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American Nurses Association on Scope and Standards of Nursing Practice

Katie D. VanderVelde
Ferris State University


American Nurses Association on Scope and Standards of Nursing Practice
The American Nurses Association (ANA) established the Nursing Scope and Standards
of Practice (2010) to help guide nurses in their professional skills and responsibilities and follow
state laws and regulations in the practice of nursing. The first six standards relate to the steps of
the nursing process and how the nurse accomplishes each step on the continuum. Standards
seven through sixteen relate to the standards of professional performance. The nurse follows the
Standards of Practice in the nursing process while addressing nursing issues and concerns, like
education, communication, and collaboration (American Nurses Association [ANA], 2010). The
ANAs Code of Ethics for Nurses (2001) has nine provisions in which the first three address the
values and commitments as a nurse, the following three outline the duties as a nurse, and the last
three describe duties with patient care. This paper will evaluate how I have met the standards of
nursing practice and code of ethics, and what standards and provisions I need more practice in.
Nursing Scope and Standards of Practice
Standards of Practice
Assessment. The registered nurse (RN) collects data which plays an important role to
the patients health and situation (ANA, 2010, p.39). In addition, the patient, family, and nurse
are involved is the process of data collection (ANA, 2010). As a student nurse I have met the
standard of being a part of data collection by performing an obstetric (OB) assessment. The
newborn assessment included admission data, reflexes, and physical assessment. One major part
of the admission data was the appearance, pulse, grimace, activity, and respirations (APGAR)
scoring. APGAR provides a compressive overview of the newborn within seconds of being
born. Even if the respirations were not within range, it would be a cause for concern. The

newborn assessment was a way of showing how pertinent each part of an assessment is, which
also included how the family can affect the newborns assessment.
Diagnosis. The registered nurse analyzes the assessment data to determine the
diagnoses or the issues (ANA, 2010, p. 40). This includes identifying risks that can affect the
patients safety which could include the environmental or personal circumstances (ANA, 2010).
As a student nurse, I have analyzed data to define a certain diagnosis and have met this standard.
Through critical thinking summaries two diagnosis were formed for the patient after an
assessment was gathered. For example, a diagnosis was made for acute confusion related to
decreased oxygen supply to the brain. Decreased oxygen supply could lead to other diagnoses;
however my assessment showed that the patients diagnosis was confusion. Determining what
the confusion was related was met through analyzing the assessment data while completing the
critical thinking summary.
Outcomes Identification. The registered nurse identifies expected outcomes for a plan
individualized to the healthcare consumer or the situation (ANA, 2010, p. 41). The expected
outcomes involve risks, costs, and benefits with clinical expertise (ANA, 2010). Identifying
outcomes in the critical thinking summaries are associated with the patients risks and benefits in
the plan of care. I have met this standard by completing several critical thinking summaries in
clinical. Along with each diagnosis an outcome had to be achieved. An outcome for one
specific patient was to demonstrate consistent ability to urinate when desire to void is perceived
or via timed schedule by 4/10/14. The expected outcome needed to be specific, measurable,
attainable, realistic, and timely. Through the critical thinking summaries, having practice to
develop smart goals and outcomes has helped to provide specific outcomes that the patient could

Planning. The RN develops strategies that aid the patient to achieve the expected
outcomes (ANA, 2010). These strategies include planned partnership with the patient or family,
which can include values, beliefs, coping skills, and culture and environment (ANA, 2010). This
standard has been met throughout each clinical rotation by writing the plan down on my chart
sheet and communicating with the patient. Spectrum has chart sheets in each report room that
includes a section on a plan with a column that asked the date for the plan to be achieved. The
sheet was very helpful for remembering the patients plan and making sure that the plan was in
place. The plan for keeping the wound clean and free from infection until wound closure was a
plan set in place for one of the patients. If the plan was not the same on the patients white board
in each room, I would make sure to change it to the most up-to-date plan of care and progress.
Implementation. The RN initiates and implements the plan for the patient efficiently
(ANA, 2010). I have met two sub-standards for the implementation throughout clinical
experience. Coordination of care along with health teaching and health promotion were met
each clinical day. One patient had cellulitis on both of her hands and needed a whirlpool bath
that morning to help heal the infections. Coordination of care was made so that the patient was
able to eat before the bath and all medications, including pain medication, was given before her
scheduled time for the whirlpool. In addition, before the patient left education was given on how
the whirlpool would help clean the cellulitis and new skin could be formed. This helped
tremendously with the patient anxiety of experiencing the whirlpool for the first time.
Consultation and prescription authority/treatment was not met as part of the implantation
standard. A higher level of education, such as an advanced practice RN, would have to meet this
standard in order to provide consultation to effect change (ANA, 2010). In addition, the standard
describes how the advanced practice RN uses prescription authority and treatment (ANA, 2010).

