Standards of Professional Nursing Practice

Standards of Professional Nursing Practice Assessment The registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation Competencies: The registered nurse Collects comprehensive data including but not limited to physical, functional psychosocial, emotional, mental, sexual, cultural, age-related, environmental, spiritual/transpersonal, and economic assessments in a systematic and ongoing process while honoring the uniqueness of the person Elicits patient values, preferences, expressed needs and their knowledge of the healthcare situation Involves the patient, family/support system other healthcare providers, and environment as appropriate, in holistic data collection Identifies barriers (such as psychosocial, financial, cultural, etc) to effective communication and makes appropriate adaptations Recognizes impact of personal attitudes, values and beliefs when assessing patients with diverse backgrounds or situations Assess family dynamics and impact on patient health and wellness Prioritizes data collection activities based on the patient’s immediate condition, or anticipated needs of the patient or situation Uses appropriate evidence-based assessment techniques and instruments and tools Synthesizes available data, information and knowledge relevant to the situation to identify patterns and variances Documents relevant data in a retrievable format Applies ethical, legal, and privacy guidelines and policies to the collection, maintenance, use and dissemination of data and information Recognizes the person as the authority on his/her own health and honors their preferences in regards to their care Diagnosis The registered nurse analyzes the assessment data to determine the diagnoses or issues Competencies: The registered nurse Derives the diagnoses or issues based on assessment data Validates the diagnoses or issues with the patient, family and other healthcare providers when possible and appropriate Documents diagnoses or issues in a manner that facilitates the determination of the expected outcomes and plan Identifies actual or potential risks to the patient’s health and safety or barriers to health, which may include but are not limited to interpersonal, systematic, or environmental circumstances Uses standardized classification systems, when available, in naming diagnoses Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation Competencies: The registered nurse Involves patient, family, significant others, and other healthcare providers in formulating expected outcomes when possible and appropriate Derives culturally appropriate expected outcomes from the diagnoses Considers associated risks, benefits, costs, current scientific evidence, expected trajectory of the condition, and clinical expertise when formulating expected outcomes Defines expected outcomes in terms of the patient, patient values, ethical considerations, environment or situation with such consideration as associated risks, benefits and costs and current scientific evidence Includes a time estimate for the attainment of expected outcomes Develops expected outcomes that provide direction for continuity of care Modifies expected outcomes that provide direction in the status of the patient or evaluation of the situation Documents expected outcomes and measureable goals Planning The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes Competencies: The registered nurse Develops in partnership with the person, family and others an individualized plan considering the person’s characteristics or situation, including but not limited to, values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture and environment and available technology Develops the plan in conjunction with the patient, family and others, synthesizing patients’ values and beliefs, developmental level, and coping styles Includes strategies in the plan of care that address each of the identified diagnoses or issues. These strategies may include, but are not limited to, strategies for promotion and restoration of health and prevention of illness, injury, and disease, the alleviation of suffering and provision of supportive care for those who are dying Provides for continuity with the plan of care Incorporates an implementation pathway or timeline within the plan Establishes the plan priorities with the patient, family and others as appropriate Utilizes the plan to provide direction to other members of the healthcare team Defines the plan to reflect current statues, rules and regulations and standards Integrates current scientific evidence, trends and research affecting care in planning Considers the economic impact of the plan on the patient, family, caregivers or other affected parties Documents the plan of care in a manner that uses standardized language or recognized terminology, and is understood by all participants Includes strategies for health, wholeness, and growth from in fancy through old age Explores practice settings and safe space and time for both the nurse and person/family/significant others to explore suggestion, potential and alternative options Modifies the plan based on the ongoing assessment of the patient’s response and other outcome indicators Implementation The registered nurse implements the identified plan Competencies: The registered nurse Partners with the person/family/significant others/ caregiver to implement the plan in a safe, realistic and timely manner Demonstrates caring behaviors towards patients, significant others and groups of people receiving care Documents implementation and any modifications, including changes or omissions, of the identified plan Utilizes technology to measure, record and retrieve patient data, implement the nursing process and enhance nursing practice Utilizes evidence-based interventions and treatments specific to the diagnosis or problem Provides holistic care that addresses the needs of diverse populations across the lifespan Advocates for health care that is sensitive to the needs of patients, with particular emphasis on the needs of diverse populations Applies appropriate knowledge of major health problems and cultural diversity in implementing the plan of care Applies health care technologies to maximize optimal outcomes for patients Utilizes community resources and systems to implement the plan of care Collaborates with health care providers from diverse backgrounds to implement the plan Integrates care with other members of the interprofessional health care team Evaluates and assesses the usefulness in integrating traditional and complementary health care practices Implements the plan of care in a safe and timely manner in accordance with the National Patient Safety goals Promotes the person’s capacity for the optimal level of participation and problem solving, honoring the person’s choices Coordinates the health care