Nursing: Scope and Standards of Practice

American Nurses Association

Silver Spring, Maryland 2015

The American Nurses Association (ANA) is a national professional association. This ANA publication, Nursing: Scope and Standards of Practice, Third 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, Third Edition, guides nurses in the application of their professional knowledge, skills, and responsibilities.

American Nurses Association

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Published by Nursesbooks.org

The Publishing Program of ANA

http://www.Nursesbooks.org

Copyright ©2015 American Nurses Association. All rights reserved. Reproduction or transmission in any form is not permitted without written permission of the American Nurses Association (ANA). This publication may not be translated without written permission of ANA. For inquiries, or to report unauthorized use, email [email protected].

Cataloging-in-Publication Data on file with the Library of Congress

ISBN-13: 978-1-55810-621-5 SAN: 851-3481 07/2015

First published: July 2015

Contents

Overview of the Content

Essential Documents of Professional Nursing

Additional Content

Audience for This Publication

Scope of Nursing Practice

Definition of Nursing

Professional Nursing’s Scope and Standards of Practice

Description of the Scope of Nursing Practice

Development and Function of the Standards of Professional Nursing Practice

Standards of Practice

Standards of Professional Performance

The Function of Competencies in Standards

Integrating the Art and Science of Nursing

The What and How of Nursing

Tenets Characteristic of Nursing Practice

The How of Nursing

The Art of Nursing

The Science of Nursing

When Nursing Occurs

Nursing Knowledge, Research, and Evidence-based Practice

The Where of Nursing Practice

Healthy Work Environments for Nursing Practice

Safe Patient Handling and Mobility (SPHM)

Fatigue in Nursing Practice

Workplace Violence and Incivility

Optimal Staffing

Supports for Healthy Work Environments

High-Performing Interprofessional Teams

Key Influences on the Quality and Environment of Nursing Practice

Societal, Cultural, and Ethical Dimensions Describe the Why and How of Nursing

Model of Professional Nursing Practice Regulation

The Code of Ethics for Nurses

Specialty Practice in Nursing

Professional Registered Nurses Today: The Who of Nursing

Statistical Snapshot

Licensure and Education of Registered Nurses

Advanced Practice Registered Nurse Roles

Professional Competence in Nursing Practice

Evaluating Competence

Professional Trends and Issues

Creating a Sustainable Nursing Workforce

Nursing Education

Technological Advances

Population Focus: Redefining Health and Well-being for the Millennial Generation

Baby Boomers: Health and Chronic Illness

Summary of the Scope of Nursing Practice

Standards of Professional Nursing Practice

Significance of Standards

Standards of Practice

Standard 1. Assessment

Standard 2. Diagnosis

Standard 3. Outcomes Identification

Standard 4. Planning

Standard 5. Implementation

Standard 5A. Coordination of Care

Standard 5B. Health Teaching and Health Promotion

Standard 6. Evaluation

Standards of Professional Performance

Standard 7. Ethics

Standard 8. Culturally Congruent Practice

Standard 9. Communication

Standard 10. Collaboration

Standard 11. Leadership

Standard 12. Education

Standard 13. Evidence-based Practice and Research

Standard 14. Quality of Practice

Standard 15. Professional Practice Evaluation

Standard 16. Resource Utilization

Standard 17. Environmental Health

Glossary

References and Bibliography

Appendix A: Nursing: Scope and Standards of Practice, 2nd Edition (2010)

Appendix B: Nursing’s Social Policy Statement: The Essence of the Profession (2010)

Appendix C: ANA Position Statement: Professional Role Competence (2014)

Appendix D: The Development of Essential Nursing Documents and Professional Nursing

Appendix E: Selected Nurse Theorists

Appendix F: Culturally Congruent Practice Resources

Index

Contributors

Nursing: Scope and Standards of Practice, Third Edition, is the product of extensive thought work by many registered nurses and a three-step review process. This document originated from the decisions garnered during a significant number of telephone conference calls and electronic mail communications of the diverse workgroup members and an intensive two-day in person weekend meeting. The first review process, a 30-day public comment period, followed. All workgroup members reviewed every comment, resulting in further workgroup refinements of the draft document. The official American Nurses Association (ANA) review process included evaluation by the Committee on Nursing Practice Standards and final review and approval by the ANA Board of Directors in June 2015. The list of endorsing organizations that completes this section reflects the broad acceptance of this resource within the profession.