The only way these two sub-standards could be met is if I furthered my education to become an
advanced practice RN.
Evaluation. The RN evaluates and documents the progress the patient has made toward
the desired outcomes, which involves partnership with the patient and effectiveness of strategies
in relation to the patients expected outcomes (ANA, 2010). This standard has been met
throughout my clinical experience. When a patient needed a pain medication I would make sure
to evaluate the pain using a zero to ten pain scale. I would also chart her level of pain along with
the intervention taken. Thirty minutes after the medication was given re-evaluation of the
patients pain was achieved. Evaluating and charting the pain level associated with the pain
medication was an important role towards attaining the outcome on decreased pain.
Standards of Professional Performance
Ethics. The RN practices in an ethical manor and provides care that protects patients
values and beliefs (ANA, 2010). I have met the standard of enabling ethical skills and respect to
others in their beliefs and values. Students have the responsibility to have respect for the patient
in regards to their dignity, autonomy, and confidentiality. Not to mention, keeping the students
values and beliefs aside with respect for the patients culture. One patient who was in the post-
partum unit was Amish and was particular about the foods eaten and electrical devices. While
still advocating for the foods that were more natural and turning the light off in the room was
respected. I also did not judge or try to persuade my beliefs on the patient.
Education. The RN attains knowledge and competence that reflects current nursing
practice (ANA, 2010, p. 56). I have partially met this standard as I have not fully completed my
baccalaureate studies. I have learned much about nursing during pre and post conference and the
nurses I follow. The nursing instructors educated the students on topics such as disease

processes, electrocardiogram changes/rhythms, medications, and blood transfusions. Once I
have finished the program I will be still learning because in nursing there is always new drugs
and disease processes to learn.
Evidence-Based Practice and Research. The RN uses evidence and research findings
to help guide correct practice decisions (ANA, 2010). I have met this standard many times in the
nursing program by completing evidence-based practice (EBP) assignments. In nursing 240 an
EBP was completed on hourly rounds during clinical nursing and in nursing 351 EBP was
completed on family presence during invasive procedures. In addition, clinical practice is
focused on EBP. For instance, one patient had a pressure ulcer on the coccyx. EBP shows that
turning the patient every two hours would help decrease the size of the pressure ulcer and to help
prevent future pressure ulcers. The patient was turned every two hours, which was marked on
the white board the time in which the patient was turned.
Quality of Practice. The RN demonstrates quality practice through being accountable,
responsible, and ethical (ANA, 2010). I have met the standard for quality of practice by
understanding to use quality improvement principles, healthcare policy, and cost effective
strategies to support system side practice improvements in the clinical setting. These
components were part of the weekly evaluation we had to fill out for clinical. One example that
fulfilled quality improvement and policy was starting an intravenous (IV) in the forearm in the
emergency department. Spectrums policy is two attempts before finding another nurse. I did not
get any blood flow on the first attempt and on the second I blew the vein. After the two attempts
the nurse ended up trying. Allowing two attempts for an IV start increases the quality and
decreases cost for Spectrum. Intravenous kits can increase cost, especially if several are done on
the same patient.

Communication. The RN communicates effectively in a variety of formats in all areas
of practice (ANA, 2010, p. 61). This includes contributing nursing perspectives with the
interprofessional team (ANA, 2010). I have met this standard through each clinical practice day.
Each week after our clinical experience a weekly evaluation had to be completed. One of
sections pertained to communicating effectively with the clients, families, and the
interdisciplinary team. More specifically, one clinical day the nurse followed did not know that
the students had to be with either the instructor or nurse to pass medications. The nurse told me
to pass the medications after the patient had breakfast. Kindly, I let the nurse know that I had to
pass medications with the nurse or instructor which was not a problem. While giving the
medication to the patient the drugs name and what it was used for was described to the patient
and any family members in the room.
Leadership. The RN demonstrates leadership in practice by partaking in vision and
goals and engaging in teamwork that helps create a healthy environment (ANA, 2010). I have
not met the standard of being a leader partially because of being a student. The charge nurse or
manager has the ability to oversee nursing care and influence nursing policy, however students
are not in control of this. I believe that in the future the opportunity to be a charge nurse and
leader will be given and more leadership roles will be met. Also, leadership lecture describes
many of the characteristics and steps to becoming a leader which has not been completed. Once
the class is finished I will have a better understanding of what steps to take to become a leader
and role model to others.
Collaboration. The RN collaborates with the patient, family and healthcare team in
order to produce the most positive outcome through nursing practice (ANA, 2010). I have met
this standard in clinical practice by emphasizing the importance of correct communication and

