Top-of-License Nursing Practice: Describing Common Nursing Activities and Nurses’ Experiences That Hinder Top-of-License Practice, Part 1

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The aims of this study were to describe nurses’ perceptions of nursing activities and analyze for consistency with top-of-license (TOL) practice.


The Advisory Board Company expert panel proposed 8 TOL core nursing responsibilities representing practice at its potential. Thus far, no empirical work has examined nursing practices relative to TOL, from staff nurses’ points of view.


This qualitative study used focus groups to explore perceptions of typical nursing activities. We analyzed activities for themes that described nurses’ work during typical shifts.


Nurses’ full scope of work included TOL-consistent categories, as well as categories that did not exemplify TOL practice, such as nonnursing care. A proposed model was developed, which depicts nurses’ total scope of work, inclusive of all activity categories. In addition, hindrances to TOL practice were also identified.


Findings from this study can inform leadership imperatives and the development of innovative, sustainable nursing practice models that support nursing practice at TOL.

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