The Regulatory Implications of Engaging Registered Nurses in Diagnoses

In 2015, the Institute of Medicine, which was recently renamed the National Academy of Medicine, identified diagnostic error as an urgent patient safety concern in their report Improving Diagnosis in Health Care. The report's foremost recommendation is to promote team-based diagnosis, specifically calling for the patient and the nursing staff to be integral members of the team and contribute to the diagnostic process. In this article, we review (a) the importance of engaging registered nurses (RNs) in diagnosis, (b) the constraints on implementation derived from scope-of-practice language in state regulations, and (c) the profession-specific nomenclature of “nursing diagnosis” as a distinct entity from “medical diagnosis.” Recommendations include scope-of-practice reform to remove barriers for nursing's full participation in diagnosis and other measures to help move toward the team-based diagnosis model envisioned by the Institute of Medicine.