collaboration. During report in the morning I make sure to ask the nurse any questions I may
have and always introduce myself to the patient and family. After report the certified nursing
assistant (CNA), nurse, and I met to talk about what the day looked like, what time lunches were,
and major health barriers and concerns for the patient. Collaboration with the CNA also focused
on when the patient would need help turning and transferring. These aspects were very
important because it helped with time management and the time certain tasks would be one
throughout the day. Collaboration also was important to point out aspects about the patients that
the nurse or student nurse may not have known.
Professional Practice Evaluation. The RN evaluates his/her personal practice by
evaluating the standards, guidelines, and rules and regulations for professional practice (ANA,
2010). I have met this standard my completing and being evaluated on the weekly, formative,
and summative evaluation forms filled out each semester. The clinical instructor looks over the
weekly evaluations to make sure the students are following the standards for professional
practice. A formative evaluation is filled out by the clinical instructor half way through the
semester while the summative is the final evaluation. For each of these evaluations the instructor
makes sure we are ready to move on the next clinical rotation. The summative evaluation is
mostly based on the standards, guidelines, and regulations and how well we accomplished them.
An examples of a category discussed in the evaluation is evaluating professional behaviors that
reflect core values and an interdisciplinary practice.
Resource Utilization. The RN utilizes appropriate resources to plan and provide
nursing services that are safe, effective, and financially responsible (ANA, 2010, p. 67). I have
met this standard through education. Under the Cerner website through the spectrum computers
there is an education section that has much information on the most recent EBP research

findings. During discharge teaching, these are used to provide the patient with safe and effective
ways to handle certain diseases and health problems. For example, a patient who had cellulitis
was leaving against medical advice. It was important to print off the discharge teaching through
the education link to have the most recent research findings on how to keep the infection clean
and free from further injury. The education pamphlets were part of the patient teaching and were
taken home with the patient. Utilizing these resources is very important for education that could
save a patients trip to the hospital again.
Environmental Health. The nurse is conscious about environmental hazards and
practices in a safe and healthy way (ANA, 2010). I have met the standard of practicing safely
that is free of potential hazards. I make sure in clinical practice to always check the bed alarm to
make sure it is on before leaving an at fall risk patients room. I also use a gait belt every time I
walk a patient and use proper body mechanics when transferring patients. In addition the kardex,
or information on the patient, shows if there are any isolation precautions and if so a gown and
gloves is warn. If strict precautions are required, looking up the guidelines on the Spectrum
website is achieved. I also am very aware of washing my hands when walking in and walking
out of each patient room and unit.
Code of Ethics for Nurses
Ethical Standard One.
The first ethical standard states, 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 [ANA], 2001, para. 1). I have met this standard
by being a caring and respectful person. I understand that everyone is different and have their

right to believe and value what they would want. Before entering a patients room knocking on
the door is priority along with introducing myself. Also when taking care of patient I make sure
to respect their race, ethnicity, age, gender, and socioeconomic status.
Ethical Standard Two.
The second ethical standard states, The nurses primary commitment is to the patient,
whether an individual, family, group, or community (ANA, 2001, para. 2). I have met this
standard when putting my own problems aside and focusing strictly on the patient or my nursing
role. When my father was in a snowmobile accident my mind was racing and it was hard to
focus on the patient. However, clinical time is separate from personal issues and total
commitment on the patient was necessary.
Ethical Standard Three.
The third ethical standard states, The nurse promotes, advocates for, and strives to
protect the health, safety, and rights of the patient (ANA, 2001, para. 3). I have met this
standard by holding off on a stool softener after the patient communicated that she was having
frequent loose stools. I advocated for the medication to be held by letting the nurse know and
marking a note on the medication administration computer chart. It was the patients right to
refuse to take the medication because of the frequent stools. However, it was also my
responsibility to keep the patient safe and healthy by not giving the Colace.
Ethical Standard Four.
The fourth ethical standard states, The nurse is responsible and accountable for
individual nursing practice and determines the appropriate delegation of tasks consistent with the
nurses obligation to provide optimum patient care (ANA, 2001, para. 4). I have met this
standard by only giving tasks to the CNA that are appropriate. One patient had medications, a

