The American Nurses Association (ANA) is a national professional

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

8515 Georgia Avenue, Suite 400

Silver Spring, MD 20910-3492

1-800-274-4ANA

http://www.Nursingworld.org

Published by Nursesbooks.org

The Publishing Program of ANA

http://www.Nursesbooks.org

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 copyright@

ana.org.

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

ISBN-13: 978-1-55810-619-2 SAN: 851-3481 07/2015

First printing: July 2015

Overview of the Content • Nursing: Scope and Standards of Practice, 3rd Ed. • xi

Overview of the Content

Essential Documents of Professional Nursing

Registered nurses practicing in the United States have two contemporary pro-

fessional 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

xii • Nursing: Scope and Standards of Practice, 3rd Ed. • Overview of the Content

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 refer-

ence. Legislators, regulators, legal counsel, and the judiciary will also want to

examine this content. In addition, the individuals, families, groups, communi-

ties, and populations using nursing and healthcare services can use this docu-

ment 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 • Nursing: Scope and Standards of Practice, 3rd Ed. • 1

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, allevia-

tion of suffering through the diagnosis and treatment of human response,

and advocacy in the care of individuals, families, groups, communities,

and populations.

This definition serves as the foundation for the following expanded descrip-

tions of the Scope of Nursing Practice and the Standards of Professional

Nursing Practice.

Professional Nursing’s Scope and Standards of Practice

A professional organization has a responsibility to its members and to the

public it serves to develop the scope and standards of practice for its profes-

sion. The American Nurses Association (ANA), the professional organization

for all registered nurses, has long assumed the responsibility for developing

and maintaining the scope of practice statement and standards that apply to

the practice of all professional nurses and also serve as a template for evalua-

tion of nursing specialty practice. Both the scope and standards do, however,

belong to the profession and thus require broad input into their development

and revision. Nursing: Scope and Standards of Practice, Third Edition describes

a competent level of nursing practice and professional performance common

to all registered nurses.

2 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

Description of the Scope of Nursing Practice

The Scope of Nursing Practice describes the “who,” “what,” “where,” “when,”

“why,” and “how” of nursing practice. Each of these questions must be answered

to provide a complete picture of the dynamic and complex practice of nursing

and its evolving boundaries and membership. The definition of nursing pro-

vides a succinct characterization of the “what” of nursing. Registered nurses

and advanced practice registered nurses comprise the “who” constituency and

have been educated, titled, and maintain active licensure to practice nursing.

Nursing occurs “when”ever 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 characterized as nursing’s response to the changing needs of society

to achieve positive healthcare consumer outcomes in keeping with nursing’s

social contract with an obligation to society. The depth and breadth in which

individual registered nurses and advanced practice registered nurses engage in

the total scope of nursing practice is dependent on their education, experience,

role, and the population served.

These definitions are provided to promote clarity and understanding for all

readers:

Healthcare consumers are the patients, persons, clients, families, groups, com-

munities, or populations who are the focus of attention and to whom the regis-

tered nurse is providing services as sanctioned by the state regulatory bodies.

This more global term is intended to reflect a proactive focus on health and

wellness care, rather than a reactive perspective to disease and illness.

Registered nurses (RNs) are individuals who are educationally prepared and

licensed by a state, commonwealth, territory, government, or regulatory body

to practice as a registered nurse. “Nurse” and “professional nurse” are syn-

onyms for a registered nurse in this document.

Graduate-level prepared registered nurses are registered nurses prepared at the

master’s or doctoral educational level; have advanced knowledge, skills, abil-

ities, and judgment; function in an advanced level as designated by elements

of the nurse’s position; and are not required to have additional regulatory

oversight.

