Posted inCardiagtech

Scope of Practice: An Introduction for Nurses

No Comments

Learning Objectives

  • Discuss the nursing scope of practice and standards of care.
  • Compare various settings in which nurses practice.
  • Describe the contributions of interprofessional healthcare team members.
  • Describe levels of nursing education and the NCLEX examination.
  • Discuss basic legal and ethical considerations in nursing.
  • Outline professional nursing organizations.
  • Examine quality and evidence-based practice in nursing.

As you embark on your nursing journey, you may ask, “What exactly is the scope of practice, and how does it apply to my nursing career?” Scope of practice refers to the services that a trained healthcare professional is considered competent to perform and authorized to undertake, as defined by their professional nursing license. [1] The nursing scope of practice establishes a framework and structured guidelines for the activities nurses can perform based on their licensure. For nurses and nursing students alike, it is crucial to continuously consider: While an employer may request a task, is performing this task within my scope of practice, or could it potentially jeopardize my nursing license?

Furthermore, nurses are obligated to adhere to legal standards in the delivery of nursing care. These standards are established by several bodies, including the American Nurses Association (ANA), individual state Nurse Practice Acts, healthcare facility policies and procedures, and federal regulatory agencies. These standards are in place to ensure the public receives safe and competent care.

This chapter will provide a foundational understanding of the core concepts surrounding nursing scope of practice and standards of care.

References

  1. American Nurses Association. (n.d.). Scope of practice. Retrieved from https://www.nursingworld.org/practice-policy/scope-of-practice/

History and Foundations of Nursing Practice

A Brief History of Nursing

Before delving into the specifics of nursing scope and standards, understanding the historical roots of the profession is beneficial. Florence Nightingale is widely recognized as the founder of modern nursing. In 1860, she established the first formal nursing school worldwide, advocating for nurses as a professional, educated workforce dedicated to caring for the sick. [1] See Figure 1.1 for a portrait of Florence Nightingale. [2]

Florence Nightingale’s pivotal contributions to healthcare began during the Crimean War in 1854. Her team observed substandard healthcare for wounded soldiers, delivered by overworked staff in unsanitary conditions. Nightingale meticulously documented hospital mortality rates and developed statistical models demonstrating that out of every 1,000 injured soldiers, 600 deaths were attributed to preventable communicable and infectious diseases. Nightingale’s nursing interventions were remarkably straightforward, emphasizing a clean environment, pure water, and nutritious food to promote healing, including providing fruit as part of the soldiers’ diets. These simple measures dramatically reduced the mortality rate from 60% to 2.2%.

In 1859, Nightingale authored “Notes on Nursing,” which became the cornerstone of the Nightingale School of Nursing’s curriculum. She championed the importance of placing patients in environments conducive to healing and recovery, distinguishing this knowledge from medical knowledge. Her emphasis on the therapeutic value of the environment laid the groundwork for many principles still applied in modern healthcare settings. Nightingale also stressed the significance of building trusting relationships with patients and believed in the therapeutic power of a nurse’s presence. She promoted confidentiality, stating that a nurse “should never answer questions about her sick except to those who have a right to ask them.” [3] These foundational concepts established the basis of nursing practice as we know it today.

Figure 1.1 Florence Nightingale

Modern nursing has evolved considerably alongside advancements in healthcare over the past 160 years. With over four million professionals, nursing constitutes the largest segment of the healthcare workforce in the United States. The scope of nursing practice is broad, encompassing health promotion, disease prevention, care coordination, and palliative care when curative treatment is not possible. Nurses directly impact patient outcomes, performing the majority of patient assessments, evaluations, and care in various settings, including hospitals, nursing homes, clinics, schools, workplaces, and ambulatory centers. They are at the forefront of ensuring patient care is safe, effective, and compassionate. Furthermore, nurses address patients and their families holistically, recognizing not only physical health needs but also social, mental, emotional, and spiritual well-being. [4]

The American Nurses Association (ANA)

Established in 1896, the American Nurses Association (ANA) is a national professional nursing organization representing nurses across all 50 states. The ANA advocates for nurses’ interests while promoting improved healthcare for all. The ANA’s mission is to “lead the profession to shape the future of nursing and health care.” [5] The ANA aims to advance the nursing profession by:

  • Fostering high standards of nursing practice.
  • Promoting a safe and ethical work environment.
  • Supporting the health and wellness of nurses.
  • Advocating for healthcare issues affecting nurses and the public. [6]

The ANA establishes numerous standards of care for professional nurses, which will be further explored in the subsequent section.

