Running head: SCOPE AND STANDARDS OF PRACTICE

Importance of Scope and Standards of Practice in BSN Education

Lindsay R. Vasquez
Nursing 324
Ferris State University

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Importance of Scope and Standards of Practice in BSN Education
The practice of nursing can lead to careers in numerous different fields, requiring
different sets of knowledge and skill. One of the appeals of the nursing occupation is that it is so
diverse and offers a surplus of opportunities. The options are endless and can lead a professional
nurse to any corner of the globe. This variety is good, however, we need to reflect on our
everyday practice experiences and scope of practice in a critical way (Gustman, 2014).
Standards of nursing and scope of practice are common items that unite all nurses in every field
and it is expected that every nurse practice within these boundaries. By having these common
regulations it strengthens nursing as a profession.
Professional Identity
Being defined as a profession often solidifies occupations as educated, respectable,
autonomous, and organized. Over a century ago, Abraham Flexner published a report with the
Carnegie Foundation that outlined characteristics of a profession (Flexner, 1910). Since the
1910 report was published, Flexners criteria have been widely used as the benchmark for
determining the professional status of various occupations and have had a profound influence on
professional education in several disciplines, including nursing (Black, 2014, p. 53).
According to Flexner, characteristics that are common to all professions are detailed in
the following criteria:
1) Is basically intellectual (as opposed to physical) and is accompanied by a high degree
of individual responsibility, 2) Is based on a body of knowledge that can be learned and
developed and refined through research, 3) Is practical, in addition to being theoretical, 4)
Can be taught through a process of highly specialized professional education, 5) Has a
strong internal organization of members and a well-developed group consciousness, and

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6) Has practitioners who are motivated by altruism and who are responsive to public
interests. (Black, 2014, p. 53)
The profession of nursing meets every one of these criteria. Flexners criteria are only one of
several methods used to judge occupations as professions. However, they all contain the same
underlying characteristics of service/altruism, specialized knowledge, and autonomy/ethics
(Black, 2014, pp. 53-54)
Nursing has struggled to gain its designation as a profession for many years. It is
extremely important that nursing be identified as a profession to demand respect from other
disciplines both inside and outside the medical realm. When identified as a profession,
individuals within nursing have as stronger voice and a higher ability to evoke policy change.
Professional status in nursing is important for those who choose nursing as a career; it
encourages commitment, longevity, and retention. As Beth Black (2014) points out, The strong
identity that professionals develop means that it is less common for them to change careers, as
compared with persons involved in occupations, which may not involve such a strong
commitment and identity (p. 54). Being identified as a profession, allows nursing to maintain
the positive public image of trusting, knowledgeable, and compassionate. In spite of challenges
facing the nursing profession, nurses are well respected by the public and enjoy a generally
positive image (Black, 2014, p. 40). This designation provides the general public with
reassurance that nurses are important and competent.
Scope of Practice
All professions have a set of regulations or rules in which they operate; nursing is no
different. As delineated by nursings professional organization, the American Nurses Association,
Professional regulation of nursing practice begins with the definition of nursing and the scope

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of professional nursing practice (White & OSullivan (Eds.), 2012, p. 6). Scope of practice for
nursing is the rules and regulations in which each and every nurse must practice within,
standards of practice are the expectations and competencies nurses are expected to meet. As
Black (2014) demonstrates, The goal of establishing standards is to improve the health and
well-being of all recipients of nursing care and to establish the responsibilities for which nurses
are accountable (p. 59). The scope and standards of practice that have been developed by the
American Nurses Association allow for self-regulation within the profession. When the standards
are not being upheld, correction action is taken. The discussion of two standards, outcomes
identification and evaluation, of nursing practice that follows will demonstrate how nursing as a
profession holds it members accountable in meeting these expectations.
Standard #3-Outcomes Identification
This standard of nursing practice expects that, the registered nurse identifies expected
outcomes for a plan individualized to the healthcare consumer or situation (White & OSullivan
(Eds.), 2012, p. 63). Nurses are expected to use their clinical knowledge base to develop
outcomes or changes they want to see in the patients health or functioning. Once the nursing
diagnosis is established via standard #2, then the Nursing Outcomes Classification (NOC) can be
used to develop appropriate outcomes specific to this diagnosis. Important characteristics that are
essential for all outcomes are that they are specific, measureable, achievable, realistic, and timeframed (White & OSullivan (Eds.), 2012, p. 63). Outcomes are not solely decided upon by the
registered nurse; but are mutually agreed upon by the patient, the nurse, and the patients other
healthcare providers. This same team has to decide on the amount of time that is needed to
accomplish each outcome; it may be short-term or long-term. This allows the patient to take
individual responsibility and pride in achieving these outcomes.

