Australasian Sonographers Association

Member Area Login

If this is the first time you are logging into the ASA website or you can't remember your password, please select Get a new password below to be sent a link to your registered email address.

Why is a Scope of Practice Important?

Wednesday, 22 January 2025

Why is a Scope of Practice Important?

Consultant Anita Hobson-Powell discusses the merits of defining the minimum expectancies for sonography by developing a scope of practice for sonographers.

The Australasian Sonography Association has taken a pivotal step in the future of supporting the regulation of the profession by engaging Advancia Consulting to support the development of a scope of practice (SOP) for sonographers across Australia and New Zealand. While advanced scopes of practice have been established for the professions, there was a notable absence of a comprehensive core SOP that defines the minimum expectancies for sonography. Sonography practices vary globally, with no global standards of practice in place.1 This results in variations in how sonographers operate and are recognised.

Most countries operate under a self-regulating framework, while some are governed by legislative protection. New Zealand and Ontario, Canada, have legislation and title protection for sonographers.1 In Australia, the government’s regulation approach follows the principle of right touch regulation, which emphasises proportionate regulation based on public risk. In Australia, only 25% of sonographers are currently registered under the NRAS due to their dual qualifications as both sonographers and radiographers. Despite extensive advocacy efforts by the ASA over the past decade, sonography has not met the Government’s criteria for inclusion in NRAS due to the scheme’s rigorous assessment measures aimed at public risk mitigation. The unintended consequences of health professionals not being included in the NRAS have become evident through the recent Scope of Practice Review led by Prof Mark Cormack. As such, the recently commenced NRAS Complexity Review led by Ms Sue Dawson is exploring options at more formalised standards for self-regulating professions moving forward. For those professions that have been classified as self-regulating, the professional entities and/or certifying entities (such as ASA) are striving to align their standards with the NRAS standards. This alignment includes professional competency standards and defined scopes of practice.

Entities entrusted with the responsibility of selfregulating a profession must establish a robust regulatory framework that remains agile, adapting to evolving landscapes while ensuring both public safety and maintaining trust. Professional bodies or regulatory bodies will often develop a package of documents and guides to formally document their professions’ full or part SOP. These documents commonly included SOP frameworks, competency standards, codes of ethics, codes of professional conduct, professional practice standards, clinical practice guidelines, professional capabilities and educational program accreditation standards.2 Broadly speaking, an SOP defines the functions, responsibilities, activities and decisionmaking capacity of a profession based on their education, knowledge and skills.

SOP plays an important role for the governing bodies defining professional capabilities and responsibilities for the professions, which in turn guides educational curricula and helps employers define job descriptions. If a healthcare professional has a defined SOP, the practitioner must abide by this SOP for their and the public’s protection. Without a defined SOP, confusion and assumptions can arise within the profession and among other healthcare professionals.3 Research conducted by Miles and colleagues across 32 countries found that 36% of sonographers surveyed believed their healthcare professionals did not fully understand their roles.1 A well-defined SOP provides a framework ensuring that sonographers are recognised for their competencies. An SOP is often misunderstood and incorrectly applied, primarily because there is a lack of consensus on what defines an SOP for a healthcare professional.2,3 Compounding this, it is important to understand there are different types of SOPs. The most commonly referred to is the ‘core’ SOP, which defines the minimum level of clinical capabilities expected of a professional upon entering the workforce.1,2 An extended scope was considered to be the scope exceeding what is considered to be the traditional scope but is supported through regulatory or legislative changes. The expanded scope is considered any scope increase irrespective of the authoring environment. Finally, advanced practice is an increase in the current scope into the remit of other professions or linked to performance measurement, being a specialisation or expert status.2

The SOPs of all medical and health professions, whether documented or not, have evolved. The evolution of SOPs has been impacted by changes in healthcare practices, models of care, population health needs, workforce maldistribution and technological advancements.3,2 While the evolution of SOPs is inevitable and necessary, changes create tension. The tension lies between detailing what current practices are and the evolution of what future practices should be.2 What could be considered novel or expanding SOP could become core practice.

There is a consensus that an individual’s SOP is not static and will evolve throughout their career. Upon successful completion of a recognised entry-level qualification, an individual practitioner is considered to have the requisite knowledge, skills and attributes to practise as a ‘medical or health professional’ aligned with their core SOP. However, as they gain more experience, pursue further education, and engage in professional development as individuals, SOP can expand, reflecting their cumulative experience.2

This is why a health professional needs to be aware of their own individual SOP and the broader SOP for their profession. By doing so, they ensure that they are practising safely, lawfully and effectively while also ensuring that their professional indemnity insurance covers their activities.4 Failure to maintain professional competencies for the profession can result in a narrowing of an individual’s SOP relative to their peers.

Continuing professional development plays an essential role in shaping a sonographer’s SOP. While continuing professional development is often viewed as a regulatory burden, it plays an important role in maintaining and expanding competencies, ensuring the professional stays abreast of new technologies, procedures and best practices. The outcomes of expanding one’s SOP are not always measured via competency assessment and/or formal credentialing.2 Instead, a decision-making framework can help guide whether new activities fall within an individual’s SOP, ensuring safe and effective practice.

The Australasian Sonography Association will inform members of their progress in developing a formal SOP for the profession.

References

  1. Miles N, Cowling C, Lawson C. The role of the sonographer – An investigation into the scope of practice for the sonographer internationally. Radiography 2022;39–47.

  2. Downie S, Walsh J, Kirk-Brown A. How can scope of practice be described and conceptualised in medical and health professionals? A systematic review for scoping and content analysis. International Journal for Health Planning Management. 2023;1184–1211.

  3. Wiggins D, Downie A, Engel R, Grace S, Brown BT. Factors that influence the scope of practice of the chiropractic profession in Australia: a thematic analysis. Chiropractic & Manual Therapies. 2024;32(18).

  4. Health & Care Professions Council. Scope of Practice. [Online]; 2024. Disponible en: https://www.hcpc-uk.org/standards/meeting-our-standards/scope-ofpractice/

  5. Schuiling KD, Slager J. Scope of practice: freedom within limits. Journal of Midwifery and Women’s Health. 2000;465–471.