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    Nursing: Scope and Standards of Practice, 4th Edition
    Nursing: Scope and Standards of Practice, 4th Edition
    Nursing: Scope and Standards of Practice, 4th Edition
    Ebook345 pages4 hours

    Nursing: Scope and Standards of Practice, 4th Edition

    By American Nurses Association

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    About this ebook

    The Nursing: Scope and Standards of Practice, 4th Edition, is an essential document for every nurse practicing in the United States. The scope of practice statement answers the who, what, when, where, how, and why questions of nursing. The standards provide authoritative statements of the actions and behaviors that all registered nurses are expected to competently perform, regardless of role, population, specialty, and setting. Each standard is accompanied by detailed competencies for the three practice levels.

    The product of extensive thought work by many registered nurses, this new edition provides:

    A revised and contemporary definition of nursing
    An extensive discussion of respect, equity, inclusion, and social justice
    The new ANA Professional Nursing Model and the revised Model Representing Regulation of Professional Nursing Practice
    An expanded discussion of the application of ethics in nursing
    A complete picture of the dynamic and complex practice of nursing and its membership and evolving boundaries.
    18 national standards of practice and professional performance and their accompanying competencies
    This premier professional resource informs and guides nurses in their vital work providing safe, quality, and competent care. It is a must-have for every registered nurse.
    LanguageEnglish
    PublisherNursesbooks
    Release dateMay 14, 2021
    ISBN9780999308882
    Nursing: Scope and Standards of Practice, 4th Edition
    Author

    American Nurses Association

    The American Nurses Association (ANA) is the premier organization representing the interests of the nation's 4 million registered nurses. ANA is at the forefront of improving the quality of health care for all. Founded in 1896, and with members in all 50 states and U.S. territories, ANA is the strongest voice for the profession

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      Book preview

      Nursing - American Nurses Association

      Nursing

      Scope and Standards of Practice

      4th Edition

      The American Nurses Association (ANA) is a national professional association. This publication reflects the position of ANA regarding the scope and standards of nursing practice and should be reviewed in conjunction with state board of nursing regulations. State law, rules, and regulations govern the practice of nursing, while Nursing: Scope and Standards of Practice, 4th Edition guides registered nurses in the application of their professional skills and responsibilities.

      About the American Nurses Association

      The American Nurses Association (ANA) is the only full-service professional organization representing the interests of the nation’s 4.2 million registered nurses through its constituent/state nurses associations and its organizational affiliates. The 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.

      American Nurses Association

      8515 Georgia Avenue, Suite 400

      Silver Spring, MD 20910

      Copyright © 2021 ANA. All rights reserved. No part of this book may be reproduced or used 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.

      ISBNs

      Print 978-0-9993088-6-8

      ePDF 978-0-9993088-7-5

      ePUB 978-0-9993088-8-2

      Mobi 978-0-9993088-9-9

      SAN: 851-3481

      Contents

      Contributors

      Nursing Scope and Standards Workgroup, 2019–2020

      Others

      ANA Committee on Nursing Practice Standards—Reviewers

      ANA Staff

      About the American Nurses Association

      About the American Nurses Association Publishing Program

      Scope of Nursing Practice

      Definition of Nursing

      Other Definitions

      Description of the Scope of Nursing Practice

      Development and Function of the Standards of Professional Nursing Practice

      The Art and Science of Nursing

      The Art of Nursing

      Care and Caring in Nursing Practice

      Professional Nursing Model

      Nursing Process

      Ethics for Nurses

      Code of Ethics Provisions

      Ethical Decision-Making Models

      Case Study: Using the Nursing Process in Ethical Situations

      Respect, Equity, Inclusion, and Social Justice

      The Science of Nursing

      Nursing Knowledge and Scholarly Inquiry

      The How of Nursing

      Ways

      Processes

      Means

      Methods

      Manner

      Advocacy

      High-Performing Interprofessional Teams

      Regulation of Nursing Practice

      Context and Environment: When Nursing Occurs

      Professional Registered Nurses Today: The Who of Nursing

      Licensure and Education of Registered Nurses

      Certified Nurse-Midwife (CNM)

      Certified Nurse Practitioner (CNP)

      Certified Registered Nurse Anesthetist (CRNA)

      Clinical Nurse Specialist (CNS)

      Professional Competence, Self-Determination, and Professional Identity in Nursing

