Factors associated with the scope of practice of primary health care nurses

In Poland, primary health care (PHC) is delivered through publicly funded, first-contact community practices, in which nurses play a key role in providing comprehensive services. However, empirical evidence describing how organizational and professional factors relate to their legally defined scope of practice remains limited. This study examined bivariate associations between selected organizational and professional characteristics and the scope of activities delivered by PHC nurses in Poland. A cross-sectional survey was conducted among 157 PHC nurses in Poland. The scope of health services was assessed using an inventory based on the Polish Minister of Health regulation covering preventive, educational, diagnostic, therapeutic, and organizational activities. Associations between the scope of services and form of employment, education level, workplace location, and age were analyzed using chi-square or Fisher’s exact tests. Significant differences in the scope of health services were observed across all analyzed factors. Form of employment showed the greatest variation, with self-employed nurses and practice owners more frequently reporting advanced clinical, diagnostic, and decision-making activities compared with nurses employed under salaried employment contracts within primary care entities (e.g., patient self-care preparation, p = 0.008; assessment of recovery process, p = 0.007). Education level was associated with advanced services, including physical examinations (p = 0.045), point-of-care diagnostic testing (p < 0.001), issuing referrals for diagnostic tests (p = 0.014), and suture removal (p < 0.001). Differences by workplace location were observed for preventive, educational, and family-oriented activities, which were reported more often in small towns and rural areas (e.g., pain assessment, p = 0.016; family caregiving capacity assessment, p = 0.035). Age was also associated with service scope of practice, with older nurses more frequently implementing health programs (p = 0.011) and delivering comprehensive care activities (p = 0.032). The scope of health services reported by PHC nurses in Poland differed across selected organizational, professional, and demographic characteristics. In bivariate analyses, variations were observed according to form of employment, education level, workplace location, and age. As these findings are based on unadjusted associations, further research using multivariable approaches is needed to clarify whether these relationships represent independent effects.