Researchers: Violetta Rozani¹, Anat Rotem²

Background: Expanding the scope of practice of registered nurses through post-basic certification (PBC) programs is a key strategy for addressing healthcare workforce shortages and improving access to care. However, the extent to which nurses fully implement their expanded roles remains unclear.

Objectives: This study aimed to evaluate the extent of scope-of-practice implementation among PBC graduates in Israel and to identify promoting and inhibiting factors affecting the utilization of their expanded roles across healthcare settings.

Method: A mixed-methods design was employed, combining quantitative survey data (N=704) with qualitative interviews (n=26). The study included registered nurses with PBC in primary care and prescription renewal (n=214), mental health (n=282), and diabetes care (n=208), working across diverse healthcare settings in Israel.

Findings: Scope-of-practice implementation varied across specialties, regions, and settings, with higher implementation observed among nurses with greater seniority and advanced education. Community-based nurses reported higher levels of autonomy compared to hospital-based nurses. Qualitative findings revealed that PBC programs enhanced professional confidence and clinical capabilities; however, implementation was often constrained by regulatory limitations, lack of role clarity, technological barriers, and insufficient organizational support. Facilitators included managerial encouragement, physician trust, and patient recognition.

Conclusions: The implementation of expanded nursing roles is influenced more by organizational and systemic factors than by individual competencies. While PBC programs effectively enhance professional capacity, their impact remains limited in the absence of supportive regulatory frameworks, clear role definitions, and enabling workplace environments.

Recommendations: Educational, policy, and organizational interventions are needed to promote the implementation of expanded scope of practice among graduates of PBC programs, supported by ongoing evaluation and research monitoring. Efforts should be made to advance interprofessional understanding of the boundaries of their roles through targeted educational initiatives, alongside regulatory alignment and the provision of organizational support, infrastructure, and professional incentives.

Research end date: 04/2026