Step 2 Realize that what may be common practice (e.g., “We’ve always done it this way”) may not necessarily be legal or in the best interests of the patient. For example: suppose a highly experienced LPN has been allowed to perform physical assessments independent of, and without collaboration with, an RN. This has been going on for years. However, in some states, this is beyond the legal scope of practice for LPNs. An RN who continues to delegate this action to LPNs is accountable for this illegal practice. Delegating tasks outside the scope of practice can be potential grounds for disciplinary action against both the LPN who performed the assessment and the RN who inappropriately delegated the task. It may also be the basis for a malpractice lawsuit if a patient is harmed as a result of such an Determine if the action taken is one that a reasonably prudent nurse with similar education, training, and experience would do; if a valid order for the task has been written by a physician, physician assistant, or APRN; and if the nurse in question has demonstrated competency in the skill and behavior required and has documentation of such competency. For example: Suppose a nurse is asked to counsel a patient regarding action. Step 3
pregnancy prevention. This patient has received a diagnosis of schizophrenia and is not currently controlled with antipsychotic medication. The nurse has not worked with patients with schizophrenia and is unsure how to assess comprehension or how to adequately communicate with this patient. Nurse colleagues say, “Just do the best you can.” What should the nurse do? In this situation, the nurse must seek help from a supervisor or another appropriate source of assistance such as a mental health specialist. Lack of competency in working with mental health patients is as much a concern as if they were asked to perform a specific motor skill procedure with which they are unfamiliar. Nursing consideration: All nurses must be sure to act within their scope of practice and within their experience and training. If nurses are asked to do something that is within the legal scope of their nursing practice, but their training and experience have not prepared them to perform this action safely and competently, they should not do it (Wacko Guido, 2020). They should seek help from a nurse who can safely and competently perform the action. They also need to seek training opportunities so that they can achieve competency in performing new procedures.
STANDARDS OF PROFESSIONAL NURSING PRACTICE
competently regardless of the setting of their practice or their specialty. Nursing consideration: Professional nursing associations such as the American Association of Critical Care Nurses have developed scope and standards of practice pertaining to their respective specialties. Such standards generally build upon the ANA’s Nursing Scope and Standards of Practice. Nurses must be aware of such scope and standards and practice within their respective specialties.
The standards of professional nursing practice focus on facilitating the delivery of safe and effective nursing care. Most, if not all, state boards of nursing describe standards and scope of practice related to their nurse practice acts. But what exactly are standards of professional nursing practice? Standards of professional nursing practice consist of the critical thinking model referred to as the nursing process and the ANA’s Standards of Professional Performance. The standards for professional nursing practice describe those duties and responsibilities that all RNs must be able to fulfill safely and
ANA STANDARDS OF PROFESSIONAL NURSING PRACTICE
The following is a summary of the highlights of the ANA Standards of Practice (American Nurses Association, 2021). Note that this is only a brief summary. Nurses should access the ANA website for further information on obtaining a copy of Nursing: Scope and Standards of Practice (4th ed.) at http://www. nursingworld.org/ identifies enhancements and barriers to effective communication based on personal, cognitive, physiological, psychosocial, literacy, financial, and cultural considerations. The nurse engages the healthcare consumer, family, significant others, and interprofessional team members in holistic, culturally sensitive data collection and integrates knowledge from current local, regional, national, and global health initiatives and environmental factors into the assessment process (ANA, 2021a, Kindle Location 1773-1780). strengths and abilities, including but not limited to support systems, health literacy, and engagement in self-care. The nurse then verifies the diagnoses, problems, and issues with the healthcare consumer and interprofessional colleagues and prioritizes diagnoses, problems, and issues based on mutually established goals to meet the needs of the healthcare consumer across the health–illness continuum and the care continuum. Nurses document diagnoses, problems, strengths, and issues in a manner that facilitates the development of the expected outcomes and collaborative plan (ANA, 2021a., Kindle Location 1831-1833).
The Standards of Professional Nursing Practice are “authoritative statements of duties that all registered nurses, regardless of role, population, or specialty are expected to perform competently.” These standards are subject to formal, periodic review and revision. Competencies, which may be evidence of standard compliance, accompany each standard (American Nurses Association, 2021a). Standard 1: Assessment “The registered nurse collects pertinent data and information relative to the healthcare consumer’s health or the situation.” Competencies related to this standard focus on methods of data collection, including the incorporation of physical, psychosocial, environmental, emotional, cognitive, sexual, cultural, age-related, spiritual, and economic factors and engages interprofessional team members in data collection collaboration. The nurse also assesses the impact of family dynamics on the healthcare consumer’s health and wellness and Standard 2: Diagnosis “The registered nurse analyzes assessment data to determine actual or potential diagnoses, problems, and issues.” The diagnosis standard competencies focus on using assessment data to identify and prioritize nursing diagnoses (not medical diagnoses). The nurse will identify actual or potential risks to the healthcare consumer’s health and safety or barriers to health, which may include but are not limited to, interpersonal, systematic, cultural, socioeconomic, or environmental circumstances. The nurse also uses assessment data, standardized classification systems, technology, and clinical decision support tools to articulate actual or potential diagnoses, problems, and issues. They identify the healthcare consumer’s
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