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Running head: STANDARDS OF PRACTICE

Nursing Scope and Standards of Practice


Amanda M. Mathy
Ferris State University

STANDARDS OF PRACTICE

Nursing Scopes and Standards of Practice


All nurses are held to high level of standards by the institution and other faculty
members. These standards are based on principles and policies of providing adequate patient
care. An organization that helps build the standards of nursing practice is the American Nurses
Association. This association builds the foundation of proper patient care and requires nurses to
uphold their standards on a daily basis. The American Nurses Association defines nursing as the
protection, promotion, and optimization of health and abilities, prevention of illness and injury,
alleviation of suffering through the diagnosis and treatment of human response, and advocacy in
the care of individuals, families, communities, and populations (American Nurses Association,
2010, p. 1). By definition, all nurses have obligations to themselves, the institution, but most
importantly the patients for providing proper care. This means that no matter what role or field
the nurse works, he or she is responsible for following the specific guidelines in order to meet the
jobs requirements.
Standards I Have Met
Standard 9: Evidence-Based Practice and Research
With education comes evidence-based practice and research as portrayed in standard 9.
Evidence-based practice incorporates current evidence to provide proper health care to patients.
Nurses are continuously working on ways to provide quick and efficient care. Nurses must
continue using their resources to discover new findings because evidence on proper care is
always changing. Currently, new findings in the health care system are being changed, such as
the medication cups, intravenous kits, and post-operative ambulation. In order for institutions to
change these skills and supplies, there must be current research on why the certain skill or supply
is not benefitting patient care. In comparison to education purposes, sharing of research findings

STANDARDS OF PRACTICE

and new evidence with peers and other staff members will provide an increase in the institutions
knowledge base overall (American Nurses Association, 2010, p. 51).
I am confident that I have met the evidence-based practice and research standard. From
the start of the nursing program, I have used evidence-based practice in nursing skills, class
lectures, papers, and in the clinical setting. I have witnessed many older generation nurses using
wrong techniques when working with a patient due to lack of evidence-based practice. The
newest research for post-operative patients shows that ambulation on the first or second day of
surgery enhances healing by decreasing the change of blood clots and promoting circulation
throughout the body (Rodts, Spinasanta, & Sasso, 2012). I have used this research to assist postoperative patients ambulate as well as provide education on the purpose of early ambulation. I
have also helped other nurses with evidence-based practice by explaining to a nurse that ripping
the tip of her glove to feel a vein is not proper technique. Although nurses believe this technique
is a shortcut, evidence shows that nurses have an increase chance of encountering blood and
transmitting it to other objects. I feel confident in my ability to use evidence-based practice and
research in my nursing practice.
Standard 10: Quality of Practice
Standard 10 considers the quality of health care that the registered nurse provides.
Quality of practice includes safe and effective measures to take care of patients. Nurses take on
many tasks throughout the day that incorporate quality of practice, such as medication
administration, documentation, and safety measures. If there is a situation where there is not
proper quality of care, the nurse should be able to identify the problem, analyze the factors
leading to the problem, and make recommendations to improve the care. With more experience,
the registered nurse can use his or her knowledge to develop and implement new policies for the

STANDARDS OF PRACTICE

organization as well as communicate to other professional health care members to improve their
knowledge on the issue as well. If qualities of practice issues occur, the nurse should make sure
he or she collects the data and evaluates the effectiveness of the certain practice. Not all quality
measures will provide the best care, so the nurses need to identify the measures and recommend
changes (American Nurses Association, 2010, p. 52).
I feel that I have met the quality of practice standard. One of my biggest patient concerns
is safety and effectiveness of care. I use quality of practice when it comes to bed alarms,
assistive ambulation devices, medication administration, and documentation. Due to falls being a
high-risk injury in the hospital, I make sure I am efficient in turning on bed alarms especially for
fall risk patients. When ambulating in the hallway or to the bathroom, I follow the registered
nurses recommendation on assistance, such as up with one and gait belt. Sometimes, patients try
to walk without assistance, but I continue to use assistive devices in case the patient loses
balance or becomes dizzy. When performing medication administration, I perform proper
medication checks on the Kardex and computer. For identification, I ask the patient for his or her
name and birthday and compare it to the hospital wristband. Once these tasks are done, I provide
proper documentation by only documenting what I have assessed or completed in a timely
manner. Overall, I feel efficient in the quality of practice standard.
Standard 14: Professional Practice Evaluation
Professional practice evaluation allows the registered nurse to evaluate his or her own
nursing practice and compare it to the guidelines, policies, and rules of professional practice.
Evaluating professional practice includes self-reflection as well as peer feedback. When
evaluation comes back, the registered nurse should be able to accept the feedback and be able to
use that to improve personal strength and growth. On the other hand, the nurse should return the