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An example of identifying outcomes can be demonstrated by describing the activity of a
post-surgical cardiothoracic patient. An outcome would be, the patient will stand at the bedside
with moderate assistance on post-operative day #1 by 0600 in the morning. Another outcome
could be, the patient will ambulate in the hallway a minimum of 100 feet four times a day by
post-operative day #3 with minimal assistance. A final outcome that could be established is, the
patient will be able to complete all ADLs including self-hygiene and incisional care by postoperative day #7 with no assistance.
Standard #6-Evaluation
This standard of nursing practice expects that, the registered nurse evaluates progress
toward attainment of outcomes (White & OSullivan (Eds.), 2012, p. 105). While establishing
the desired outcomes is important, it is just as critical to evaluate if the patient is meeting these
outcomes. Without evaluation, outcomes may never be realized. As the American Nurses
Association argues, Without the ability to appropriately evaluate, the RN is simply following
orders and can potentially cause a break-down in the entire system (White & OSullivan (Eds.),
2012, pp. 105-106). In practice, lackadaisical nurses may extend a patients length of stay by
failing to evaluate outcomes and make adjustments as needed. Evaluating allows for the
interventions to be changed or outcomes to be modified. Nurses must create a collective system
of accountability by evaluating outcomes through constant evaluation and re-evaluation and
adjustment in collaboration with others (White & OSullivan (Eds.), 2012, p. 105). It is once
again important to include the patient in the evaluation process in order to determine the best
changes to achieve successful outcomes.
An example of evaluating an outcome of pain control in a post-operative cardiothoracic
patient would be determining whether the current medications are giving good pain relief to the

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patient. This could be done by using the numeric rating scale in which patients determine a pain
value of zero to ten, zero being no pain and ten being the worst pain imaginable. If the patient
consistently rates pain as high, evaluation would determine that the current medications might
need to be changed or adjusted in dosage. On the contrary, if the patient is over sedated or vital
signs are affected by medication, evaluation can determine that the medication needs to be
decreased, changed, or discontinued. Timely evaluation is essential when treating pain in order to
give the patient the best pain control possible.
Transition
Achieving a BSN degree adds dimension to your nursing career and according to the
American Association of Colleges of Nursing, the stressed concepts of a BSN degree include
patient-centered care, interprofessional teams, evidence-based practice, quality improvement,
patient safety, informatics, clinical reasoning and critical thinking, genomics, cultural sensitivity,
professionalism, and practice across the lifespan (Black, 2014, p. 137). This is far more advanced
than the general educational concepts emphasized in an ADN program; professional behaviors,
communication, assessment, clinical decision making, caring interventions, teaching and
learning, collaboration, and managing care (Black, 2014, p. 139). Different from scope of
practice, which can sometimes confine and delineate how we practice, standards of professional
performance, describe a competent level of behavior in the professional role (ANA, 2010, p.
11). Nursing, like any other profession, needs regulation and improvement to achieve these
competencies. The Quality and Safety Education for Nurses Institute makes sure that nurses are
accomplishing this through KSAs (knowledge, skills, and attitudes), their mark of achievement.
The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the
challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs)

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necessary to continuously improve the quality and safety of the healthcare systems within which
they work (Quality and Safety Education for Nurses Institute, 2014). There are numerous KSAs
that are gained from a BSN education that transition nurses into their roles as a BSN provider.
Nursing is a career of continuous improvement and it is getting better all the time. Obtaining a
BSN education expands this improvement. The number of nurses seeking secondary education
after they graduate is exponentially increasing. Regardless of the reasons for obtaining a BSN, it
has repeatedly demonstrated to benefit patients and nurses alike. In fact, Studies showed that
every 10% increase in the proportion of BSN-prepared nurses on a hospitals staff was associated
with a 4% decrease in the risk of death for patients (Haverkamp & Ball, 2013, p. 144). When a
nurse extends his or her education into a BSN they gain more knowledge, develop better skills,
and change their attitudes toward patients and the profession.
Knowledge
The nursing standard of evidence-based practice (EBP) and research is a prime example
of a standard that addresses the knowledge aspect of the QSEN Initiative. Knowing how to
integrate EBP into clinical practice takes education and practice. Black (2014) describes EBP by
saying, The ultimate goal is for nurses to participate in the research process and apply research
findings to clinical practice (p. 225). In order to effectively conduct EBP, research and study
skills must be taught in the nursing core curriculum. While EBP is a core concept of a BSN
education, it is only briefly mentioned in an ADN program because of lack of curriculum time.
Some of the struggle of teaching EBP is, Rather than isolating the teaching of EBP skills and
knowledge to a sole research course, critical appraisal of evidence should also be integrated into
every classroom and clinical learning experience (White & OSullivan (Eds.), 2012, p. 135). In