Advanced practice registered nurses (APRNs) are registered nurses:

• Who have completed an accredited graduate-level education pro-

gram preparing the nurse for one of the four recognized APRN

roles [certified registered nurse anesthetist (CRNA), certified nurse

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 3

midwife (CNM), clinical nurse specialist (CNS), or certified nurse

practitioner (CNP)];

• Who have passed a national certification examination that measures

APRN-, role-, and population-focused competencies and maintain

continued competence as evidenced by recertification in the role

and population through the national certification program;

• Who have acquired advanced clinical knowledge and skills prepar-

ing the nurse to provide direct care to patients, as well as a compo-

nent of indirect care; however, the defining factor for all APRNs is

that a significant component of the education and practice focuses

on direct care of individuals;

• Whose practices build on the competencies of registered nurses

(RNs) by demonstrating a greater depth and breadth of knowledge,

a greater synthesis of data, increased complexity of skills and inter-

ventions, and greater role autonomy;

• Who are educationally prepared to assume responsibility and

accountability for health promotion and/or maintenance as well as

the assessment, diagnosis, and management of patient problems,

which includes the use and prescription of pharmacologic and

non-pharmacologic interventions;

• Who have clinical experience of sufficient depth and breadth to

reflect the intended license; and

• Who have obtained a license to practice as an APRN in one of the

four APRN roles: certified registered nurse anesthetist (CRNA), certi-

fied nurse midwife (CNM), clinical nurse specialist (CNS), or certified

nurse practitioner (CNP) (APRN Joint Dialogue Group, 2008).

Development and Function of the Standards of Professional Nursing Practice

The Scope of Practice Statement is accompanied by the Standards of

Professional Nursing Practice. The standards are authoritative statements of

the duties that all registered nurses, regardless of role, population, or specialty,

are expected to perform competently. The standards published herein may

serve as evidence of the standard of care, with the understanding that applica-

tion of the standards depends on context. The standards are subject to change

with the dynamics of the nursing profession, as new patterns of professional

practice are developed and accepted by the nursing profession and the public.

In addition, specific conditions and clinical circumstances may also affect the

application of the standards at a given time, e.g., during a natural disaster or

epidemic. As with the scope of practice statement, the standards are subject to

formal, periodic review, and revision.

4 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

The Standards of Professional Nursing Practice consist of the Standards of

Practice and the Standards of Professional Performance.

Standards of Practice

The Standards of Practice describe a competent level of nursing care as

demonstrated by the critical thinking model known as the nursing process.

The nursing process includes the components of assessment, diagnosis, out-

comes identification, planning, implementation, and evaluation. Accordingly,

the nursing process encompasses significant actions taken by registered nurses

and forms the foundation of the nurse’s decision-making.

Standard 1. Assessment

The registered nurse collects pertinent data and information relative to the

healthcare consumer’s health or the situation.

Standard 2. Diagnosis

The registered nurse analyzes the assessment data to determine actual or

potential diagnoses, problems, and issues.

Standard 3. Outcomes Identification

The registered nurse identifies expected outcomes for a plan individualized to

the healthcare consumer or the situation.

Standard 4. Planning

The registered nurse develops a plan that prescribes strategies to attain

expected, measurable outcomes.

Standard 5. Implementation

The registered nurse implements the identified plan.

Standard 5A. Coordination of Care

The registered nurse coordinates care delivery.

Standard 5B. Health Teaching and Health Promotion

The registered nurse employs strategies to promote health and a safe

environment.

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 5

Standard 6. Evaluation

The registered nurse evaluates progress toward attainment of goals and

outcomes.

Standards of Professional Performance

The Standards of Professional Performance describe a competent level of

behavior in the professional role, including activities related to ethics, cultur-

ally congruent practice, communication, collaboration, leadership, education,

evidence-based practice and research, quality of practice, professional practice

evaluation, resource utilization, and environmental health. All registered nurses

are expected to engage in professional role activities, including leadership,

appropriate to their education and position. Registered nurses are accountable

for their professional actions to themselves, their healthcare consumers, their

peers, and ultimately to society.

Standard 7. Ethics

The registered nurse practices ethically.

Standard 8. Culturally Congruent Practice

The registered nurse practices in a manner that is congruent with cultural

diversity and inclusion principles.

Standard 9. Communication

The registered nurse communicates effectively in all areas of practice.

Standard 10. Collaboration

The registered nurse collaborates with healthcare consumer and other key

stakeholders in the conduct of nursing practice.

Standard 11. Leadership

The registered nurse leads within the professional practice setting and the

profession.

Standard 12. Education

The registered nurse seeks knowledge and competence that reflects current

nursing practice and promotes futuristic thinking.

6 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

Standard 13. Evidence-based Practice and Research

The registered nurse integrates evidence and research findings into practice.