STANDARDS OF PRACTICE

favor and evaluate other peers by giving constructive criticism (American Nurses Association,
2010, p. 59).
I definitely feel that I have met the standard of professional practice evaluation. Every
day in the clinical setting, I am giving feedback on my performance by the clinical instructor,
registered nurse, nursing technician, and peers. Instead of taking it offensively, I take the
constructive criticism to improve my nursing skills and knowledge. In regards to personal
feedback, I evaluate my actions and compare them to the policies and guidelines of nursing
practice. An example of this is when I performed a catheter insertion and I had not done the
procedure in the correct steps. I provided proper catheter care, but I evaluated my steps later that
day in order to correct the steps I would use on the next catheter insertion.
Standards I Am Working On
Standard 7: Ethics
The ethics standard in nursing care provides nurses with the understanding that their
beliefs and values can interfere with the obligation to care for the patient in the nursing
profession. The nurse must deliver proper care to the patient by accepting and protecting the
patients rights, values, and beliefs. If the patient is unable to make decisions for them, nurses
must also be able to make decisions that would benefit the patient. The nurses role is to be an
advocate for their patient, which means they should not allow unethical behavior if it endangers
the patient. The nurse must also be confident enough to question orders and plans of care for the
patient. Nurses also make a commitment to confront ethical dilemmas and contribute to the
health care team to resolve them no matter how uncomfortable the dilemma may be (American
Nurses Association, 2010, p. 47).

STANDARDS OF PRACTICE

I have currently still working on the ethical standard. I have encountered and ethical
situation regarding the patients right to health information. One specific dilemma occurred when
a thirty-year-old patient I was taking care of was diagnosed with pancreatic cancer, a deadly
cancer. While the patient was asleep, the mother asked the physician about the new terminal
diagnosis and if he could avoid telling the news to the daughter. The mother wanted to protect
her daughter from being defeated and becoming depressed; however, the patient had the right to
know about her health. In the end, we discussed the new diagnosis with the patient and answered
her questions. Although I was a part of an ethical dilemma, I am continuing to work on this
standard because I need to have the ability to act as an advocate for my patient and any ethical
issues he or she encounters.
Standard 8: Education
Standard 8 discusses the registered nurses knowledge and competence based on current
nursing practice. The nurse makes a commitment to lifelong learning in order to stay up-to-date
with advanced knowledge, skills, and technology. Self-reflection, educational classes,
conferences, and meetings are methods of lifelong learning that improve personal growth of the
individual. Competence with skills specific to the institution, location, role, and situation is
essential for a registered nurse. With limited knowledge and old nursing skills, the patient could
possibly be harmed (American Nurses Association, 2010, p. 49).
Personally, I am still working on standard eight regarding education. Due to nursing
school, I am continuously increasing my knowledge base and personal growth by learning from
the class setting and clinical experience. Each semester, I learn about new areas of nursing, such
as pediatrics, obstetric, critical care, orthopedics, home health care, public health, medical
surgical, and mental health, that continue to add to my knowledge in the field of nursing. Before

STANDARDS OF PRACTICE

a new clinical rotation, I learn about the policies of each institution and how my skills differ from
the policies. I quickly adapt to this setting and make sure my role follows the institutions
guidelines. I know as a future registered nurse, lifelong learning is required. I believe that
education is a standard that all nurses are continuously working on no matter what their
experience is. Although I have shared educational findings with peers, I have not been able to do
so in a professional setting. When I become a registered nurse, I will participate in formal and
informal consultations, so I can add my thoughts on educational issues in order to improve that
specific institutions health care.
Standard 11: Communication
Communication is a key standard for all registered nurses. The registered nurse must be
able to use his or her communication skills in all encounters with patients, families, and other
staff members. For patients and families, it is important for registered nurses to use therapeutic
communication that is honest and direct but also comforting. For other staff members, it is vital
that the nurse uses his or her own professional perspective that will lead to intelligent
recommendations for the patients care and institution as a whole. Communication is not only
about talking but also about listening to other individuals ideas. Nurses need to be able to listen
to other members information and ensure that is the best option for the patient (American Nurses
Association, 2010, p. 54).
In the communication aspect, I feel that I am currently still working on this standard.
From the start of nursing school, I have been able to assess my own communication skills and
see what works well with the staff and patients in the hospital. I am becoming more experienced
with contacting physicians regarding patient care and questioning their rationale for the best
treatment option. Therapeutic communication is necessary for registered nurses, so I have been

STANDARDS OF PRACTICE

working on conveying therapeutic communication to the patients and families. I am still


uncertain how to communicate with mental health patients and families for example. Once I gain
more experience, I will feel more comfortable about talking to patients with a mental health
illness.
Standard 13: Collaboration
All medical professions require collaboration in order for the team to be successful.
Collaboration in health care means the registered nurse and other staff members cooperatively
work together by solving problems and making decisions that will impact patient care. With
collaboration, awareness of the knowledge, skills, and duties of all health care members is
demonstrated. All registered nurses are taught about delegation, which is assigning tasks to other
colleagues in order to complete tasks in a safe, efficient, and timely manner. Delegation provides
a sense of collaboration. Health care professionals work on team building processes and conflict
management (American Nurses Association, 2010, p. 57).
With my lack of experience, I feel that I am still working on meeting this standard due to
my collaboration with the staff in clinical. Since there are many care providers for one patient, I
make sure to talk with the registered nurse and nursing technician about what tasks need to be
done and who will complete them. I rarely delegate by giving jobs to other people, but I listen to
what tasks I am delegated to. I have been a part of team building exercises, and I continue to use
this knowledge by working as a cooperative team member. I have overheard the nursing staff in
conflict, and the staff was able to talk it out and end in a positive outcome. Once I become a
registered nurse, I will uphold the responsibility to delegate and help with positive outcomes for
the patient and institution as a whole.
Standard 15: Resource Utilization