Nursing Scope and Standards Workgroup, 2014–2015

Elizabeth Thomas, MED, RN, NCSN, FNASN, Chairperson

Chad Allen, RN

Sheri-Lynne Almeida, DrPH, MSN, MED, RN, CEN, FAEN

Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CCDPD, FIAAN

Nancy Barr, MSN, RN

Patricia Bartzak, DNP, RN, CMSRN

Mavis Bechtle, MSN, RN

Jennifer Bellot, PhD, MHSE, RN, CNE

Tom Blodgett, PhD, MSN, GCNS, RN-BC

Patricia Bowe, MS, BSN, RN

Katreena Collette-Merrill, PhD, RN

Kahlil Demonbreun, DNP, RNC-OB, WHNP-BC, ANP-BC

Sheila Eason, MS, BSN, RN, CNOR

Tim Fish, DNP, MBA, RN, CENP

Matthew French-Bravo, MSN, RN

Heather Healy, MS, APRN, FNP-BC, NEA-BC

Susan Howard, MSN, RN-BC

Brenda Hutchins, DNP, ANP-BC, GNP-BC

Lorinda Inman, MSN, RN, FRE

Donna Konradi, PhD, RN, CNE

Mary Ann Lavin, ScD, APRN, ANP-BC, FNI, FAAN

Carla Mariano, EdD, RN, AHN-BC, FAAIM

Lucy Marion, PhD, RN, FAANP, FAAN

Deborah Maust Martin, DNP, MBA, RN, NE-BC, FACHE

Cindy McCullough, MSN, CMSRN, AGCNS-BC

Kris A. McLoughlin, DNP; APRN; PMH-CNS, BC; CADC-II, FAAN

Joyce Morris, MSN, RN-BC

Sandra J. Fulton Picot, PhD, RN, CLNC, FGSA, FAAN

Deborah Poling, PhD, RN, FNP-BC, CNE

Lori L. Profata, DNP, RN, NE-BC

Karen Rea-Williams, MS, FNP

ShyRhonda Roy, MSN, RN

Debbie Ruiz, RN

Kathryn Schroeter, PhD, RN, CNE, CNOR

Melida Shepard, RN, BSN, CPHQ

Suzanne Sikes-Thurman, BA, BSN, RN

Janice Smolowitz, EdD, DNP, RN, ANP-BC

Lynn Tomascik, MSN, RN

Linda Wagner, MA, RN, NE-BC

Acknowledgment of Special Contribution

Marilyn (Marty) Douglas, PhD, RN, FAAN

ANA Committee on Nursing Practice Standards

Richard Henker, PhD, RN, CRNA, FAAN: co- chair 03/2014–12/2015

Tresha (Terry) L. Lucas, MSN, RN: co- chair 07/2011–12/2014

Danette Culver, MSN, APRN, ACNS-BC, CCRN

Deborah Finnell, DNS, PMHNP-BC, CARN-AP, FAAN

Renee Gecsedi, MS, RN

Deedra Harrington, DNP, MSN, APRN, ACNP-BC

Maria Jurlano, MS, BSN, RN, NEA-BC, CCRN

Carla A. B. Lee, PhD, APRN-BC, CNAA, FAAN, FIBA

Verna Sitzer, PhD, RN, CNS

ANA Staff, 2014-2015

Carol J. Bickford, PhD, RN-BC, CPHIMS, FAAN – Content editor

Mary Jo Assi, DNP, RN, FNP-BC, NEA-BC

Maureen E. Cones, Esq. – Legal Counsel

Eric Wurzbacher, BA – Project editor

Yvonne Humes, MSA – Project assistant

About the American Nurses Association

The American Nurses Association (ANA) is the only full-service professional organization representing the interests of the nation’s 3.4 million registered nurses through its constituent member nurses associations and its organizational affiliates. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on healthcare issues affecting nurses and the public.

About Nursesbooks.org, The Publishing Program of ANA

Nursesbooks.org publishes books on ANA core issues and programs, including ethics, leadership, quality, specialty practice, advanced practice, and the profession’s enduring legacy. Best known for the Essential documents of the profession on nursing ethics, scope and standards of practice, and social policy, Nursesbooks.org is the publisher for the professional, career-oriented nurse, reaching and serving nurse educators, administrators, managers, and researchers as well as staff nurses in the course of their professional development.

Overview of the Content

Essential Documents of Professional Nursing

Registered nurses practicing in the United States have two contemporary professional resources that inform their thinking and decision-making and guide their practice. First, the Code of Ethics for Nurses with Interpretive Statements (American Nurses Association, 2015) lists the nine succinct provisions and accompanying interpretive statements that establish the ethical framework for registered nurses’ practice across all roles, levels, and settings. Secondly, the 2015 Nursing: Scope and Standards of Practice, Third Edition, outlines the expectations of professional nursing practice. The scope of practice statement presents the framework and context of nursing practice and accompanies the standards of professional nursing practice and their associated competencies that identify the evidence of the standard of care.

Additional Content

For a better appreciation of the history, content, and context related to Nursing: Scope and Standards of Practice, Third Edition, readers will find the additional content of the six appendices useful:

• Appendix A. Nursing: Scope and Standards of Practice, Second Edition (2010)

• Appendix B. Nursing’s Social Policy Statement: The Essence of the Profession (2010)

• Appendix C. ANA Position Statement : Professional Role Competence (2014)

• Appendix D. The Development of Essential Nursing Documents and Professional Nursing

• Appendix E. List of Selected Nurse Theorists

• Appendix F. Culturally Congruent Practice Resources

Audience for This Publication

Registered nurses in every clinical and functional role and setting constitute the primary audience of this professional resource. Students, interprofessional colleagues, agencies, and organizations also will find this an invaluable reference. Legislators, regulators, legal counsel, and the judiciary will also want to examine this content. In addition, the individuals, families, groups, communities, and populations using nursing and healthcare services can use this document to better understand what constitutes the profession of nursing and how registered nurses and advanced practice registered nurses lead within today’s healthcare environment.

Scope of Nursing Practice

Definition of Nursing

The following contemporary definition of nursing has been slightly modified from that published in the 2003 Nursing’s Social Policy Statement, Second Edition, and included in the 2004 and 2010 editions of Nursing: Scope and Standards of Practice, with the inclusion of facilitation of healing and groups:

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response,