dressing change, and had a bowel movement all at the same time. The medication and dressing
change was accomplished by the nurse and I, and the bowel movement was delegated to the
CNA with my help. Time management also played a role, because grabbing the medication out
of the pyxis could be done while the bowel movement was being taken care of.
Ethical Standard Five.
The fifth ethical standard states, The nurse owes the same duties to self as to others,
including the responsibility to preserve integrity and safety, to maintain competence, and to
continue personal and professional growth (ANA, 2001, para. 5). I have met this standard by
using proper body mechanics during transferring and taking breaks when feeling dizzy or light
headed. One of the patients was a one person transfer, and I used my knees and kept my back
straight while transferring. In addition while turning a bed rest patient, the CNA was called to
help so that back injuries did not occur. During the same day, I was feeling a light headed and
made sure to take a quick break to sit down and eat something in order to preserve my integrity
and safety.
Ethical Standard Six.
The sixth ethical standard states, The nurse participates in establishing, maintaining, and
improving health care environments and conditions of employment conducive to the provision of
quality health care and consistent with the values of the profession through individual and
collective action (ANA, 2001, para. 6). I have met this standard several times during clinical
practice. For example, when giving wound care and catheter care, I make sure to use sterile
technique. In addition, I use standard precautions by washing my hands while entering and
leaving a patients room. I also use contact isolation when a patient has Clostridium difficile or
Methicillin-resistant Staphylococcus aureus (MRSA). Being a role model to the proper standard

and contact precautions allows others to practice the correct way so that the health care
environment can be improved collectively.
Ethical Standard Seven.
The seventh ethical standard states, The nurse participates in the advancement of the
profession through contributions to practice, education, administration, and knowledge
development (ANA, 2001, para. 7). I have not met this standard because of not having the
opportunity to advance in the practice of nursing. Once I graduate the nursing program,
education and administration may be more realistic. Administration could be an opportunity
once practicing in the medical surgical unit for a couple of years. Skills have been taught on
how to provide contributions to practice, education, and administration of knowledge
development through the leadership class. In addition, finding EBP articles and writing EBP
papers will help prepare myself for administration and education.
Ethical Standard Eight.
The eighth ethical standard states, The nurse collaborates with other health professionals
and the public in promoting community, national, and international efforts to meet health needs
(ANA, 2001, para. 8). I have met this standard during my service learning hours in Guatemala.
Donations were made to the nursing home and clinics in Guatemala for gauze pads and other
health care appliances. In addition, while giving hepatitis A injections education was taught
about proper hand washing. I also helped volunteer at the Stehouwer clinic in Cadillac where
many individuals in poverty came in. Collaborating with the doctor and other nurses there
helped develop ways to meet these patients needs. One example of this was advocating with the
doctor for surgery with patients who had an abscess or mole.


Ethical Standard Nine.
The ninth ethical standard states, The profession of nursing, as represented by
associations and their members, is responsible for articulating nursing values, for maintaining the
integrity of the profession in its practice, and for shaping social policy (ANA, 2001, para. 9). I
have not met this standard due to not being an RN and a part of the professional RN association,
like the American Nurses Association (ANA). Once the opportunity to be a part of a
professional association or organization maintaining integrity and articulating nursing values will
be priority. Clinical practice has shown me what things could be changed or made better, like
being able to clock in a half an hour early to gather key information on the patients before report
Professional Development Plan
In order to achieve and maintain competency in each standard three specific and
measurable goals have to be attained. My first goal is to be a part of an organization or
association that maintains integrity and articulates nursing values, like the ANA, once I graduate
the nursing program and have a career in nursing. The second goal is to work my way up to
administration level after a few years of medical surgical. This way I have a better possibility at
advancement and education in nursing that could lead to policy changes, like staffing and shift
changes. The third goal is to continue to assess and evaluate my leadership skills so that one day
I can successfully be a charge nurse or manager. This way I have more of a opportunity to
oversee nursing care and influence nursing policy.


