Updated: Aug 6
One of the most common questions I get asked regarding practicing functional medicine as a nurse is about scope of practice, and for good reason! It is a confusing topic, and we do not want to put our hard-earned licenses at risk!
I created the Functional Medicine for Nurses™ program through the Integrative Nurse Coach™ Academy, a program that gives me the opportunity to not only teach, but also support both RNs and NPs navigating the legalities of incorporating Functional Medicine into their own practice. Each student in the program is required to research their own scope of practice and we explore what they found. I have come to learn that the majority of US states have very vague guidelines for nurses.
The one commonality in every state is the nurse’s role as an EDUCATOR.
As nurses, we teach our clients in virtually every encounter, whether we realize it or not.
Education is the foundation of care when practicing functional medicine.
As I began studying functional medicine, I realized how much of the content was material I had learned in nursing school, but they are topics that are rarely given any priority in modern healthcare- our food choices, essential nutrients, stress, lifestyle, toxin exposures, and more. As I listened to lecture after lecture reviewing this fundamental nursing content before moving on to the HOW of functional medicine, a light bulb went off for me!
Nurses already know functional medicine!
We learned so much of it in our initial nursing training, but we weren’t given the tools to act. With functional medicine, we return to our nursing roots, and we layer in the HOW to restore health for our clients. Once we make those connections, we are ready to EDUCATE our clients on these important topics.
When we consider these inherent nursing skills and our role as EDUCATORS, it becomes an obvious and natural partnership! Functional medicine is also called “root cause medicine”, because we look for the root cause of health conditions- the WHY. We look at the person as a whole, hear their unique story, and help them uncover the underlying mechanisms at play in their health concerns. It is often related to their lifestyle, their food choices, and their exposures such as toxins- all in combination with their genetic predispositions.
Bringing this full circle to the topic of scope of practice, we can see the powerful role nurses can play as EDUCATORS regarding these common root causes of health concerns.
As a nurse practitioner in Washington state, I have full practice authority, which allows me to write prescriptions and order lab work, but I haven’t written a prescription in a long time. Truth be told, over 95% of what I do in my consulting practice is RN scope of practice.
Before initial sessions, my clients are asked to upload lab results from the past two years for me to review. For some clients, this is all we use to make significant progress. It is disheartening how often they have been told their labs were “all normal” for years, but I am able to use my functional medicine perspective to see signs of chronic inflammation or infection, hormone imbalance, insulin resistance, poor digestion, nutrient deficiencies, and so much more!
You’d be surprised how much information is truly present in a complete metabolic panel (CMP) and complete blood count (CBC) that is overlooked by most practitioners! And all within the normal reference ranges! My client sessions are up to 90 minutes long, and the majority of that time is spent listening to their health story, and then educating and empowering them to make informed decisions about their health challenges.
What is the other 5% of my practice that is NP scope of practice? I do order lab work for my clients on a case-by-case basis. RNs in the Functional Medicine for Nurses™ course have several options to choose from based on their comfort level and scope of practice:
Many choose to work without any fancy testing, and they are able to help clients drastically improve their health outcomes by EDUCATING them on functional medicine practices.
Some RNs choose to recommend labs their clients can request from their primary care providers through insurance, and they educate their clients on how to advocate for their lab tests.
Other RN students choose to partner with NPs and MDs that order labs, and they have a symbiotic partnership.
There are also companies that have ordering providers signing for lab work and addressing any critical values, and we discuss these options during the course.
Some RN students report their clients are getting labs done without an ordering provider through online sources, and the RN is able to review these results and refer the client to a provider for any necessary treatment, if indicated.
It is a personal decision each nurse makes as to what they are comfortable offering their clients based on their licensure and unique scope of practice.