      Professional Competence

      Self-Determination

      Professional Identity

      The Professional Responsibility of Mentoring in Nursing: Paying It Forward

      A Potpourri of Opportunities for the Future

      Environment

      Disaster Planning and Management

      Reimbursement and Cost-Effective Care Economic Structures

      Structural Competency

      Protection of Healthcare Workers

      Health

      Quality of Life

      Aging in Place

      Palliative Care Conversations

      Reimagining Nursing Initiative

      Standards of Professional Nursing Practice

      Significance of Standards

      The Function of Competencies in Standards

      Standards of Practice

      Standard 1. Assessment

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 2. Diagnosis

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 3. Outcomes Identification

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 4. Planning

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 5. Implementation

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 5A. Coordination of Care

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 5B. Health Teaching and Health Promotion

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 6. Evaluation

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standards of Professional Performance

      Standard 7. Ethics

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 8. Advocacy

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 9. Respectful and Equitable Practice

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 10. Communication

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 11. Collaboration

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 12. Leadership

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 13. Education

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 14. Scholarly Inquiry

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 15. Quality of Practice

      Competencies 101

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 16. Professional Practice Evaluation

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse

      Additional Competencies for the Advanced Practice Registered Nurse

      Standard 17. Resource Stewardship

      Competencies

      Additional Competencies for the Graduate-Level Practice Registered Nurse, Including the Advanced Practice Registered Nurse

      Standard 18. Environmental Health

      Competencies

      Additional Competencies for the Graduate-Level Prepared Registered Nurse, Including the Advanced Practice Registered Nurse

      Glossary

      References

      Appendix A. Ethics, Morals, and Ethical Theories and Approaches

      Ethics and Morals

      Ethical Theories and Approaches

      Consequentialism and Deontology

      Ethical Principlism

      Ethics of Care and Virtue Ethics

      Appendix B. Selected Nurse Theorists

      Appendix C. The Development of Essential Nursing Documents

      A Timeline of Development

      Appendix D. Position Statement: Professional Role Competence

      Definitions and Concepts in Competence

      Competence and Competency in Nursing Practice

      Evaluating Competence

      Recommendations/Next Steps

      References

      Index

      Contributors

      Nursing: Scope and Standards of Practice, Fourth Edition, is the product of extensive thought work by many registered nurses examining the American Nurses Association’s Nursing: Scope and Standards of Practice, Third Edition (2015b) followed by a three-step review process. This document originated from the multitude of decisions garnered during a significant number of video telephone conference calls and email communications of the diverse workgroup members in 2019–2020. The workgroup was always guided by Abe Lincoln’s quote, The best way to predict your future is to create it. The first review involved a 30-day public comment period. All workgroup members reviewed every submitted comment, resulting in further workgroup refinements of the draft document. The two following official American Nurses Association (ANA) review processes included evaluation by the Committee on Nursing Practice Standards in December 2020 and final review and approval by the ANA Board of Directors in January 2021.

      NURSING SCOPE AND STANDARDS WORKGROUP, 2019–2020

      Patricia J. Bartzak, DNP, RN, CMSRN, TCRN (Co-Chair)

      Kahlil A. Demonbreun, DNP, RNC-OB, WHNP-BC, ANP-BC, FAANP, FAAN (Co-Chair)

      Barbara A. Brunt, MA, MN, RN, NPD-BC, NE-BC, FABC

      Carol Peyton Bryant, DNP, RN, ACNP, CCRN

      Colleen Casper, DNP, MS, RN

      Tracy K. Davidson, DNP, MPH, RN

      Jessica L. Dzubak, MSN, RN

      Carla A. Lee, PhD, EdS, MN, RN, APRN-BC, A/FNP, CNS, CHES, FIBA, FAAN

      Kristy Nielson, DNP, RN, CCRN-K, CNE

      Jennifer Pettis, MS, RN, CNE, WCC

      Colleen L. Quesnell, DNP, RN, WHNP-BC, ANP-BC, CNM

      Catherine Robichaux, PhD, RN, Alumna CCRN

      Deborah Shields, PhD, RN, CCRN, QTTT, AHN-BC

      Suzanne H. Sikes-Thurman, BSN, RN

      Felicia D. Stewart, DNP, RN-BC, FNP-C

      Deirdre Thornlow, PhD, RN, CPHQ

      Linda L. Wagner, MA, RN, NE-BC

      OTHERS

      Lisa Herrington, MSN, BSN, RN-BC

      Monica E. Kolbuk, MSN, RN, CEN

      Joyce N. Morris, MSN, RN-BC

      Jamie L. Sirman, MSN, RN-BC, CDE

      ANA COMMITTEE ON NURSING PRACTICE STANDARDS—REVIEWERS

      Mona Pearl Treyball, PhD, RN, CNS, CCRN-K, FAAN (Co-chair)

      Stacy McNall, MSN, RN, IBCLC, PMPNP-BC (Co-chair)

