Background: Nurses’ scope of practice revolves around the ‘what‘ and ‘why’ of nursing. Within long-term care their scope of practice is largely centred on the domains of physical, relational and psychosocial needs of older people, that is, the fundamentals of care. The professional practice environment in which nurses deliver the fundamentals of care has been described as sensitive to contextual modulators shaping the nurses’ scope of practice, the fundamentals of care and their ability to think, feel and act like a nurse i.e., their professional identity. Despite, research into nursing tends to lack a contextual lens, whereas the domains of fundamentals of care are often investigated in isolation. Aim: To explore the scientific literature (I), nurses’ scope of practice in general and in relation to the fundamentals of care and contextual modulators (II-III) as well as registered nurses’ professional identity (IV) in long-term care. 

Methods: This thesis adopts a fixed sequential mixed methods design, underpinned by a pragmatic research philosophy. It integrates quantitative and qualitative data through a structured framework that supports incremental, contextually oriented research. Building on the premise that empirical nursing phenomena—such as those explored in this thesis, including nurses' scope of practice, the fundamentals of care, and professional identity—can be understood as events situated within a complex system (i.e., system events) that are intrinsically entangled with and shaped by their surrounding context (i.e., contextual modulators)–this thesis employs a multi-method scientific inquiry to capture and explore this complexity. Correspondingly, four different but complementary research designs were utilised in this thesis: a scoping review (I), structured direct observations (II), qualitative descriptive- (III), and cross-sectional design (IV). 

Results: While the literature primarily linked the fundamentals of care to physical needs (I), observations suggested that nurses integrated relational and psychosocial needs and strived to adopt a person-centred care. The clinical decision-making process was largely targeting physical needs, while contextual modulators were omnipresent in influencing the nurses’ practice (II). Nurses reported ambiguity, emotional strain, and challenging professional practice environments that limited their ability for a comprehensive fundamental nursing that eroded understanding of the scope of practice and professional identity (III). This was further underpinned by registered nurses reporting that aspects of their professional identity were seemingly less internalised, furthermore underpinned by generational belonging in which older registered nurses perceived a better internalised professional identity than younger generations (IV). 

Conclusion: Framing nurses’ scope of practice as a systems event supports the view of the entanglement between nurses’ role and function, the fundamentals of care, professional identity, and contextual modulators, highlighting the intricate nature of nurses’ scope of practice. 

The nurses’ scope of practice defines their roles and functions, addressing the fundamental physical, relational, and psychosocial needs of individuals requiring care. This understanding is conceptually linked to what nursing is and serves as an expression of professional identity.

While the fundamentals of care are central to nursing, the scope of practice for addressing older people’s fundamental care needs in long-term care is sparsely described in the literature and often viewed in isolation rather than within the systems and contexts in which it occurs. This thesis explores nursing practice in long-term care, employing a contextual lens to examine how environmental factors influence the professional working environment, nurses’ scope of practice, and their activities related to the fundamentals of care.

Insights are based on a pragmatic, fixed sequential mixed-methods design, employing diverse approaches to explore the core concepts underpinning this work. The findings are applicable to nurses, leaders, managers, educators, and policymakers, offering insights to improve the professional working environment, enhance the scope of practice, and elevate the quality of fundamentals of care in long-term care settings.