of individuals across the lifespan using principles of interpforessional models of care delivery and case management 5A. Coordination of Care: The registered nurse coordinates care delivery Competencies: The registered nurse Coordinates implementation of the plan Documents the coordination of the care Coordinates and manages care to meet the special needs of vulnerable populations in order to maximize independence and quality of life Assists the person to recognize alternatives by identifying options for care choices 5B. Health Teaching and Health Promotion The registered nurse employs strategies to promote health and a safe environment Competencies: The registered nurse Provides health teaching that addresses such topics as healthy lifestyles, risk-reducing behaviors, developmental needs, activities of daily living and preventive self-care Uses health promotion and health teaching methods appropriate to the situation and the patient’s values, beliefs, health practices Seeks opportunities for feedback and evaluation of the effectiveness of the strategies used 5C. Consultation and 5D.Prescriptivie Authority Reserved for APRN 6. Evaluation The registered nurse evaluates progress toward attainment of outcomes Competencies: The registered nurse Conducts a systematic, ongoing and criterion-based evaluation of the outcomes in relation to the structures and processes prescribed by the plan of care and the indicated timeline Collaborates with the person and others involved in the care or situation in the evaluation process Evaluates, in partnership with the person, the effectiveness of the planned strategies in relation to the person’s responses and the attainment of the expected outcomes Documents the results of the evaluation Uses ongoing assessment data to revise the diagnoses, outcomes, the plan, and the implementation as needed Disseminates the results to the patient, family and others involved in accordance with federal and state regulations Actively participates in assessing and assuring the responsible and appropriate use of interventions in order to minimize unwarranted or unwanted treatment and patient suffering Standards of Professional Performance 7. Ethics The registered nurse integrates ethical provisions in all areas of practice. Competencies: The registered nurse Uses Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) to guide practice Delivers care in a manner that preserves and protects patient autonomy, dignity, rights, values and beliefs Respects the centrality of the patient/family as core members of any health care team Upholds and advocates for patient confidentiality within legal and regulatory parameters Serves as a patient advocate assisting patients in developing skills for self advocacy and informed decision-making Maintains a therapeutic and professional patient-nurse relationship with appropriate professional role boundaries Demonstrates a commitment to practicing self-care, managing stress, and connecting with self and others Contributes to resolving ethical issues involving patients, colleagues, community groups, systems and other stakeholders Takes appropriate action regarding instances of illegal, unethical or inappropriate behavior that can endanger or jeopardize the best interest of the patient or situation Cooperates in an interpforessional team to make ethical decisions regarding the application of technologies and the acquisition and sharing of data Demonstrates professional comportment (openness, honesty, integrity and authenticity) Speakes up when appropriate to question health care practice when necessary for safety and quality improvement Education The registered nurse attains knowledge and competency that reflects current nursing practice Competencies: The registered nurse Incorporates new ideas and interventions to improve patient care Participates in ongoing educational activities related to appropriate knowledge bases and professional issues Demonstrates a commitment to lifelong learning through self-reflection and inquiry to address learning and personal growth needs 4. Seeks experiences that reflect current practice to maintain knowledge, skills, abilities and judgment in clinical practice or role performance Acquires knowledge and skills appropriate to the specialty area, practice setting, role or situation Maintains professional records that provide evidence of competency and life long learning Uses technology to support evidence-based nursing practice that facilitates improved patient outcomes Seeks experiences and formal and independent learning activities to maintain and develop clinical and professional skills and knowledge Identifies learning needs based on nursing knowledge, the various roles the nurse may assume, and the changing needs of the population Completes personal self-assessment of one’s own role and competence Stays informed of local and national issues that would impact public and social policy and professional nursing practice Participates in ongoing consultation to address issue of caring for others Evidence-Based Practice and Research The registered nurse integrates evidence and research findings into practice Competencies: The registered nurse Utilizes current evidence-based nursing knowledge, including research findings, to guide practice decisions Critically analyzes evidence-based practice and research findings for application to practice Participates in the development of evidence-based practice through research activities. Participation levels occur appropriate to the nurse’s education and position Shares research activities and/or findings with peers and others Quality of Practice The registered nurse systematically enhances the quality and effectiveness of nursing practice Competencies: The registered nurse Demonstrates quality by documenting the application of the nursing process in a responsible, accountable, and ethical manner Uses the results of quality improvement activities to initiate changes in nursing practice and in the healthcare delivery system Uses creativity and innovation in nursing practice to improve care delivery Incorporates new knowledge to initiate changes in nursing practice Participates in quality improvement activities Obtains and maintains professional certification if available in the area of expertise Communication The registered nurse uses a a wide variety of communication skills and formats in all areas of practice Competencies: The registered nurse Communicates effectively in a variety of written, spoken and technological formats Assesses own level of communication skill in encounters with patients and families Seeks continuous improvement of own communication and conflict resolution skills Acknowledges different styles of communication used by patients, families and health care providers Models effective communication and promotes cooperative behaviors