Assessment and Diagnosis
A Physical Therapist (PT) is evaluating a patient with a sprained ankle. During the assessment, they begin to ask detailed questions about the patient's heart history and a family history of diabetes.
What is overstepping. While a PT can screen for general health information that may impact their treatment, diagnosing or delving deeply into systemic diseases is outside their scope. This falls under the scope of an NP or RN, who perform comprehensive health histories.
A Certified Nursing Assistant (CNA) is assisting a patient who is immobile. The patient needs to be repositioned in bed to prevent pressure sores. The CNA follows the care plan and uses proper body mechanics to safely turn the patient onto their side.
The CNA is not overstepping. Repositioning patients, providing hygiene, and helping with mobility are all core responsibilities and well within a CNA's scope of practice, as long as they are following the patient's care plan.
A Medical Assistant (CMA) prepares a patient for an allergy shot. The CMA verifies the patient's identity, the specific medication, and the dose as ordered by the physician, and then administers the injection.
The Medical Assistant is not overstepping. Administering injections, especially vaccines and allergy shots, is a common and appropriate task within a CMA's scope of practice, provided they have the proper training and are acting under the supervision of a physician or other licensed provider.
An RN observes a patient who has been struggling with depression and anxiety. The RN tells the patient, "You need to see a psychiatrist immediately for medication."
The RN is overstepping by giving a direct order to a patient about what they "need." An RN can assess a patient's psychological state and recommend a referral, but prescribing the course of action (e.g., "you need medication") is the scope of a physician, NP, or psychiatrist. The correct action would be to inform the patient and suggest, "I'm going to talk to the doctor about a referral for you to see a mental health professional."
A Certified Medical Assistant (CMA) provides a handout to a patient with a new diagnosis of hypertension. The CMA points out the section on lifestyle changes and tells the patient to "ask the doctor or nurse if you have specific questions about diet."
The Medical Assistant (CMA) is not overstepping. Providing pre-approved educational materials and directing the patient to the appropriate licensed professional for more detailed or medical-specific questions is well within a CMA's scope. They are facilitating education without providing medical advice.
A Certified Nursing Assistant (CNA) is taking a patient's vital signs and notices they are slurring their words and have a drooping face. The CNA tells the patient's family, "I think your dad is having a stroke."
The CNA is overstepping. While a CNA's job is to observe and report changes, they do not have the training to diagnose a medical condition. This is the scope of an RN, NP, or MD. The CNA should have immediately reported the observations to the supervising nurse.
A Nurse Practitioner (NP) performs a routine outpatient surgical procedure to remove a benign mole. While the patient is on the operating table, the NP notices a new growth and decides to remove it as well, assuming it is also benign.
The Nurse Practitioner (NP) is overstepping. While many NPs perform minor surgical procedures, performing a new, unplanned procedure without a pre-operative diagnosis and consent is outside their scope. This falls under the scope of a surgeon (MD), who would assess the new growth and get consent before proceeding.
A Nurse Practitioner (NP) diagnoses a patient with a urinary tract infection (UTI) based on their symptoms, a urine analysis, and their medical history. The NP then writes and sends a prescription for an antibiotic to the patient's pharmacy.
The Nurse Practitioner is not overstepping. The ability to diagnose common illnesses and prescribe appropriate medications is a fundamental part of an NP's scope of practice, which is why they are often referred to as primary care providers.
A Physical Therapist (PT) evaluates a patient with chronic low back pain. During the evaluation, the PT suspects the patient's pain might be related to a kidney issue and immediately refers them to a Nephrologist.
This is within the PT's scope. A key part of a PT's role is differential diagnosis—identifying when a patient's symptoms are not related to a musculoskeletal issue and making an appropriate referral. The PT is not diagnosing the kidney issue but is recognizing a potential "red flag" and referring to the appropriate specialist.
