Healthcare facilities depend on a multidisciplinary team whose roles are defined by statutory, regulatory, and organizational frameworks. Practicing within one’s legally defined scope is essential to safeguarding patient safety, maintaining professional integrity, and protecting both clinicians and organizations from legal and regulatory consequences. When individuals exceed their scope of practice, the risks include patient injury, malpractice claims, regulatory sanctions, disciplinary action, and reputational harm.
Scope of practice is shaped by a combination of state practice acts, professional standards, certifying bodies and organizational policies. It includes the specific activities, procedures, and decision‑making functions that a clinician is authorized to perform based on education, training, experience, and demonstrated competence.
Professional organizations—such as the American Nurses Association (ANA), the American Society of Radiologic Technologists (ASRT), and the National Association of State EMS Officials (NASEMSO)—publish standards, practice frameworks, and guidance that further define role boundaries and ensure consistent expectations across settings.
Registered Nurses (RNs) may conduct assessments, provide patient education, and administer medications, but cannot independently diagnose or prescribe, unless licensed as an Advanced Practice Registered Nurse (APRN).
Scope varies by state, including supervision requirements for APRNs and prescriptive authority. Violations commonly occur when nurses independently initiate procedures, modify treatment plans, or administer medications without provider orders.
Accrediting bodies have increasingly identified potential scope‑of‑practice concerns related to therapeutic duplication within healthcare organizations. Therapeutic duplication occurs when a prescribing provider orders two or more medications intended for the same clinical indication without clearly specifying the sequence, priority, or conditions under which each medication should be administered. When such orders lack explicit provider guidance, the responsibility for determining which medication to administer—and in what order—may inadvertently shift to the RN. This situation places the RN at risk of functioning outside the legally defined scope of nursing practice, as determining or selecting a medication regimen constitutes prescriptive decision‑making, which is reserved for licensed providers authorized to diagnose and prescribe.
To mitigate these risks, organizations should ensure that RNs are thoroughly trained and consistently encouraged to seek clarification whenever medication orders are ambiguous, incomplete, or appear duplicative. Clear expectations should be established so nurses understand that consulting the prescribing provider is required, not optional, when the order does not clearly define administration parameters. This practice not only protects the RN’s license but also promotes patient safety and regulatory compliance.
Radiologic technologists (RTs) are authorized to position patients, operate imaging equipment, and acquire diagnostic images. They must follow established imaging protocols, ensure that there is an informed consent when applicable, verify patient identity, and maintain accurate documentation. They are not licensed to interpret images, provide diagnostic opinions, or modify imaging protocols without radiologist or provider direction.
As coverage gaps persist in healthcare facilities, some are turning to radiologic technologists to offer diagnostic opinions. Lawsuits have arisen when RTs have offered informal diagnostic opinions, resulting in unnecessary procedures.
Paramedics possess advanced emergency skills, including airway management, cardiac monitoring, ECG acquisition, and administration of specific medications under standing orders or real‑time medical direction. Their authorized role changes substantially when they transition from field care to in‑hospital roles, as state laws vary on what constitutes permitted “emergency medical care” in a healthcare facility. Some states, such as Oklahoma, limit paramedic practice in hospitals strictly to the delivery of emergency care.
To support safe, compliant practice and reduce legal exposure, healthcare organizations should:
Practicing within one’s scope is not merely an administrative requirement—it is a professional, ethical, and legal mandate. Nurses, radiologic technologists, and paramedics each face unique risks when exceeding their authority or working without appropriate supervision or orders.
Healthcare organizations play a critical role in reinforcing safe practice boundaries through strong policies, education, competency validation, and a culture of safety. By doing so, they protect patients, staff, and the organization as a whole.
ANA (2026) Scope of Practice. NursingWorld.org https://www.nursingworld.org/practice-policy/scope-of-practice/
ASRT (2025) The ASRT Practice Standards for Medical Imaging and Radiation Therapy. ASRT.org. https://www.asrt.org/main/standards-and-regulations/professional-practice/practice-standards-online
Ernstmeyer K, Christman E, (Eds.) (2024). Chapter 5, Legal Implications. Nursing Management and Professional Concepts 2nd edition. https://www.ncbi.nlm.nih.gov/books/NBK610473/
Joint Commission (2026). FAQ Is therapeutic duplication prohibited by Joint Commission? www.jointcommission.org. https://www.jointcommission.org/en-us/knowledge-library/support-center/standards-interpretation/standards-faqs/000002339
NASEMSO (2026). EMS Scope of Practice. Nasemso.org. https://nasemso.org/content.aspx?page_id=22&club_id=157064&module_id=701418
Sterling JA. A Call to Action: Range Orders and Therapeutic Duplication. Hospital Pharmacy. 2012;47(2):82-88. doi:10.1310/hpj4702-82
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