Learn More About the American Nurses Association

For more information, visit the American Nurses Association website.

Watch: Discover the American Nurses Association

Watch the video Discover the American Nurses Association to learn more. [7]

References

  1. Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4(2), e29475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/
  2. Hering, Henry (1814-1893). Florence Nightingale (H Hering NPG x82368).jpg. https://commons.wikimedia.org/wiki/File:FlorenceNightingale(H_Hering_NPG_x82368).jpg.
  3. Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4(2), e29475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/
  4. Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK209880/
  5. American Nurses Association. (n.d.). About ANA. Retrieved from https://www.nursingworld.org/ana/about-ana/
  6. American Nurses Association. (n.d.). About ANA. Retrieved from https://www.nursingworld.org/ana/about-ana/
  7. American Nurses Association. (2010, May 14). Discover the American Nurses Association (ANA) [Video]. YouTube. https://youtu.be/PRwPhOjeqL4

Regulations and Standards in Nursing

Nursing standards are established by various organizations, including the American Nurses Association (ANA), state Nurse Practice Acts, healthcare agency policies, federal regulators, and other professional nursing bodies. These standards are crucial for ensuring safe and competent patient care.

ANA Scope and Standards of Practice

The American Nurses Association (ANA) provides two key resources that define standards and guide professional nursing practice in the United States: The Code of Ethics for Nurses and Nursing: Scope and Standards of Practice. The Code of Ethics for Nurses provides an ethical framework for nursing practice across all roles, levels, and settings, further discussed in the “Legal Considerations and Ethics” section of this chapter. Nursing: Scope and Standards of Practice outlines a professional nurse’s scope of practice, addressing the who, what, where, when, why, and how of nursing. It also establishes 18 standards of professional practice expected of all registered nurses. [1]

The “who” in nursing practice are educated and licensed nurses actively practicing nursing. The “what” of nursing is defined as: “Nursing integrates the art and science of caring, focusing on the protection, promotion, and optimization of health and human functioning; preventing illness and injury; facilitating healing; and alleviating suffering through compassionate presence. Nursing encompasses the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations, acknowledging the interconnectedness of humanity.” [2] In essence, nurses address human responses to health issues and life processes, advocating for patient care.

Nursing practice occurs “when” nursing knowledge, wisdom, caring, leadership, practice, or education are needed, anytime, anywhere. The “where” encompasses any environment where a healthcare consumer requires care, information, or advocacy. The “why” of nursing practice is rooted in nursing’s response to society’s evolving needs, aiming for positive healthcare outcomes aligned with nursing’s social contract and societal obligation. The “how” of nursing practice involves the methods and approaches nurses use to practice professionally. [3] The ANA further delineates the “how” through its standards of practice, divided into the Standards of Professional Nursing Practice and the Standards of Professional Performance.

The Standards of Professional Nursing Practice are “authoritative statements describing the actions and behaviors expected of all registered nurses, regardless of their role, population, specialty, or setting.” [4] These standards define competent nursing practice based on the critical thinking model of the nursing process, comprising assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. [5] Each of these standards is detailed in the “Nursing Process” chapter of this text. It is important to note that while this chapter introduces the general scope of nursing practice, for critical care nurses, the application of the nursing process is intensified due to the complex and rapidly changing conditions of their patients. Accurate nursing diagnosis and management, often requiring APA citations when documented or presented academically, are paramount in critical care.

