Chapter 3: Scope of Practice, Standards of Practice
Scope of Practice
What is “scope of practice?” This phrase can be taken quite literally: the scope of practice of medical laboratory technologists is the sum total of the work that we are qualified to do—the procedures, analysis of procedures and results, and interpretation and reporting of results. Our scope of practice is clearly defined by the MLT Act (Section 2, [l]):
Medical laboratory technology” means the collection and handling of laboratory specimens, analysis of specimens and the interpretation of quality-control data to verify the accuracy and precision of test results for use by health-care practitioners in diagnosis, treatment and prevention of disease.
Note that our scope of practice is quite general; it is more a list of competencies than a list of procedures and tasks. This is because, given the broad range of things that we do and the constantly evolving body of knowledge and technology that we work with, no list could ever be complete or correct for long. Every fully licensed MLT in Nova Scotia is qualified to work within the full scope of practice. The general nature of our scope of practice, however, should— and does—allow for overlap with other members of the health care team.
SCENARIO:
Shelly learns from her friend Hwa, who is a registered nurse, that the plastics and burns unit has just started using a new point of care (POC) test kit for detecting blood in urine. She doesn’t say anything to Hwa, but she has immediate concerns because this is clearly a chemistry laboratory test that falls within the MLT scope of practice. She also wonders how the staff on the unit are being trained to perform the test, and how quality control issues are being handled. She discusses her concerns with her supervisor, who tells her the test is approved for use on the unit, but Shelly remains unconvinced that it’s okay. Ultimately, she provides the information to the registrar at the NSCMLT. Is Shelly right that nurses shouldn’t be performing this test?
Our scope of practice is not exclusive: the act defines what we can legally do, but it does not necessarily prevent others from doing the same things. Section 42 of the MLT Act specifically mentions nursing, medicine, and a number of other professions whose scope of practice may include things that MLTs do. These professionals, of course, must remain within the scope of practice of their own profession.
The nursing scope of practice includes “assessing the client to establish the client’s state of health and wellness.” Checking for the presence of blood in urine, along with other simple test procedures available as POC kits, does fall under patient assessment, and nurses have the educational background to apply the necessary critical thinking skills to the procedure.
Shelly is right, however, that nurses should receive thorough training, and that effective quality control is necessary. She’s also correct that the responsibility for ensuring that anyone performing POC testing is trained and competent in the procedures lies with the laboratory. We are the experts on quality control of lab tests, and POC testing is one area of overlap where medical laboratory technology and nursing can collaborate to provide excellent patient care.
Health care workers who are not covered by the exemptions in section 42 of the MLT Act, however, cannot do our work except under specific circumstances. For example, medical laboratory assistants can do limited things that fall inside our scope of practice, but only while assisting an MLT, and only while under the control and supervision of an MLT.
SCENARIO:
The clinical chemistry laboratory uses a hemoglobin assay test to detect blood in urine. The test analyzes multiple samples at once. An experienced lab assistant is trained and assigned to perform the preanalytical part of the procedure. She diligently follows quality control procedures for the test.
One day, the lab is extremely busy and several staff are out sick. The MLA has often watched while results are recorded and believes that as long as control samples give correct results, interpretation is straightforward. On this occasion she decides to help the technologists out by recording the specimen and quality control results on the printed specimen queue.
When Amanda, an MLT assigned to the procedure, is handed the queue, she refuses to take professional responsibility for the lab assistant’s work despite all the evidence that everything has been done correctly. Amanda believes that interpretation of these results falls within the scope of practice of an MLT and that a lab assistant is not qualified to do the work. Is Amanda correct?
In order for someone to do work that falls within the scope of practice of MLTs, that person must have their own professional scope of practice that includes the work, and fall under an exemption identified in Section 42 of the MLT Act. Lab assistants do not have a professional scope of practice, and are not specifically named in the MLT Act. However, 42s allows for the “carrying out of specific tasks constituting part of the practice of medical laboratory technology by persons authorized under the regulations and under the supervision and control of a medical laboratory technologist.”
Health care workers who are not covered by the exemptions in section 42 of the MLT Act, however, cannot do our work except under specific circumstances. For example, medical laboratory assistants can do limited things that fall inside our scope of practice, but only while assisting an MLT, and only while under the control and supervision of an MLT.
In turn, the regulations say:
For the purposes of clause 42(s) of the MLT Act, a person that is not a member may carry out tasks constituting part of the practice of medical laboratory technology as long as:
- [a] the tasks involve only
- data entry and procurement/receipt
- specimen processing
- performance of pre- analytical procedures...
and
- [c] the tasks are carried out while the person is supporting and assisting a member and is under the supervision and control of a member.
Amanda is correct, and she should inform her supervisor of the incident. What the lab assistant did went beyond pre-analytical, and involved the analysis and interpretation of test results; and, while her intentions were good, the lab assistant should not have read the test results.
Standards of Practice
Standards of practice are statements that describe the practice of medical laboratory technology – the conduct and performance expected of a licensed MLT. You might think of them as a shared understanding of what MLTs do. The concept of a shared understanding makes standards of practice more than official documents; in fact, they are not always written down. A standard of practice might be anything that the average MLT would agree is appropriate. We should therefore always be aware of the culture of the profession, and the expectations inherent in that culture.
Educators in our profession, and after them, managers, play an important role in introducing MLTs to the professional culture, and maintaining that culture in both classroom and workplace. More than any other group, these people are role models for us all, and therefore have standards of practice that go beyond the general ones.
Written standards of practice go further than legislation and regulations in that they provide specific descriptions of competent, collaborative, ethical, and safe practice. They are sufficiently broad to be applicable to MLTs in all practice settings. At the same time, they are sufficiently precise to literally provide a standard against which performance can be measured. The NSCMLT Professional Practice Committee has developed the NSCMLT Standards of Practice document, which describes the practice of MLTs working on the bench in a clinical setting, technologists in research, managers, directors, and educators. As an MLT, you uphold these standards, and if you are aware that they are not being met, by yourself or others, it’s your professional responsibility to document the deficiency, and report it. (See professional misconduct, chapter 11).
The NSCMLT Standards of Practice document is a useful resource for the College and for employers because it provides a yardstick for measuring performance and professionalism in MLTs in Nova Scotia. More importantly, however, it is a useful resource for individual MLTs to measure their own performance, and refresh their understanding of what the profession demands of them. Remaining mindful of the standards of practice motivates MLTs to maintain competency and pursue lifelong learning to stay current.
Conclusion
Our scope of practice is a legal description of what MLTs do; however, we’re not necessarily the only ones who can legally do everything that falls within our scope. The careful determination of who can and who cannot do certain things is important for the quality of laboratory testing and the safety of the public.
Standards of practice are more specific than the scope of practice and describe the characteristics of competent, collaborative, ethical, and safe practice. The NSCMLT standards of practice make a useful reference for MLTs who strive to practise with excellence.
