Top-of-license practice for registered nurses: A scoping review

Jeanne Hlebichuk; Rachelle J. Lancaster; Vida Vizgirda; Sharon Quinlan

doi:10.1016/j.outlook.2025.102397

Top-of-license practice for registered nurses: A scoping review

Jeanne Hlebichuk, Rachelle J. Lancaster, Vida Vizgirda, Sharon Quinlan

Advocate Health - Midwest

Advocate Aurora Health

Research output: Contribution to journal › Article

Abstract

Background: Registered nurses are vital to healthcare delivery, yet often perform non-nursing tasks, contributing to inefficiencies, dissatisfaction, and turnover. The concept "top-of-license" (TOL) nursing practice, introduced in 2013, remains inconsistently defined and applied.

Purpose: To explore how TOL nursing practice is defined and applied in existing literature.

Methods: A scoping review was conducted using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Searches of 15 databases and gray literature (no start date-May 4, 2024) yielded 1,377 articles. Following screening, 45 articles met inclusion criteria.

Findings: Definitions and applications of TOL varied. Three themes emerged: (a) work-workforce efficiency, (b) benefits to patients-improving patient care and clinical outcomes, and (c) benefits to nurses-nurse perceptions of clinical practice. Limited articles measured TOL outcomes. Definitions and applications of TOL varied, thus differentiation from scope of practice and a definition are provided.

Discussion: Standardizing the definition of TOL is essential to advance research, policy, and improve care quality and outcomes.

Original language	American English
Journal	Nursing Outlook
DOIs	https://doi.org/10.1016/j.outlook.2025.102397
Status	Published - Apr 17 2025

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10.1016/j.outlook.2025.102397License: Unspecified

http://institutionalrepository.aah.org/nurs/389

Cite this

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title = "Top-of-license practice for registered nurses: A scoping review",

abstract = "Background: Registered nurses are vital to healthcare delivery, yet often perform non-nursing tasks, contributing to inefficiencies, dissatisfaction, and turnover. The concept {"}top-of-license{"} (TOL) nursing practice, introduced in 2013, remains inconsistently defined and applied.Purpose: To explore how TOL nursing practice is defined and applied in existing literature.Methods: A scoping review was conducted using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Searches of 15 databases and gray literature (no start date-May 4, 2024) yielded 1,377 articles. Following screening, 45 articles met inclusion criteria.Findings: Definitions and applications of TOL varied. Three themes emerged: (a) work-workforce efficiency, (b) benefits to patients-improving patient care and clinical outcomes, and (c) benefits to nurses-nurse perceptions of clinical practice. Limited articles measured TOL outcomes. Definitions and applications of TOL varied, thus differentiation from scope of practice and a definition are provided.Discussion: Standardizing the definition of TOL is essential to advance research, policy, and improve care quality and outcomes.",

author = "Jeanne Hlebichuk and Lancaster, {Rachelle J.} and Vida Vizgirda and Sharon Quinlan",

year = "2025",

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doi = "10.1016/j.outlook.2025.102397",

language = "American English",

journal = "Nursing Outlook",

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TY - JOUR

T1 - Top-of-license practice for registered nurses: A scoping review

AU - Hlebichuk, Jeanne

AU - Lancaster, Rachelle J.

AU - Vizgirda, Vida

AU - Quinlan, Sharon

PY - 2025/4/17

Y1 - 2025/4/17

N2 - Background: Registered nurses are vital to healthcare delivery, yet often perform non-nursing tasks, contributing to inefficiencies, dissatisfaction, and turnover. The concept "top-of-license" (TOL) nursing practice, introduced in 2013, remains inconsistently defined and applied.Purpose: To explore how TOL nursing practice is defined and applied in existing literature.Methods: A scoping review was conducted using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Searches of 15 databases and gray literature (no start date-May 4, 2024) yielded 1,377 articles. Following screening, 45 articles met inclusion criteria.Findings: Definitions and applications of TOL varied. Three themes emerged: (a) work-workforce efficiency, (b) benefits to patients-improving patient care and clinical outcomes, and (c) benefits to nurses-nurse perceptions of clinical practice. Limited articles measured TOL outcomes. Definitions and applications of TOL varied, thus differentiation from scope of practice and a definition are provided.Discussion: Standardizing the definition of TOL is essential to advance research, policy, and improve care quality and outcomes.

AB - Background: Registered nurses are vital to healthcare delivery, yet often perform non-nursing tasks, contributing to inefficiencies, dissatisfaction, and turnover. The concept "top-of-license" (TOL) nursing practice, introduced in 2013, remains inconsistently defined and applied.Purpose: To explore how TOL nursing practice is defined and applied in existing literature.Methods: A scoping review was conducted using Arksey and O'Malley's framework and PRISMA-ScR guidelines. Searches of 15 databases and gray literature (no start date-May 4, 2024) yielded 1,377 articles. Following screening, 45 articles met inclusion criteria.Findings: Definitions and applications of TOL varied. Three themes emerged: (a) work-workforce efficiency, (b) benefits to patients-improving patient care and clinical outcomes, and (c) benefits to nurses-nurse perceptions of clinical practice. Limited articles measured TOL outcomes. Definitions and applications of TOL varied, thus differentiation from scope of practice and a definition are provided.Discussion: Standardizing the definition of TOL is essential to advance research, policy, and improve care quality and outcomes.

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DO - 10.1016/j.outlook.2025.102397

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JO - Nursing Outlook

JF - Nursing Outlook

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