Scope of Nursing Practice as Perceived by Nurses Working in China: A Multicenter Cross-Sectional Survey

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Abstract

Purpose: To examine variations in Chinese nurses’ Actual Scope of Practice (ASCOP) by educational qualifications and professional titles, and to identify regulatory gaps in competency-based role assignments within China’s evolving healthcare system. Method: A nationwide cross-sectional study using the validated Chinese Nurses’ ASCOP Questionnaire is used. Data from 1,540 nurses were analyzed through descriptive statistics, independent t-tests, one-way ANOVA, and Bonferroni correction. ASCOP scores (1–5 scale) were compared across education levels (diploma, bachelor’s, postgraduate) and titles (junior/senior). Results: The overall ASCOP score was 3.95, with significant disparities in high-complexity tasks: postgraduate nurses (4.25) and senior nurses outperformed diploma holders (3.71) and juniors (p < 0.01). Low-complexity tasks showed no educational differences (p > 0.05), though bachelor’s or postgraduate nurses reported higher frequencies (4.12 vs. 3.89). Alarmingly, 37.6% of junior nurses routinely performed high-risk procedures beyond their competency. Conclusion: A systemic mismatch exists between nurses’ qualifications and assigned responsibilities, reflecting inadequate regulatory oversight. To address this, this study recommends: (1) competency-based tiered authorization systems, (2) legal framework updates aligning with China’s healthcare reforms, and (3) dynamic monitoring mechanisms. These measures could standardize practice boundaries, mitigate occupational risks, and optimize nursing workforce utilization, particularly in resource-constrained settings.

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