Online Undergraduate Course

NURS 410 - Health Care Delivery Systems & Informatics

Module 12: Professional Practice Standards, Policy, and Liability

Professional Practice Standards

What are standards and how do they impact delivery of nursing care?  Standards are considered rules, expectations, level of quality required, set by those in authority positions, and can be measured. The American Nurses Association has standards for nursing practice. They define standards as “authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable”. Standards reflect values and priorities of the nursing profession. They may change over time reflecting the diverse needs of patients and the health care delivery system. Standards provide direction for professional practice and a framework for the evaluation of professional practice. To do this, standards are written in measurable terms that define how the nurse will be accountable to the public (ANA, 2010, p.1).

ANA has published 3 resources that inform nurses’ thinking and decision-making and guide their
Practice and we focus on two of the three in this module:

  • Nursing’s Social Policy Statement: The Essence of the Profession (2010c) defines nursing, conceptualizes nursing practice, and describes the social context of nursing.
  • Nursing: Scope and Standards of Practice (2010) states the RN scope of practice and presents standards and competencies that outline the professional role of the RN.
  • Code of Ethics for Nurses with Interpretive Statements (2015) establishes the ethical framework for RNs across all roles, levels, and settings.

The ANA Scope & Standards of Practice (2010) applies to all registered nurses. The overarching principles of the ANA Scope & Standards of Practice are:

  • The patient includes the individual, family, groups, communities, and populations;
  • Cultural, racial, and ethical diversity of the patient must always be considered when providing care and,
  • They apply to all professional registered nurses engaged in practice, regardless of clinical or functional specialty, practice setting, or educational preparation.

The ANA Scope & Standards of Practice is composed of Standards of Practice and Standards of Professional Performance:

Standards of Practice (competent level of practice based on the nursing process):

Standard 1. – Assessment- The registered nurse collects comprehensive data pertinent to the healthcare consumer’s health and/or the situation.

Standard 2. – Diagnosis- The registered nurse analyzes the assessment data to determine the diagnoses or the issues.

Standard 3. - Outcomes Identification- The registered nurse identifies expected outcomes for a plan individualized to the healthcare. The graduate-level prepared specialty nurse or advanced practice registered,/ nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect consumer or the situation.

Standard 4. – Planning- The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Standard 5. – Implementation- The registered nurse implements the identified plan.

Standard 5A. - Coordination of Care- The registered nurse coordinates care delivery.

Standard 5B. - Health Teaching and Health Promotion- The registered nurse employs strategies to promote health and a safe environment.

Standard 5C. – Consultation- The graduate-level prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change.

Standard 5D. - Prescriptive Authority and Treatment- The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.

Standard 6. – Evaluation- The registered nurse evaluates progress toward attainment of outcomes.

Question

You have just started at a new facility. Your preceptor is orienting you to resources available on the facility’s intranet. Your preceptor shows you how to access standard care plans based on nursing diagnosis and identifies the ones that are most frequently used on your unit. Your preceptor tells you to select the most appropriate one and insert it into the patient’s record. The preceptor says, “That’s all we do for the plan of care here.” Does this practice meet ANA Standards?

No, this is not sufficient nor correct.

Standard 3. Outcomes Identification identifies that the RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation. Competencies for this standard specify that the RN:

  • Involves the healthcare consumer, family, and other healthcare providers in formulating expected outcomes when possible and appropriate.
  • Defines expected outcomes in terms of the healthcare consumer, healthcare consumer culture, values, and ethical considerations.
  • Modifies expected outcomes according to changes in the status of the healthcare consumer or evaluation of the situation.

Failing to individualize standardized care plans is out of compliance with ANA standards. Individualized care plans are the basis of patient-centered care. Standard care plans may be useful as resources when constructing elements of an individualized plan of care. Standardized care plans identify nursing diagnoses, interventions and outcomes that are very useful in planning care. The key is to use the standardized care plan as a resource and to modify the standardized plan to fit the particular circumstances of your patient.

Standards of Professional Practice (competent level of behavior in the professional role):

Standard 7. – Ethics- The registered nurse practices ethically.

Standard 8. – Education- The registered nurse attains knowledge and competency that reflects current nursing practice.

Standard 9. - Evidence-based Practice and Research- The registered nurse integrates evidence and research findings into practice.

Standard 10. - Quality of Practice- The registered nurse contributes to quality nursing practice.

Standard 11. – Communication- The registered nurse communicates effectively in all areas of practice.

Standard 12. – Leadership- The registered nurse demonstrates leadership in the professional practice setting and in the profession.

Standard 13. – Collaboration- The registered nurse collaborates with healthcare consumer, family, and others in the conduct of nursing practice.

Standard 14. - Professional Practice Evaluation- The registered nurse evaluates her or his own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations.

Standard 15. - Resource Utilization- The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective, and financially responsible.

Standard 16. - Environmental Health- The registered nurse practices in an environmentally safe and healthy manner.

Question

Your patient has rheumatoid arthritis and over the past seven years has had joint replacements of an ankle and a hip. One year ago, the patient had a fusion of the cervical spine. Knowing bone repair is helped by increasing the amount of calcium consumed and absorbed into the bones. Recently, you read in a magazine that 2% milk actually has more calcium per ounce that does whole milk or Greek yogurt. You contact the dietary department and order a high calcium diet. Is this appropriate?

What do you think?

No. Standard 9 explains that the registered nurse uses the best available research evidence to improve patient care. Reading an article in a magazine would not constitute peer-reviewed or relevant research evidence. Without considering the patients’ full medication condition, high calcium direct may or may not be appropriate.

“Nursing: Scope and Standards of Practice delineates the professional responsibilities of all professional registered nurses engaged in nursing practice, regardless of the setting ” (ANA, 2010, p. 6).

Newly updated and revised, the ANA Code of Ethics for Nurses with Interpretive Statements (2015a) sets the expectation that nurses apply ethical principles when providing, discussing, and coordinating patient care. Deemed “Year of Ethics”, the ANA constantly promotes application of, not just the ability to discuss, how the Interpretive Statements guide nursing practice. Today the Code of Ethics for Nurses with Interpretive Statements (2015a) continue to give nurses a framework for ethical analysis and decision making and guides all nurses in the application of their professional skills and responsibilities.

You might remember that Nightingale felt that all nurses had an ethical duty to patients and that ethical duty was paramount regardless of the patient’s condition, gender, sexual orientation, ethnicity, or position in life. The ANA believes this premise as well and plus the revisions to the Interpretive Statements, or Code, are in direct response to the external and internal demands place on the healthcare delivery system. As nurses play a role in healthcare reform, applying the ethical principles will be paramount.

Review Virginia Commonwealth Medical Center nursing web site to see how that organization integrates the Interpretive Statements into the nursing practice model within the organization. You can go directly to the nursing page at https://www.vcuhealth.org/for-medical-professionals/nursing/about-nursing-at-vcu/about-nursing-at-vcu

Look at the navigation links on the right and check them out (About Nursing at VCU)

Consider how the Interpretive Statements support the Scope & Standards of Practice within Virginia Commonwealth Medical Center.


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