Initiates requests for assistance when situation warrants it Uses information technologies to communicate health promotion/disease prevention information to the patient in a variety of settings Understands the principles of group process and negotiation Participates in building consensus or resolving conflict in the context of patient care Demonstrates effective communication and information sharing across disciplines and throughout transitions in care Identifies problems that occur in day to day work routines and participates in deriving solutions to inefficiencies Asserts own position/perspective in discussions about patient care Questions the rationale supporting routine approaches to care processes and decisions when they do not appear to be in the best interest of the patient Communicates observations or concerns related to hazards and errors to patients, families and/or health care team Follows communication practices to minimize risks associated with transfers between providers and across transition in care delivery Leadership The registered nurse demonstrates leadership in the professional practice setting and the profession Competencies: The registered nurse Promotes healthy work environments in local, regional, national or international communities Directs the coordination of care across setting and among caregivers Oversees the nursing care given by others while retaining accountability for the quality of care given to the patient Displays the ability to define a clear vision, the associated goals, and a plan to implement and measure progress Demonstrates a commitment to continuous, lifelong learning and education for self and others Mentors others for the advancement of nursing practice, the profession and quality health care Contributes to a culture where creativity, flexibility and innovation are expected in the work environment Demonstrates positive energy, excitement and a passion for quality work Values people as the most precious asset in an organization Treats others with respect, trust and dignity Participates in key roles on committees, councils and administrative teams Participates in professional organizations Communicates effectively with team members and others Manages conflict effectively Seeks ways to advance nursing’s professional autonomy, accountability and self-regulation Demonstrates awareness of own strengths and constraints as a team member Participates in designing systems that support effective teamwork and positive outcomes Participates in efforts to influence health care policy on behalf of patients and the profession Collegiality The registered nurse interacts with and contributes to the professional development of peers and colleagues Competencies: The registered nurse Adheres to standards and applicable codes of conduct that govern behavior among peers and colleagues to create an environment promoting cooperation, respect and trust Shares knowledge and skills with peers and colleagues as evidenced by such activities as patient care conferences or presentations at formal or informal meetings Provides peers with feedback regarding their practice and/or role performance Interacts with peers and colleagues to enhance one’s own professional nursing practice and/or role performance Maintains compassionate and caring relationships based on mutual respect between peers and colleagues Contributes to an environment that is conducive to the education of healthcare professionals Contributes to a supportive and healthy work environment Collaboration The registered nurse collaborates with patient, family and others in the conduct of nursing practice Competencies: The registered nurse Partners with others to effect change and generate positive outcomes through the sharing of knowledge of the patient and/or situation Communicates with patient, family and healthcare providers regarding patient care and the nurse’s role in the provision of that care Promotes conflict management and engagement Cooperates in creating a documented plan focused on outcomes and decisions related to care and delivery of services that indicates communication with patients, families and others Documents referrals, including provisions for continuity of care Professional Practice Evaluation The registered nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statues, rules and regulations Competencies: The registered nurse Provides age appropriate care in a culturally and ethnically sensitive manner Engages in self-evaluation of practice on a regular basis, identifying areas of strength as well as areas in which professional development would be beneficial Obtains informal feedback regarding one’s own practice from patients, peers, professional colleagues and others Participates in systematic peer review as appropriate Takes action to achieve goals identified during evaluation process Provides rationales for practice beliefs, decisions and actions as part of the informal and formal evaluation processes Resource Utilization The registered nurse utilizes appropriate resources to plan and provide nursing services that are safe, effective and financially responsible Competencies: The registered nurse Assess individual patient care needs and resources available to achieve desired outcomes Allocates resources based on identified patient care needs, potential for harm, complexity of the task and desired outcome Delegates tasks based on patient need and caregiver competency Identifies cost and benefits in evaluating resources available with the patient, family and healthcare team Advocates for the design and implementation of technology that enhances nursing practice and healthcare delivery Modifies practice when necessary to promote a positive interface between patients, care providers and healthcare delivery Assists the patient and family in identifying and securing appropriate and available services to address needs across the healthcare continuum Assists the patient and family in understanding costs, risks and benefits of treatment and care Environmental Health The registered nurse integrates the principles of environmental health for nursing in all areas of practice Competencies: The registered nurse Works to reduce or eliminate environmental health risks in the healthcare setting Participates in creating environments that promote health and healing, including attention to sound, noise and light Advocates for the mitigation of the negative impact of products used in the healthcare system on the environment Communicates environmental health risks and exposure reduction strategies to patients, families, colleagues and communities Utilizes scientific evidence to determine if a product or treatment is a potential environmental threat Advocates for environmental justice, including a commitment to the health of vulnerable populations and the elimination of health disparities