A Medical Assistant (CMA) provides a handout to a patient about their new medication. When the patient asks about potential side effects, the CMA reads a list from the official drug information sheet and says, "Don't worry, none of these are serious."
The CMA is overstepping. While CMAs can provide patient education materials, interpreting side effects and offering reassurance is outside their scope. It could be seen as giving medical advice. The CMA should have said, "I can provide you with this information, but for specific questions about side effects, you should ask the RN or Physician."
A Paramedic responds to a patient with chest pain and difficulty breathing. After a quick physical exam, the paramedic tells the patient, "You're having a panic attack, not a heart attack. You can stay home."
The Paramedic is overstepping. While they can differentiate between certain symptoms, definitively diagnosing a panic attack and ruling out a life-threatening condition like a heart attack without a hospital workup is outside their scope. Their role is to stabilize the patient and transport them to a hospital for definitive diagnosis by a physician or NP.
A Medical Assistant (CMA) in a family practice is performing a routine check-up on a patient with a mild laceration. The CMA decides to clean and suture the wound, stating they've seen the doctor do it many times.
The CMA is overstepping. Performing sutures or other invasive procedures is outside of a CMA's scope of practice. This is the scope of a physician (MD) or a Registered Nurse (RN), and sometimes an NP, depending on state laws and supervision.
An NP is treating a patient for a common cold. After the patient asks about antibiotics, the NP tells them, "I think you need to get a new doctor. They should have given you antibiotics for this."
The NP is overstepping. While they can diagnose and prescribe, criticizing the care of another professional is a breach of professional courtesy and ethics. It also provides a diagnosis (a bacterial infection) without proper testing. The NP's scope includes proper medication management and patient education, not criticizing other professionals.
An RN is in an interdisciplinary care meeting discussing a patient with a complex wound. The RN explains the patient's non-verbal pain cues and their difficulty with self-dressing due to limited mobility. Based on this information, the RN suggests a referral to an occupational therapist (OT).
The Registered Nurse (RN) is not overstepping. The RN's role is to act as a patient advocate and a central hub of communication within the healthcare team. By observing the patient's challenges and suggesting a referral to the appropriate specialist, the RN is practicing within their scope to ensure comprehensive and holistic care.
A Paramedic is treating a patient at home who has a history of asthma and is having a mild flare-up. After administering a nebulizer treatment, the paramedic educates the patient on the proper use of their rescue inhaler, making sure they understand the correct technique for administering the medication during an asthma attack.
The Paramedic is not overstepping. Patient education, particularly on the use of emergency medications and devices, is a critical component of a paramedic's scope of practice. They are trained to provide immediate care and to empower patients with the knowledge needed to manage their condition during an emergency.
A Nurse Practitioner (NP) is seeing a patient for a follow-up visit after a recent hospital discharge for pneumonia. The patient complains of lingering fatigue and a cough. The NP listens to the patient's lungs, checks their oxygen saturation, orders a chest x-ray, and prescribes a new medication to help with the cough.
The NP is not overstepping. The actions of performing a physical assessment, ordering diagnostic tests, and prescribing medication are all within a Nurse Practitioner's scope of practice for managing a patient's condition.
A Paramedic arrives at the scene of a car crash. The injured patient has a significant bleeding laceration on their arm. The paramedic decides to use their personal trauma kit to suture the wound and apply a medical-grade glue to save the patient a trip to the ER for stitches.
The Paramedic is overstepping. Paramedics are trained in immediate life-saving interventions and wound management, but typically do not perform sutures. This is the scope of a surgeon (MD), NP, or RN in an emergency or clinical setting.
A Certified Nursing Assistant (CNA) is assisting a patient with their morning medications. The patient asks to take their pill with a can of soda instead of water. The CNA says, "Sure, that's fine," and hands them the soda.
The CNA is overstepping. A CNA's scope does not include medication administration or making decisions about how a medication should be taken. They should have consulted with an RN or LPN to ensure there would be no drug interaction, as some medications are not compatible with soda.