Standard 14. Quality of Practice

The registered nurse contributes to quality nursing practice.

Standard 15. Professional Practice Evaluation

The registered nurse evaluates one’s own and others’ nursing practice.

Standard 16. Resource Utilization

The registered nurse utilizes appropriate resources to plan, provide, and sustain

evidence-based nursing services that are safe, effective, and fiscally responsible.

Standard 17. Environmental Health

The registered nurse practices in an environmentally safe and healthy manner.

The Function of Competencies in Standards

The competencies that accompany each standard may be evidence of demon-

strated compliance with the corresponding standard. The list of competen-

cies is not exhaustive. Whether a particular standard or competency applies

depends upon the circumstances. For example, a nurse providing treatment to

an unconscious, critical healthcare consumer who presented to the hospital by

ambulance without family has a duty to collect comprehensive data pertinent

to the healthcare consumer’s health (Standard 1. Assessment). However, under

the attendant circumstances, that nurse may not be expected “to assess family

dynamics and impact on the healthcare consumer’s health and wellness” (one

of Starndard 1’s competencies). In the same instance, Standard 5B. Health

Teaching and Health Promotion might not apply at all.

Integrating the Art and Science of Nursing

Nursing is a learned profession built on a core body of knowledge that reflects

its dual components of art and science. Nursing requires judgment and skill

based on principles of the biological, physical, behavioral, and social sciences.

Registered nurses employ critical thinking to integrate objective data with

knowledge gained from an assessment of the subjective experiences of health-

care consumers. Registered nurses use critical thinking to apply the best avail-

able evidence and research data to diagnosis and treatment decisions. Nurses

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 7

continually evaluate quality and effectiveness of nursing practice and seek to

optimize outcomes.

Nursing promotes the delivery of holistic consumer-centered care and opti-

mal health outcomes throughout the lifespan and across the health–illness

continuum within an environmental context that encompasses culture, ethics,

law, politics, economics, access to healthcare resources, and competing priori-

ties. Similarly, nursing promotes the health of communities by using advocacy

for social and environmental justice, community engagement, and access to

high-quality and equitable health care to maximize population health outcomes

and minimize health disparities. Nursing advocates for the well-being, comfort,

dignity, and humanity of all individuals, families, groups, communities, and

populations. Nursing focuses on healthcare consumer and interprofessional

collaboration, sharing of knowledge, scientific discovery, and social welfare.

The What and How of Nursing

What Is Nursing?

What is nursing? 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, and advocacy in the care of individuals, families,

groups, communities, and populations. This succinct but very powerful

definition statement (see p. 11) reflects the evolution of the profession. The

integration of the art and science of nursing is described in the following

detailed scope and standards of practice content.

Nursing is a learned profession built on a core body of knowledge that

reflects its dual components of art and science. Nursing requires judgment

and skill based on principles of the biological, physical, behavioral, and social

sciences.

Tenets Characteristic of Nursing Practice

The conduct of nursing practice in all settings also can be characterized by

the following tenets that are reflected in language that threads throughout

the scope of practice statement and standards of practice and professional

performance.

1. Caring and health are central to the practice of the registered nurse.

Professional nursing promotes healing and health in a way that

builds a relationship between nurse and patient (Watson, 2008,

2012). “Caring is a conscious judgment that manifests itself

in concrete acts, interpersonally, verbally, and nonverbally”

8 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

(Gallagher-Lepak & Kubsch, 2009, p. 171). While caring for indi-

viduals, families, groups, and populations is the key focus of nursing,

the nurse additionally promotes self-care as well as care of the envi-

ronment and society (Hagerty, Lynch-Sauer, Patusky, & Bouwseman,

1993; ANA, 2015).

2. Nursing practice is individualized.

Nursing practice respects diversity and focuses on identifying and

meeting the unique needs of the healthcare consumer or situation.

Healthcare consumer is defined to be the patient, person, client, fam-

ily, group, community, or population who is the focus of attention

and to whom the registered nurse is providing services as sanctioned

by the state regulatory bodies.

3. Registered nurses use the nursing process to plan and provide individu-

alized care for healthcare consumers.