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the less amount of time ADN nurses spend in clinical, there should be more emphasis placed on
teaching these concepts.
Skills
The nursing standard most representative of the development of skills is quality of
practice. Development of this standard can be accomplished at many different levels throughout
a nurses career. A new nurse might have an entirely different quality of his or her practice than
an experienced nurse. However, it is important for every nurse, regardless of skill level, to
demonstrate quality in the care they provide. Nurses are engaged every day in identifying areas
for improvement, for monitoring, for measuring, and for reporting quality (White & OSullivan
(Eds.), 2012, p. 147). It takes experience to recognize issues quickly and implement interventions
promptly. Patricia Benner recognized the different skill levels of nurses in her work From Novice
to Expert and demonstrated that nurses who are engaged can advance in their skill level by
clinical practice and experiences. The core concepts of quality improvement and patient safety
are part of the BSN curriculum and are completely absent from the ADN program of study. In
fact, almost all of the quality improvement positions that are available in any institution require a
BSN degree or higher. For example, a clinical nurse leader (CNL), who is masters prepared, has
a primary focus on quality improvement and safety. As McKinney (2010) points out, I think
nurses have always tried to look more holistically at patients and families,
and now CNLs have the time and capability to look at the bigger picture,
implement evidence-based standards of care and figure out where change
may improve outcomes (p. 28). There is far more exposure and education on all the
core measures required by auditing and government agencies in a BSN curriculum, that it makes
you aware and your practice quality improves.

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Attitude
Ethics, the nursing standard that is often more difficult to sift through and open to a lot of
interpretation, addresses the QSEN initiative of attitude. There is special consideration placed on
the ethics of the nursing profession and a document, Code of Ethics for Nurses with Interpretive
Statements, was formatted to help nurses work through some of their complex questions. Nurses
are constantly challenged to keep their opinions personal and to care for their patients in an
unbiased manner. Every nurse will tell you this is not the easiest task to accomplish, patients can
be difficult and hard to understand. It takes exposure to these unique circumstances to learn how
to respond to patients and their families. BSN prepared nurses are allotted more clinical hours
which gives them this added exposure. A BSN curriculum also offers the core concepts of
cultural sensitivity and professionalism that an ADN curriculum fails to address. According to
Provision One of the code, The nurse, in all professional relationships, practices with
compassion and respect for the inherent dignity, worth, and uniqueness of every individual,
unrestricted by considerations of social or economic status, personal attributes, or the nature of
health problems (American Nurses Association, 2010, p. 11). Practicing ethically requires a
nurse to develop the attitude that they are going to do the best thing for the patient, set their own
beliefs and feeling aside, and respect the autonomy and wishes of every individual.
Significance
A baccalaureate in nursing degree allows the student more time to study and contemplate
scope and standards of practice than a diploma or associate degree prepared registered nurse. By
studying the scope and standards of practice, it increases a nurses knowledge base and produces
better patient outcomes. Patients are given more effective, safe care. As Beth Black (2014) wrote,
Research has demonstrated that patient outcomes are more positive for patients cared for by

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bachelors- or higher- degree-prepared RNs (p. 7). The curriculum in this course equips
bachelors prepared nurses with the comprehension they need to advance nursing as a profession
and produce more competent nurses.
Nurses are the front-line staff that treats patients on a daily basis. In some positions, they
are at a patients bedside around the clock and are the biggest source of information on the
patients condition. They are an advocate for the patients wishes and often serve as
communication between family members and clinical staff.
Nurses are leaders in healthcare and remain the largest group of healthcare workers in our
country. The emergence of advanced practice registered nurses (APRNs) is a testimony to the
progression of the profession and it stresses the importance of continued education. When the
American Nurses Association discusses education in the field of nursing, it states, Education is
a requisite for acquisition of the knowledge, skills, and abilities needed to maintain current, safe,
and effective clinical practice (White & OSullivan (Eds.), 2012, p. 123). Advancements in
medicine occur daily and in order to provide patient with the most up-to-date care, education is a
life-long ongoing process for every member of the nursing profession.

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References
American Nurses Association. (2010). Code of Ethics for Nurses with Interpretive Statements.
Silver Spring, MD: Nursesbooks.org.
American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice (2nd
ed.). Silver Spring, MD: Nursesbooks.org.
Black, B. P. (2014). Professional Nursing: Concepts & Challenges. Chapel Hill, NC: Elsevier.
Flexner, A. (1910). Medical Education in the United States and Canada: A Report to the
Carnegie Foundation for the Advancement of Teaching. Retrieved from
http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.p
df
Gustman, S. (2014). Transition into Professional Nursing [Syllabus]. School of Nursing, Ferris
State University, Big Rapids, MI.
Haverkamp, J.J., & Ball, K. (2013). BSN in 10: What Is Your Opinion? Association of
periOperative Registered Nurses, 98 (2), 144-152.
McKinney, M. (2010). Nurses in charge; Growing number of patient-safety and qualityimprovement initiatives at hospitals are being spearheaded by nurse leaders. Modern
Healthcare, 40 (49), 28.
Quality and Safety Education for Nurses Institute. (2014). Graduate KSAs. Retrieved from
http://qsen.org/competencies/graduate-ksas/
White, K. M., & OSullivan, A. (Eds.). (2012). The Essential Guide to Nursing Practice:
Applying ANAs Scope and Standards in Practice and Education. Silver Spring, MD:
Nursesbooks.org.