A Physical Therapist (PT) is treating a patient with chronic lower back pain. During the session, the patient confides in the PT that the pain is making it difficult to care for their young children and is causing significant emotional distress. The PT acknowledges the patient's concerns and recommends that they also speak to a social worker or a mental health professional for support.
The Physical Therapist (PT) is not overstepping. While a PT's primary focus is on physical function, their scope of practice includes a holistic approach to patient care. Recognizing that psychosocial factors can impact a patient's physical well-being, a PT has the responsibility to refer a patient to other professionals who can address those needs. This shows proper interprofessional collaboration and an understanding of the patient's complete health.
A Surgeon (MD) is speaking with a patient after a routine surgery. The patient asks about their post-operative diet. The surgeon spends ten minutes detailing the specific caloric intake, macronutrient breakdown, and meal plan for the next month.
The Surgeon (MD) is overstepping. While a surgeon can give general guidance, providing a detailed nutritional plan is the scope of a registered dietitian or a nutritionist. The surgeon's time and expertise are best used for surgical matters, and a referral to the dietitian would be the most appropriate action.
A Surgeon (MD) is conducting a follow-up with a patient who is three months post-op from a complex abdominal surgery. During the conversation, the patient mentions feeling sad, isolated, and having trouble sleeping. The surgeon diagnoses the patient with "post-operative depression" and tells them they'll need to be on an antidepressant for at least six months.
The Surgeon is overstepping. While an MD can diagnose and prescribe medication, the definitive diagnosis of a mental health condition like depression requires a full psychological evaluation. A surgeon is not trained in the comprehensive assessment required to distinguish between normal post-operative blues, grief, and clinical depression, nor are they the most appropriate professional to manage this long-term. This is the scope of a psychiatrist, psychologist, or a licensed mental health counselor in collaboration with a Nurse Practitioner (NP) or family physician for medication management. The appropriate action would have been for the surgeon to acknowledge the patient's feelings and refer them to a mental health professional.
A surgeon (MD) is performing a high-risk open-heart surgery. During the procedure, the patient's blood pressure drops critically low. The surgeon, recognizing the immediate threat to the patient's life, directs the anesthesia team to administer a specific vasopressor medication and adjusts the surgical approach to minimize blood loss.
The Surgeon is not overstepping. Managing a patient's condition during a surgical procedure, including making real-time decisions about medication and surgical technique to save the patient's life, is the most critical part of a surgeon's scope of practice. Their training and expertise are specifically for this type of complex, high-stakes intervention.
A Registered Nurse (RN) calls in a prescription refill for a patient's pain medication, based on a conversation they had with the patient about their pain level, without consulting the attending physician or NP.
The RN is overstepping. An RN cannot independently prescribe medication. This is the scope of a physician (MD) or Nurse Practitioner (NP). The RN's role is to assess and advocate for the patient, then communicate the need for a refill to the appropriate provider.
An RN in a hospital sees a patient who has been uncooperative with their physical therapy. The RN calls the Physical Therapist (PT) and says, "This patient is lazy. You should just discharge them from therapy since they're not trying."
The RN is overstepping. While an RN can provide observations about patient behavior, deciding on a patient's treatment plan or discharge is not in their scope. This decision is the scope of the Physical Therapist based on their own professional assessment and goals for the patient. The correct action is to report the patient's lack of cooperation and allow the PT to make the professional judgment call.
A Certified Nursing Assistant (CNA) is in a patient's room. The patient, who has Type 1 diabetes, asks the CNA to show them how to adjust their insulin dose based on their blood sugar readings. The CNA demonstrates the calculation and injection technique.
The CNA is overstepping. While a CNA can assist with some patient education, teaching complex medication management, like adjusting insulin dosage, is the scope of a Registered Nurse (RN) or a Nurse Practitioner (NP), who have the clinical knowledge to ensure the patient is safely managing their medication.