The nursing process is cyclical and dynamic, interpersonal and col-

laborative, and universally applicable. Nurses use theoretical and

evidence-based knowledge of human experiences and responses to

collaborate with healthcare consumers to assess, diagnose, identify

outcomes, plan, implement, and evaluate care that has been individ-

ualized to achieve the best outcomes. Nursing actions are intended

to produce beneficial effects, contribute to quality outcomes, and

above all, “do no harm.” Nurses evaluate the effectiveness of care

in relation to identified outcomes and use evidence-based practice

to improve care. Critical thinking underlies each step of the nursing

process, problem-solving, and decision-making.

4. Nurses coordinate care by establishing partnerships.

The registered nurse establishes partnerships with persons, fami-

lies, groups, support systems, and other providers, utilizing effective

in-person and electronic communications, to reach a shared goal of

delivering safe, quality health care to address the health needs of the

healthcare consumer and the public. The registered nurse is respon-

sible and accountable for communicating and advocating for the

planning and care coordination focused on the healthcare consumer,

families, and support systems (ANA, 2013a). Collaborative interpro-

fessional team planning is based on recognition of each individual

profession’s value and contributions, mutual trust, respect, open dis-

cussion, and shared decision-making.

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 9

5. A strong link exists between the professional work environment and the

registered nurse’s ability to provide quality health care and achieve opti-

mal outcomes.

Professional nurses have an ethical obligation to maintain and

improve healthcare practice environments conducive to the pro-

vision of quality health care (ANA, 2015). Extensive studies have

demonstrated the relationship between effective nursing practice

and the presence of a healthy work environment. Mounting evi-

dence demonstrates that negative, demoralizing, and unsafe condi-

tions in the workplace (unhealthy work environments) contribute to

errors, ineffective delivery of care, workplace conflict and stress, and

moral distress.

The How of Nursing

The “how” of nursing practice is defined as the ways, means, methods, processes,

and manner by which the registered nurse practices professionally. The ways

in which registered nurses practice reflect integration of the five core practice

competencies of all healthcare professionals: healthcare consumer-centered

practice, evidence-based practice, interprofessional collaboration, use of infor-

matics, and continuous quality improvement (Institute of Medicine, 2003).

Registered nurses recognize that using a holistic approach prevents omission

of relevant data when implementing the nursing process. When incorporat-

ing a healthcare consumer-centered approach, the registered nurse collaborates

with and treats all healthcare consumers with the utmost respect. The reg-

istered nurse demonstrates culturally congruent practice, always advocating

that healthcare consumers have sufficient information and questions answered,

enabling them to exercise their autonomy to make the final decisions regarding

their preferred care.

To achieve the best healthcare consumer outcomes, the “how” requires the

registered nurse to employ evidence-based practice as a means to incorporate

the best available evidence, healthcare consumer preferences, provider exper-

tise, and contextual resources in which nursing is delivered. Closely linked to

the best healthcare consumer outcomes is the need for effective interprofes-

sional collaboration. Thus, an essential component of the “how” of registered

nursing is care coordination (ANA, 2013a), requiring effective communica-

tions by all stakeholders.

Additionally, the “how” of registered nursing practice encompasses methods

such as communicating predictably and comprehensively using approaches

such as informatics, electronic health records, and established processes to pre-

vent errors. Methods can include situation, background, assessment, recommen-

dation (SBAR) (The Joint Commission Enterprise, 2012) and TeamSTEPPS

10 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

as evidence-based methods of building teamwork and communication skills

(Department of Defense 2014; Agency for Healthcare Research and Quality,

n.d.).

Critical to the practice of professional nursing is ethical conduct of research

to generate new knowledge and translate that knowledge to practice using

theory-driven approaches (Estabrooks, Thompson, Lovely, & Hofmeyer, 2006).

Finally, the “how” of registered nursing practice reflects the manner in which

the registered nurse practices according to the Code of Ethics for Nurses with

Interpretive Statements, standards for professional nursing practice, institutional

review boards’ protocols, and directives of other governing and regulatory

bodies that guide the conduct of professional nursing practice.

