Top-of-license practice for registered nurses: A scoping review

Abstract

Background: Registered nurses are vital to healthcare delivery, yet often perform non-nursing tasks, contributing to inefficiencies, dissatisfaction, and turnover. The concept "top-of-license" (TOL) nursing practice, introduced in 2013, remains inconsistently defined and applied.

Purpose: To explore how TOL nursing practice is defined and applied in existing literature.

Methods: A scoping review was conducted using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Searches of 15 databases and gray literature (no start date-May 4, 2024) yielded 1,377 articles. Following screening, 45 articles met inclusion criteria.

Findings: Definitions and applications of TOL varied. Three themes emerged: (a) work-workforce efficiency, (b) benefits to patients-improving patient care and clinical outcomes, and (c) benefits to nurses-nurse perceptions of clinical practice. Limited articles measured TOL outcomes. Definitions and applications of TOL varied, thus differentiation from scope of practice and a definition are provided.

Discussion: Standardizing the definition of TOL is essential to advance research, policy, and improve care quality and outcomes.

Keywords: Gray literature; Nurses; Patient care; Scope of practice; Workforce.