I have not come across any jurisdictions where RNs are authorized to DIAGNOSE patients, BUT they are able to review labs and provide EDUCATION. This always reminds me of my years as a bedside RN. At the beginning of each shift, I was eager to look up each of my assigned patient’s lab results. Often during my shift, I would educate my patients on their lab results, “Your kidney function decreased since yesterday on your lab work, so we are adjusting your dose of furosemide today.” OR “Your potassium was low on your lab work, so we are supplementing with oral potassium. Signs of low potassium include the leg cramps you have been experiencing. You can also get potassium from some foods in your diet including……”
In my discussions with students concerned about scope of practice, I definitely feel that RNs undervalue the role they play as EDUCATORS, and realizing the value of this huge aspect of our profession can feel very empowering.
Can RN’s recommend supplements? Nutrition?
Many students come to the program wary of recommending supplements, so I love to use that as an example also. How often as an RN have you recommended someone with a sprained ankle apply
heat and ice, elevate their leg, and alternate ibuprofen and acetaminophen? We do it all the time! How often have you as an RN looked at someone’s lab work and seen low vitamin D, and you may have told them to grab a bottle of Vitamin D at the pharmacy and follow the directions on the bottle? We do it all the time!
When someone is deficient in a nutrient, it is certainly appropriate to EDUCATE them on the benefits of supplementation. My caveat to this is those clients with renal impairment, as they would have challenges clearing any excessive amounts of some supplements. Of course, other supplements like herbal blends may have drug interactions and may be contraindicated. That is where getting a solid foundation in the functional medicine HOWcomes into play. When we use our nursing judgment and know-how to help our clients make informed decisions for their health, they can experience true healing and improved health outcomes!
Lots of functional medicine practitioners use little or no lab work or supplements. There is an immense amount of healing power in foods, and that is my go-to for the majority of my clients! When we talk about nutrition, licensed providers like RNs and NPs can become concerned about working outside their scope by recommending a “diet.” In the US, guidelines for recommending a “diet” vary significantly by state. What is consistent is the EDUCATOR role.
How often, as an RN, have we educated patients on the benefits of the DASH diet for heart health, the effect of carbohydrates on blood glucose levels for a patient newly diagnosed with diabetes, or foods to avoid during pregnancy? Nurses teach their patients about food ALL THE TIME! It is no different to educate them on the role their food choices may be playing in their health as it applies to our functional medicine guidance for them.
Our current healthcare system is wrapped up in diagnosis-based algorithms that almost always lead to a prescription medication. Despite all the modern advances we have made, the prevalence of nearly every chronic health condition is on the rise. Most people don’t need more prescriptions! They need a caring healthcare practitioner to listen to their unique story, educate them on the root cause of their concerns, and to engage, motivate, and empower them to take their health into their own hands!
Functional Medicine for Nurses™ is now offered in partnership with the Institute for Functional Medicine
When I was invited to develop the Functional Medicine for Nurses™ course for the Integrative Nurse Coach Academy, it was an easy YES! I am so thrilled to be able to share what I have learned in a way that is targeted and meaningful for nurses, nurse coaches, and nurse practitioners in a format that is an affordable, comprehensive foundation in functional medicine. The course merges foundational nursing knowledge with the HOW of functional medicine.
The Integrative Nurse Coach Academy recently partnered with the Institute for Functional Medicine (IFM), the leading voice for functional medicine. IFM recognizes the key role nurses should play in using a root cause approach to healthcare. That’s why the organization has chosen to partner with INCA to support the growing number of nursing professionals seeking options for a respected, comprehensive functional medicine educational program exclusively for nurses.
IFM is providing INCA’s Functional Medicine for Nurses™ students with access to valuable resources that coincide with each learning module within the course as well as a complimentary one-year student membership, which features numerous discounts for IFM programs for nurses who wish to expand their functional medicine knowledge.
Our partnership gives students access to a wealth of resources and support from the most respected source in functional medicine- the Institute for Functional Medicine. It also lends credibility to this exciting education opportunity for nurses seeking to learn functional medicine from a respected source. I truly believe nursing combined with the functional medicine HOW is the most powerful combination of skills to truly revolutionize what we offer our clients, and to finally offer them a path to true happiness and healing!