These activities reflect nursing’s long-standing commitment to its responsibil-

ities to the society out of which it grew and continues to serve. Such a profes-

sional relationship and associated expectations and contributions toward the

evolution of a health-oriented system of care were first formally articulated in

the 1980 Nursing: A Social Policy Statement. Later editions of the social policy

statement in 1995, 2003, and 2010 confirmed the importance of nurse–

healthcare consumer partnerships; healthcare consumers’ decision-making,

accountability, and responsibility of choice; and the necessary focus on health-

care consumer-centered care and outcomes.

Nursing’s Social Policy Statement: The Essence of the Profession identifies the

following statements that undergird professional nursing’s social contract with

society (ANA, 2010b, p. 6):

• Humans manifest an essential unity of mind, body, and spirit.

• Human experience is contextually and culturally defined.

• Health and illness are human experiences. The presence of

illness does not preclude health, nor does optimal health pre-

clude illness.

• The relationship between the nurse and patient occurs within

the context of the values and beliefs of the patient and nurse.

• Public policy and the healthcare delivery system influence

the health and well-being of society and professional nursing.

• Individual responsibility and interprofessional involvement

are essential.

Consult Appendix B, Nursing’s Social Policy Statement for discussion of

other content important to understanding the societal context related to the

decision-making and conduct of professional nursing practice.

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 11

The Art of Nursing

The art of nursing is based on caring and respect for human dignity. A com-

passionate approach to patient care carries a mandate to provide care com-

petently. Such competent care is provided and accomplished through both

independent practice and partnerships. Collaboration may be with individuals

seeking support or assistance with their healthcare needs, interprofessional

colleagues, and other stakeholders.

The art of nursing embraces spirituality, healing, empathy, mutual respect,

and compassion. These intangible aspects promote health. Nursing embraces

healing. Healing is fostered by helping, listening, mentoring, coaching, teach-

ing, exploring, being present, supporting, touching, intuition, service, cultural

competence, tolerance, acceptance, nurturing, mutually creating, and conflict

resolution.

Nursing focuses on the protection, promotion, and optimization of health

and quality of life; prevention or resolution of disease, illness, or disability;

facilitation of healing, alleviation of suffering; and transition to a dignified and

peaceful death. Nursing needs are identified from a holistic perspective and

are met in the context of a culturally sensitive, caring, personal relationship.

Nursing includes the diagnosis and treatment of human responses to actual or

potential health problems. Registered nurses employ practices that are promo-

tive, supportive, and restorative in nature.

Care and Caring in Nursing Practice

The act of caring is foundational to the practice of nursing: “A great truth, the

act of caring is the first step in the power to heal” (Moffitt, 2004, p. 23). Watson

(2012), in her Human Caring Science Theory, emphasizes the personal relation-

ship between patient and nurse; highlights the role of the nurse in defining the

patient as a unique human being to be valued, respected, nurtured, under-

stood, assisted; and stresses the importance of the connections between the

nurse and patient. Human care and caring is viewed as the moral ideal of nurs-

ing consisting of human-to-human attempts to protect, enhance, and preserve

humanity and human dignity, integrity, and wholeness by assisting a person

to find meaning in illness, suffering, pain, and existence. Human caring helps

another gain self-knowledge, self-control, self-caring, and self-healing so that

a sense of inner harmony is restored regardless of the external circumstances.

Human caring is not just an emotion, concern, attitude, or benevolent desire.

It involves values, knowledge, caring actions, acceptance of consequences,

a will, and a commitment to care. Human caring is related to intersubjec-

tive human responses to health-illness-healing conditions; a knowledge of

health-illness, environmental-personal relations, and the nurse caring process;

and self-knowledge in relation to both strengths and limitations. Human caring

12 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

follows a process consisting of antecedents, attributes, and outcomes of caring,

which go on to affect future encounters of caring.

This process includes the care recipient and the nurse, both of whom are

required in a human caring relationship. The nurse must possess competence,

professional maturity, interpersonal sensitivity, a moral foundation that sup-

ports caring actions, and access to a setting that is conducive to caring, while

the care recipient must possess a need for and openness to caring. When

combined, these antecedents can produce an intimate relationship between the

care recipient and the nurse in which caring can occur to improve the physical

and mental well-being of the healthcare consumer and feelings of satisfaction

and renewal for the nurse.

