Nursing: Scope and Standards of Practice, Second Edition Guides Nurses in the Application of Their Professional Skills and Responsibilities

2010 EDITION Scope AND Standards OF PRACTICE Nursing 2nd Edition ANA Standards of Professional Nursing Practice The Standards of Practice Standards of Practice describe a competent level of nursing care Standard 1. Assessment as demonstrated by The registered nurse collects comprehensive data pertinent to the critical thinking the healthcare consumer’s health or the situation. model known as the nursing process. The Standard 2. Diagnosis nursing process includes The registered nurse analyzes the assessment data to determine the components of the diagnoses or issues. assessment, diagnosis, outcomes identification, Standard 3. Outcomes Identification planning, implementation, The registered nurse identifies expected outcomes for a plan and evaluation. individualized to the healthcare consumer or the situation. Accordingly, the nursing process encompasses Standard 4. Planning significant actions The registered nurse develops a plan that prescribes strategies taken by registered and alternatives to attain expected outcomes. nurses and forms the foundation of the nurse’s Standard 5. Implementation decision-making. 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 practice 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. http://www.Nursingworld.org source: American Nurses Association (2010). Nursing: Scope and Standards © 2010 American Nurses Association of Practice, 2nd Edition. Silver Spring, MD: Nursesbooks.org; (pgs. 8–9). Nursing 2nd EdITIOn American Nurses Association Silver Spring, Maryland 2010 Library of Congress Cataloging-in-Publication data American Nurses Association. Nursing : scope and standards of practice. — 2nd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-55810-282-8 (pbk.) ISBN-10: 1-55810-282-5 (pbk.) ISBN-13: 978-1-55810-288-0 (eBook, PDF format) ISBN-13: 978-1-55810-296-5 (eBook, PDF format for site licenses) ISBN-13: 978-1-55810-358-0 (eBook, EPUB format) ISBN-13: 978-1-55810-359-7 (eBook, Mobipocket format) 1. Nursing—Standards—United States. I. Title. [DNLM: 1. Nursing—standards—United States—Practice Guideline. 2. Clinical Competence— standards—United States—Practice Guideline. WY 16] RT85.5.A47 2010 610.7302’1873—dc22 2010028581 The American Nurses Association (ANA) is a national professional association. This ANA publication—Nurs- ing: Scope and Standards of Practice, Second Edition—reflects the thinking of the nursing profession on various issues and should be reviewed in conjunction with state board of nursing policies and practices. State law, rules, and regulations govern the practice of nursing, while Nursing: Scope and Standards of Practice, Second Edition guides nurses in the application of their professional skills and responsibilities. Published by Nursesbooks.org The Publishing Program of ANA www.Nursesbooks.org/ American Nurses Association 8515 Georgia Avenue, Suite 400 Silver Spring, MD 20910-3492 1-800-274-4ANA http://www.NursingWorld.org Design: David Fox, AURAS Design, Silver Spring, Maryland Typesetting: House of Equations, Arden, North Carolina Printing: McArdle Printing, Upper Marlboro, Maryland Editorial services: Steve A. Jent, Denton, TX (copyediting); Grammarians, Inc., Washington, DC: Kelly Saxton (proofreading); Eric Wurzbacher, Silver Spring, MD (indexing). © 2010 American Nurses Association. All rights reserved. No part of this book may be reproduced or utilized in any form or any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher. ISBN-13: 978-1-55810-288-0 Contents Contributors vii Endorsing Organizations xiii Overview of the Content xvii Foundational Documents of Professional Nursing xvii Audience for This Publication xviii Scope of Nursing Practice 1 Definition of Nursing 1 Professional Nursing’s Scope and Standards of Practice 1 Description of Scope of Nursing Practice 2 Development and Function of Nursing Standards 2 The Function of Competencies in Standards 2 The Nursing Process 3 Tenets Characteristic of Nursing Practice 4 Healthy Work Environments for Nursing Practice 5 Model of Professional Practice Regulation 8 Standards of Professional Nursing Practice 9 Standards of Practice 9 Standards of Professional Performance 10 Professional Competence in Nursing Practice 12 Definitions and Concepts Related to Competence 12 Competence and Competency in Nursing Practice 13 Evaluating Competence 