We often hear the phrase “practice at the top of their license” in nursing, but what does that mean? Nurses have substantial autonomy and responsibilities, so it is crucial to define how to work best and use all the skills that make being a registered nurse “unique.”

After assessment, the next skill a registered nurse should do is escalate, if necessary. Escalation requires being an advocate for their patient’s care. Nurses must advocate for their patients, escalating concerns until they receive appropriate responses to provide optimal care. This could involve escalating their apprehensions to a provider to highlight an issue with their patient. It also can include alerting the charge nurse that their patient’s acuity has changed and they will need assistance with their assignment to deliver the best care to their patient. “Trusting your gut” is another term nurses use, but that gut feeling comes from experience, and continuing to escalate goes hand in hand with that feeling.

Nurses must also continue to keep up with their skills, stay abreast of new practices in an ever-changing care landscape and recognize patient deterioration. This is especially important for high-risk, low-volume skills. Nurses may not experience these skills frequently at the bedside, but when they do, there is a high potential for risk to the patient. In these situations, it is easy for the nurse to forget the steps and precautions they may take for a particular skill. Nurses practicing at the top of their license will regularly refresh themselves on these skills. Houston Methodist also provides many resources for these skills, including Elsevier Clinical Skills, so nurses can review them before performing them.

Because nurses wear so many hats, time management is crucial to ensure they can practice at the top of their license. Nurses must know when and what to prioritize and what they can delegate. Nurses spend much time doing tasks they can safely delegate to someone else. When nurses delegate appropriately, it frees them up to focus on their “unique” skills, such as assessing or critically thinking about their patient’s condition to improve the care they are providing. Delegation also involves knowing what tasks can be delegated and following up on the outcome. Integrating this into the workflow can enhance nursing practice at the bedside.

Practicing at the top of your license may mean something different for everyone, depending on where they are in their career. Being a newer nurse may mean getting familiar with your new roles and responsibilities to perform your best. If you are a tenured nurse, this may mean refining those skills and developing new ones to continue to be a great care provider.

Remember your “why” and you will find that you will continue to seek new ways to work effectively and efficiently to remain at the “top of your license.”