Registered nurses’ knowledge, attitude and practice regarding their scope of practice in Botswana

BACKGROUND: The articulation of the scope of practice in nursing is important to provide boundaries for registered nurses in which to practice. Registered nurses in Botswana have frequently experienced challenges and raised concerns with their scope of practice. Research related to registered nurses’ knowledge, attitudes and practice regarding their scope of practice appears to be limited in the African context, particularly in Botswana. AIM: The aim of this study was to develop guidelines for professional nurses to explore and describe registered nurses’ knowledge, attitude and practice regarding their scope of practice in Botswana. METHODS: A convergent parallel mixed-methods design was employed using a three-tier sampling approach to ensure a representative sample of various settings, health facilities and nurses. For the purpose of this article, the data from the qualitative component are reported. Thirty registered nurses, working in the public health sector in Botswana, participated in semi-structured interviews. Data were analysed using thematic content analysis. FINDINGS: Data analysis revealed that registered nurses’ scope of their knowledge was lacking. Registered nurses’ attitudes were reflected in the adaptation process to expanded practice, as demonstrated through emotive aspects, adjustments to practice beyond scope and the learning of new skills considered beyond scope. Participants reported implementing many skills deemed beyond their scope, whilst their motive to do so included their experience of a lack of control over practice, lack of resources or they were doing so out of consideration for the patient. Guidance in terms of their scope was found to be inadequate. CONCLUSION: As in other resource-limited countries in Africa, registered nurses in Botswana experience challenges with their scope of practice. Inadequate boundaries may result in compromised nursing care and may have detrimental consequences for both the patient and the nurse.