13 Professional Registered Nurses Today 14 Statistical Snapshot 14 Licensure and Education of Registered Nurses 14 Roots of Professional Nursing 15 iii CONTeNTs Nursing Research and Evidence-Based Practice 15 Specialty Practice in Nursing 17 Advanced Practice Registered Nurse Roles 18 Nurses in Advocacy and Society 20 Progression of Nursing Education 20 IOM Influences on the Quality and Environment of Nursing Practice 21 Integrating the Science and Art of Nursing 22 The Science of Nursing 22 The Art of Nursing 23 Nursing’s Societal and Ethical Dimensions 24 Caring and Nursing Practice 25 Continued Commitment to the Profession 26 Professional Trends and Issues 26 Summary of the Scope of Nursing Practice 29 Standards of Professional Nursing Practice 31 Significance of Standards 31 Standards of Practice 32 Standard 1. Assessment 32 Standard 2. Diagnosis 34 Standard 3. Outcomes Identification 35 Standard 4. Planning 36 Standard 5. Implementation 38 Standard 5A. Coordination of Care 40 Standard 5B. Health Teaching and Health Promotion 41 Standard 5C. Consultation 43 Standard 5D. Prescriptive Authority and Treatment 44 Standard 6. Evaluation 45 Standards of Professional Performance 47 Standard 7. Ethics 47 Standard 8. Education 49 Standard 9. Evidence-Based Practice and Research 51 Standard 10. Quality of Practice 52 Standard 11. Communication 54 Standard 12. Leadership 55 Standard 13. Collaboration 57 iv Nursing: Scope and Standards of Practice, 2nd Edition CONTeNTs Standard 14. Professional Practice Evaluation 59 Standard 15. Resource Utilization 60 Standard 16. Environmental Health 61 Glossary 63 References and Bibliography 69 Appendix A. ANA’s Principles of Environmental Health for Nursing Practice 73 Appendix B. Professional Role Competence: ANA Position Statement 75 Appendix C. The Development of Professional Nursing and Its Foundational Documents 87 A Time Line of Development 87 Some Specialty Nursing Practice Scope and Standards 90 Appendix D. Nursing: Scope and Standards of Practice (2004) 93 Index 149 Nursing: Scope and Standards of Practice, 2nd Edition v Contributors Nursing: Scope and Standards of Practice, Second Edition is the product of significant thought work by many registered nurses and a four-step review process involving those listed below. The document originated from the deci- sions garnered during a significant number of telephone conference calls and electronic mail communications of the diverse workgroup members, then fol- lowed by an extensive public comment period. The review process included two evaluations by the Committee on Nursing Practice Standards and Guidelines of ANA’s Congress on Nursing Practice and Economics, and finally, review and approval by the American Nurses Association Board of Directors in May 2010. The list of endorsing organizations that completes this section reflects the broad acceptance of this resource within the profession. Nursing Scope and Standards Workgroup, 2009–2010 Ann O’Sullivan, MSN, RN, NE-BC, CNE – Chair Julia Rose Barcott, RN Nancy Bonalumi, MS, RN, CEN, FAEN Susan B. Collins, FNP-BC, AHN-BC Louise Darling, BSN, RNC, IBCLC Gwen A. Davis, MN, RN, CDE Melanie Duffy, MSN, RN, CCRN, CCNS Diane Earl, RN Janice Cooke Feigenbaum, PhD, RN Jacqueline Fournier, APRN, BC Michael J. Kremer, PhD, CRNA, FAAN vii CONTRIbUTORs Kathleen A.V. Lavery, MS, CNM Beth Martin, MSN, RN, CCNS, ACNP-BC, ACHP Deborah Maust Martin, MSN, RN, MBA, NE-BC, FACHE Mary-Anne Ponti, MSN, MBA, RN, CNAA-BC Harry F. Smith, CDR, NC, USN Juan Carlos Soto, EdD, MSN, RN Cindy Diamond Zolnierek, MSN, RN ANA Staff, 2009–2010 Carol J. Bickford, PhD, RN-BC Content editor Katherine C. Brewer, MSN, RN Content editor Maureen E. Cones, Esq. Legal Counsel Yvonne Humes, MSA Project Coordinator Eric Wurzbacher Project Editor Committee on Nursing Practice Standards and Guidelines. 2009–2010 Tresha L. Lucas, MSN, RN, CNAA-BC – Chair Rosemary Pais Brown, MSN, RN Julia A. Dangel, MSN, RN Judith Harris, EdD, ARNP Richard Henker, PhD, RN, CRNA Wanda Lewis, DHA, RN, CCRN Sandi McDermott, RN, MSN, NEA-BC Margaret Nelson, MS, RN Elizabeth Libby Thomas, Med, RN, NCSN, FNASN Congress on Nursing Practice and Economics, 2008–2010 ChaIR Kathleen M. White, PhD, RN, CNAA-BC VIce-ChaIR Ann M. O’Sullivan, RN, MSN, NE-BC, CNE viii Nursing: Scope and Standards of Practice, 2nd Edition CONTRIbUTORs MembeRs Susan A. Albrecht, PhD, RN, FAAN Mary L. Behrens,

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