and wellbeing by helping them to engage with their activities, you can be reassured that this is within the scope of practice of an occupational therapist.”
Anne highlights that sometimes employers ask all staff to do a new task – for example, monitoring service users’ weight – and provide training for the task.
“Some people are uncomfortable with doing these tasks, but we have to remind them of what is best for the service user. How could a healthy weight help them with their activities? And how disruptive might it be for a separate health professional to visit them, just for this purpose?”
When decisions need to be quick
What about situations where decisions need to be made more quickly?
Bill Kilvington, Patient Safety Lead with the College of Operating Department Practitioners, shared an example of Helen*, an experienced operating department practitioner (ODP), who came to the College for advice:
In the hospital, Helen was regularly using a Guedel airway device to help keep unconscious patients’ airways open. She had completed immediate life support training which included training on using the Guedel airway.
Outside of her hospital role, Helen also volunteers as a first responder in her local community. Helen was responding to some emergency calls for people who were unconscious, where she felt a Guedel airway could be beneficial.
She knew her qualifications and experience meant she could use the Guedel airway safely in hospital. Outside the hospital there was more to consider. For example, Helen had to think about whether the patient was at risk of vomiting. If the patient was not deeply unconscious, as they would be if they were under an anaesthetic in a hospital, using the Guedel airway could trigger their gag reflex.
In the emergency situations she was responding to, Helen had to ask herself: What are the possible implications of using the airway? What are the implications of not using it? Is the risk to the patient greater than the risk of not acting?
If she could think it through and justify her actions – even if under normal circumstances she would do something else – she could justify it as being within her scope of practice.
Bill also explains that many professionals work in environments that are not traditionally part of the ODP role, such as in critical care. These enhanced roles involve tasks that are underpinned by their primary skills, knowledge and experience as ODPs.
“Our advice,” says Bill, “would be to ask yourself: does this meet a patient need, are you competent to do it and does your employer recognise that you carry out the role?
“Sometimes a practitioner has to make a judgement call as to whether their inaction in an emergency situation could lead to greater harm than acting outside of their normal scope of practice. Before taking such action you should always reflect upon whether you can justify your actions and what alternative options might be available.”
When it’s not within your scope
There may be situations where you think through what you’ve been asked to do, and conclude that it’s not within your competency levels.
“If you decide a particular activity is outside your scope of practice, you should speak to your employer about it,” says Anne. “You should have training, support and supervision if they want you to do that task – as well as the opportunity to raise your concerns.”
Our standards say registrants “must keep up to date with and follow the law, our guidance and other requirements relevant to your practice”. We expect decisions around scope of practice to be informed by the law. If there are legal restrictions on the roles or tasks you can perform in your profession, you need to limit yourself to what is legally permissible.
For more information
Read our information on scope of practice, or get in touch with your professional body.
* names have been changed