      Patricia Bowe, DNP, MS, RN

      Nena M. Bonuel, PhD, RN, APRN-BC, ACNS-BC, CCRN-K

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

      Elizabeth O. Dietz, EdD, RN, CS-NP, CSN

      Kirk Koyama, MSN, RN, CNS, PHN

      Tonette McAndrew, MPA, RN

      Amy McCarthy, MSN, RN, RNC-MNN, NE-BC

      Linda Inez Perkins, MSN, RN-BC

      Verna Sitzer, PhD, RN, CNS

      ANA STAFF

      Carol J. Bickford, PhD, RN-BC, CPHIMS, FAMIA, FHIMSS, FAAN (content editor)

      Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC (contributor)

      Alison May, BS (graphics designer)

      Erin Walpole, BA, PMP (production editor)

      James Angelo, MA (publications manager)

      ABOUT THE AMERICAN NURSES ASSOCIATION

      The American Nurses Association (ANA) is the premier organization representing the interests of the nation’s 4.2 million registered nurses. ANA advances the profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on healthcare issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all.

      ABOUT THE AMERICAN NURSES ASSOCIATION PUBLISHING PROGRAM

      The American Nurses Association (nursingworld.org/nurses-books/) 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 foundational documents of the profession on nursing ethics, scope and standards of practice, and social policy, ANA is the publisher for the professional, career-oriented nurse, reaching and serving nurse educators, administrators, managers, and researchers during their professional development.

      Scope of Nursing Practice

      "Imagine a world without nurses. Think of a world without persons who know what nurses do;

      who have the effect that nurses have on the health of individuals, families, and the nation;

      who enjoy the trust that nurses enjoy from the American people.

      Imagine a world like that, a world without nurses."

      Margretta Gretta Madden Styles, EdD, RN, FAAN

      DEFINITION OF NURSING

      Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.

      This revised definition presents reordering the content from the 2015 version (ANA, 2015b), including the art and science of caring, replacing abilities with human functioning, and incorporating references to compassionate presence and recognition of the connection of all humanity. Such refinements reflect an evolution of thinking over the past five years and present enhancements intended to lead into the future.

      Formatting the definition as a bullet list provides an opportunity to further appreciate the richness and diversity of the integrated concepts:

      Nursing:

      Integrates the art and science of caring

      Protects, promotes, and optimizes health and human functioning

      Prevents illness and injury

      Facilitates healing

      Alleviates suffering through compassionate presence

      Nursing is:

      the diagnosis and treatment of human responses and

      advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.

      OTHER DEFINITIONS

      These definitions are provided to promote clarity and understanding for all readers:

      Healthcare consumers are the patients, persons, clients, families, groups, communities, or populations who are the focus of nurses’ attention. Healthcare consumers receive nursing services as sanctioned by the state regulatory bodies. The more global term healthcare consumer is intended to reflect a proactive focus on health and wellness care, rather than a reaction to disease and illness.

      Registered nurses (RN) are individuals who are educationally prepared and then licensed by a state, commonwealth, territory, or government regulatory body to practice as a registered nurse. Nurse and professional nurse are synonyms for a registered nurse in this document. Numerous jurisdictions have identified nurse as a protected title.

      Graduate-level prepared registered nurses are registered nurses prepared at the master’s or doctoral educational level; have advanced knowledge, skills, abilities, and judgment; function in an advanced level as designated by elements of the nurse’s role; and are not required to have additional regulatory oversight.

      Advanced practice registered nurses (APRN) are a subset of graduate-level prepared registered nurses who have completed an accredited graduate-level education program preparing the nurse for special licensure recognition and practice for one of the four recognized APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). APRNs assume responsibility and accountability for health promotion and/or maintenance, as well as the assessment, diagnosis, and management of healthcare consumer problems, which includes the use and prescription of pharmacologic and nonpharmacologic interventions (APRN Joint Dialogue Group, 2008). Some clinicians in this classification began APRN practice prior to the current educational preparation requirement and have been grandfathered to hold this designation.

      DESCRIPTION OF THE SCOPE OF NURSING PRACTICE

      The Scope of Nursing Practice describes the who, what, where, when, why, and how associated with nursing practice and roles. Each question must be answered to provide a complete picture of the dynamic and complex practice of nursing and its membership and evolving boundaries. The definition of nursing provides a succinct characterization of the what of nursing. All registered nurses, including those identified as graduate-level prepared nurses or advanced practice registered nurses, comprise the who constituency and have been educated, titled, and maintain active licensure to practice nursing. Nursing occurs when there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education, anytime, anywhere.

      Nursing occurs in any environment where there is a healthcare consumer in need of care, information, or advocacy. The how of nursing practice is defined as the ways, means, methods, and manners that nurses use to practice professionally. The why is

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