In a caring relationship, the nurse utilizes well-honed assessment skills based

on insight garnered through interpersonal sensitivity to accurately identify

nuances and help find meaning in the care recipient’s situation. Interventions

that reflect a caring consciousness may require creativity and daring, but can

also be demonstrated in simple gestures of interpersonal connection, such as

attentive listening, touching, and making eye contact, and sensitivity to cultural

meanings associated with caring behaviors (Finfgeld-Connett, 2007).

Caring is

• Grounded in ethics, beginning with respect for the autonomy of the

care recipient,

• Grounded, as a science, in nursing, but is not limited to nursing,

• An attribute that may be taught, modeled, learned, mastered,

• Capable of being measured and analyzed scientifically,

• The subject of study within caring science institutes/academies

worldwide, and

• Central to relationships that lead to effective healing, cure, and/or

actualization of human potential.

The caring embraced by nursing and described here does not compete with

nor is it diminished by technological advances, individual or group wealth or

its absence, professional or socioeconomic status or prestige or its lack, or any

other parameter that attempts to categorize the place of the person in society.

The act of caring, as well as the theory and science of caring, is all-inclusive:

The nursing profession has an ethical and social responsibility to

both individuals and society to sustain human caring in instances

where it is threatened, and to be the guardian of human caring,

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 13

individually and collectively, serving as the vanguard of society’s

human caring needs now and in the future. If nursing does not fulfill

its societal mandate for sustaining human caring, preserving human

dignity and humanness in self, systems, and society, it will not be

carrying out its covenant to humankind and its reason for existence

as a profession. (Watson, 2012, p. 42)

Cultural Components of Care

Leininger (1988) considered care for people from a broad range of cultures

and contributed to the unique body of nursing knowledge by translating and

integrating transcultural precepts from the field of anthropology into nurs-

ing science. She provided nursing with a global context, specifically exposing

nursing to worldly cultures and learned behaviors, beyond those encountered

within a dominant culture. Transcultural literacy has deepened nursing’s holis-

tic approach by providing a framework to better understand and provide care

to culturally diverse individuals, groups, and communities.

The Science of Nursing

Nurses as scientists rely on qualitative and quantitative evidence to guide pol-

icies and practices, but also as a way of identifying the nurses’ impact on

the health outcomes of healthcare consumers. When describing how nurses

complete professional thinking and activities, the nursing process emerges as a

commonly used analytical critical thinking framework.

The nursing process is conceptualized as a cyclic, iterative, and dynamic

process including assessment, diagnosis, outcomes identification, planning,

implementation, and evaluation. The nursing process supports evidence-based

practice and relies heavily on the bidirectional feedback loops between com-

ponents, as illustrated in Figure 1. The hexagon delineates the six steps of the

nursing process beginning with assessment at the 12 o’clock position, followed

clockwise with diagnosis, outcomes identification, planning, implementation,

and evaluation. Note the iterative actions reflected with bidirectional arrows.

The Standards of Practice included in the first ring coincide with the steps

of the nursing process to represent the directive nature of the standards as the

professional nurse completes each component of the nursing process. Similarly,

the surrounding Standards of Professional Performance identified in the out-

ermost ring reflect how the professional nurse adheres to the Standards of

Practice, completes the nursing process, and addresses other nursing practice

issues and concerns.

14 • Nursing: Scope and Standards of Practice, 3rd Ed. • Scope of Nursing Practice

FIGURE 1. The Nursing Process and the

Standards of Professional Nusing Practice

(

–

)

= Feedback loop

N u r s i n g

P r o ce s s

N u r s i n g

P r o ce s s

N u r s i n g

P r o ce s s

N u r s i n g

P r o ce s s

N u r s i n g

P r o ce s s

N u r s i n g

P r o ce s s

ﬁ

Scope of Nursing Practice • Nursing: Scope and Standards of Practice, 3rd Ed. • 15

The Standards of Practice

These standards describe a competent level of nursing practice demonstrated

by the critical thinking model known as the nursing process; its six compo-

nents correspond to these standards.

Standard Nursing Process Component

Standard 1 Assessment

Standard 2 Diagnosis

Standard 3 Outcomes Identification

Standard 4 Planning

Standard 5 Implementation

Standard 6 Evaluation

The Standards of Professional Performance

These standards describe a competent level of behavior in the professional

role appropriate to their education and position.

Standard 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