Action Plan
Even though most of the standards were met, a few standards will have to be fully met.
The first goal regarding the integration and articulation of nursing values through an organization
would need to be persuaded first through a job position. Depending on where I get a job, the
organization or association may vary. Once I find a job, perhaps in psychiatric or OB, the search
for a specific organization may be easier. Each hospital and field of nursing has different
organizations to be a part of. For example, if working in OB I would search for an organization
such as Association of Women's Health, Obstectrics (OB), and Neonatal Nurses (AWHONN). If
I find a job in psychiatrics or mental health, searching for an organization such as the American
Psychiatric Nurses Association would be another step in fulfilling this goal. Once these
associations are found research into what the association is about and their main mission
statement will be needed.
The second goal to work my way up to an administration or manager position would be
to first have some years in the medical surgical unit. After completing the leadership class this
semester more experience and knowledge on the ways become a leader with be beneficial. In
addition, depending on where administration takes place, further education may be necessary.
However, long term care facilities generally are satisfied with a bachelors degree. In addition,
leadership skills will need to be practice, which may be fulfilled with some experience as a
charge nurse in the medical surgical unit.
In relation, the third goal is to assess and evaluate my leadership skills so that one day I
can have an impact in nursing policies and procedures. This may take a few years considering
policy change is a big step in the nursing field. However, the first step is to pass my leadership
class with understanding of how leadership and management skills are accomplished. In

addition, finding resources related to the facility I will be working at will help to understand to
policies at my designation. For example, Spectrums policies and procedures may be different
than Munsons and finding the resources under the facilities websites will be the next step. After
working at my designation, policies that could be changed most likely will be encountered.
Along with experience in the field will bring leadership such as being the charge nurse for the
day or influencing other nurses and staff. Practicing good leadership skills involves being a role
model with procedures and excellent bed-side nursing, which can influence nurses and staff
around me.
Evaluation Plan
In order to evaluate the first goal I will keep a calendar that shows for the week if I have
found an organization or association part or a part of the facility/department upon designation
(See Appendix A). If the calendar shows for the week that the search failed and no organization
nor association was successful, more time the following week will be spent in trying to find a
particular association. The second week will be more detailed and will show each day what
websites or people encountered throughout the search. This way more time is spent in the search
and a better evaluation of where not to go for information will be influential.
Evaluation of the second goal will include steps that will need to be conquered to make
my way up to administration level. For instance a checklist of having experience, around two
years, in the medical surgical unit will be my first step. Having the opportunity to be a charge
nurse will be my second step. If necessary, attending college for further education may be my
third step. A timeline will be made with the steps on it (See Appendix B). Once each step is
accomplished a check mark will be placed and completed.

The third goal will be evaluated by two evaluation plans. The first will be a table that
contains policies and procedures that could be changed at the specific facility in one column.
The other column will contain how the policies could be improved or changed (See Appendix
C). The second component will be a success log that shows for each week how I improved my
leadership skills. This way I can look back on how I have improved my own work and personal
skills to help the patients and staff at the facility.
Reflecting on the nursing standards and ethics has made me realize what I have
accomplished throughout the last year and a half. It has provided me with confidence to able to
conquer critical nursing values, ethics, and standards that were new to me. Each nursing
standard has emphasized critical components in nursing that will be life long and always a part of
my nursing career. It had showed me what areas of nursing can be improved and my strengths
that can be role modeled to others. The goals set in place will help me successfully conquer the
standards that have yet to be completed. A path set in place enables me to accomplish steps
along my nursing career.


American Nurses Association. (2001). Code of ethics for nurses. Silver Spring, MD.
American Nurses Association. (2010). Nursing Scope and Standards of Practice. Silver Spring,


Appendix A

Sunday Monday Tuesday Wednesday Thursday Friday Saturday


Success or
no success?
for org.
search? If

used to find
for org.
search? If
used to find
for org.
search? If
used to find

16 17 18 19 20 21

23 24 25 26 27 28

Appendix B


Appendix C
Name or description of policies and/or
procedures needing changed?
How policies and/or procedures could be
changed? Steps to take?
Ex. Hours of work? Questionnaire to employees, charge nurses
on what hours are beneficial and efficient?
Ex. Census of residents vs. nurses? Develop a plan of action to experience how
many patients nurses can handle. How care
is important with less patients?