STANDARDS OF PRACTICE

Registered nurses utilize resources on a daily basis in the health care setting. For the
patients needs, the nurse uses resources with health care professionals, as well as on the
computer and the institutions policies to provide proper care. Resources could help families and
patients with the costs, risks, and benefits in decision-making of treatment or care of the patient.
With new advancements of technology or plan of care, the nurse acts as an advocate to increase
awareness and knowledge to other health care professionals and patients as well. If a patients
plan of care includes a desired outcome or goal, utilization of resources is necessary to provide
reasons for these plans (American Nurses Association, 2010, p. 60).
Out of all the standards, I feel that I have exceeding in meeting this standard. Due to lack
of experience, I use resources for every tasks I complete with a patient. Before I perform an
intravenous insertion or drain emptying, I make sure to look up information from the institutions
policy and computer on the proper technique. Before medication administration, I ensure that I
look at the medication references on Cerner to obtain the name, usage, dose, route, time, and
adverse effects of every medication. Using resources helps me identify proper care and have
support on what my actions are.
Standards I Have Not
Standard 12: Leadership
Leadership is needed for the nursing role as explained in standard 12. Registered nurses
take the leadership role by being responsible and taking accountability for their actions. Leaders
in this setting should communicate effectively and treat every patient, family, and staff member
with trust, respect, and dignity. Being a leader entails being a role model to other colleagues by
following the policy and working towards the goals and vision of the institution. Leaders can be
mentors to other colleagues, but also be led by colleagues. A leader is also a follower in certain

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situations, so the negative connotation of being a follower is false for the medical setting. The
registered nurse will go out of his or her way to participate in professional organizations and be a
part of big changes for the institution (American Nurses Association, 2010, p. 55).
I feel that I have not met this standard yet because I have not worked in a professional
setting yet. In my life right now, I lead various groups, such as my soccer team and my nursing
program; however, I am a follower when it comes to the clinical setting. My inexperience leads
me to listen to other health care members and follow them when I dont know what to do. When
it comes to professional organizations and groups, I am the individual who listens and takes
notes in order to gain a better understanding of the professional setting. I think leadership is
highly valued in this profession, and I will work on this standard when I am finally a registered
nurse.
Standard 16: Environmental Health
Environment health requires the registered nurse to practice in a safe and healthy manner.
This means the nurse should be educated on environmental health risks, concepts, and strategies
in order to act upon it. Assessment of the environment is the first priority because factors such as
sound, smell, noise, and light can harm the patients health. After assessment, implementation of
health strategies is necessary. Implementation requires proper communication to health care staff
members by explaining what environmental health strategies are being used. If uneducated about
these risks, nurses should attend environmental health conferences and utilize resources on this
material. This standard is to promote overall healthy communities (American Nurses
Association, 2010, p. 61).
I do not feel that I have met this standard yet because of my lack of experience and
knowledge on environmental health. In my public health rotation, I was first introduced to

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environmental health risk factors in the Big Rapids community, such as lack of medical
resources and location issues. Besides that two-week rotation, I have not been a part of
educational conferences on environmental health, so I am unaware how this ties in the
professional setting. I am also unaware of the concepts and strategies that registered nurses use
when environmental health risks occur. I feel that my experience as a registered nurse will give
me more resources on environmental threats as well as ways to reduce the environmental health
risks. I will then be able to advocate and communicate about exposure reduction strategies.
Conclusion
The standards or professional nursing practice provides specific guidelines that every
nurse should be aware of and follow thoroughly. A nurse, who follows these standards, will be
able to provide proper patient care by providing incorporating safety measures and efficient
techniques. Besides helping the patient, the nurse will be able to assist health care members with
important health care decisions that will impact the institution and a specific unit. All of the
guidelines are important, but nurses should focus on the evidence-based practice and education
guidelines because that will improve the nurses knowledge. With lifelong education and usage
of current research, nurses will be up-to-date with their skills and be able to educate the patient
with current information. An important reason nurses choose this career is to help individuals
stay healthy. If all nurses followed the standards of professional nursing practice, they would be
giving their best effort on helping every individual.

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References

Americans Nurses Association. (2010). Scope and Standards of Practice: Nursing. Silver Spring,
MD.
Rodts, M., & Spinasanta, S. (2012). Post-operative care: Activity, incision care, rehab and
recover. Retrieved from http://www.spineuniverse.com/treatments/surgery/postoperative-care-activity-incision-care-rehab-recovery