The Standards of Professional Performance include 12 additional standards outlining a nurse’s professional conduct, including ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health. All registered nurses are expected to engage in these professional roles based on their education, position, and role. Registered nurses are accountable for their professional behaviors to themselves, healthcare consumers, peers, and society. [6] The 2021 Standards of Professional Performance are:

  • Ethics. The registered nurse integrates ethical principles in all aspects of practice.
  • Advocacy. The registered nurse advocates for patients in all roles and settings.
  • Respectful and Equitable Practice. The registered nurse practices with cultural humility and inclusivity.
  • Communication. The registered nurse communicates effectively across all professional practice areas.
  • Collaboration. The registered nurse collaborates with healthcare consumers and other key stakeholders.
  • Leadership. The registered nurse demonstrates leadership within the profession and practice setting.
  • Education. The registered nurse pursues knowledge and competence reflecting current and future nursing practice.
  • Scholarly Inquiry. The registered nurse integrates scholarship, evidence, and research findings into practice.
  • Quality of Practice. The registered nurse contributes to quality nursing practice.
  • Professional Practice Evaluation. The registered nurse evaluates their own and others’ nursing practice.
  • Resource Stewardship. The registered nurse utilizes appropriate resources to provide safe, effective, and financially responsible nursing services.
  • Environmental Health. The registered nurse practices in an environmentally safe and healthy manner. [7]

Historically, nurses recited the Nightingale Pledge, affirming their commitment to the profession’s ethical and moral values: “I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling, with loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.” While some language is outdated, the essence remains: Nursing is a calling, demanding dedication to serving the community according to ANA standards and ethics. [8]

Nurse Practice Act

Beyond the ANA standards, nurses must legally comply with regulations set by the Nurse Practice Act, enforced by the Board of Nursing in each state. The Board of Nursing is the state regulatory body that sets standards for safe nursing care and licenses qualified candidates based on the Nurse Practice Act established by the state legislature. The Nurse Practice Act defines nursing practice regulations and scope within that state. Non-compliance can lead to license revocation by the Board of Nursing.

For details on the Wisconsin Board of Nursing, Standards of Practice, and Rules of Conduct, refer to the hyperlinked PDFs below. [9]

Learn More About Wisconsin Nursing Regulations

Explore the Wisconsin Administrative Code and the Board of Nursing.

Read about Wisconsin Standards of Practice for Nurses in Chapter N 6.

Read about Wisconsin Rules of Conduct in Chapter N 7.

Nursing students must understand their scope of practice as outlined in their state’s Nurse Practice Act. They are legally accountable for the quality of patient care, just as licensed nurses are. Students are expected to recognize their knowledge and experience limitations, alerting supervisors in situations exceeding their competence. Violations of practice standards can lead to license denial for nursing graduates.

Employer Policies, Procedures, and Protocols

In addition to ANA standards and state Nurse Practice Acts, nurses and students must adhere to agency-specific policies, procedures, and protocols. For example, a hospital policy might mandate daily thorough skin assessments for all patients. Failure to comply, leading to a pressure injury, could result in liability for the nurse. Agencies also have specific procedural steps for nursing skills, like urinary catheter insertion. A protocol, as defined by the Wisconsin Nurse Practice Act, is “a precise and detailed written plan for a regimen of therapy.” For instance, a hypoglycemia protocol might dictate actions for low blood sugar, such as administering orange juice and re-checking blood glucose levels. Agency-specific policies, procedures, and protocols supersede nursing school teachings, and non-compliance can lead to legal liability. Therefore, nurses and students must always review and follow current agency-specific guidelines when providing care.

However, nurses and students must always operate within their Nurse Practice Act-defined scope of practice, even when following agency guidelines. Instances have occurred where nurses or students were asked to perform tasks outside their scope, jeopardizing their licenses. Protecting your nursing license and adhering to the state’s Nurse Practice Act is paramount in patient care.

Federal Regulations

Nursing scope and standards are also influenced by federal regulations from agencies like The Joint Commission and the Centers for Medicare & Medicaid Services.

The Joint Commission

The Joint Commission is a national organization accrediting over 20,000 healthcare organizations in the US. Its mission is to continuously improve healthcare for the public by encouraging organizations to excel in safe, effective, high-quality, and valuable care. [10] The Joint Commission sets standards for safe, high-quality healthcare.

National Patient Safety Goals

The Joint Commission annually establishes National Patient Safety Goals for various agency types based on current national safety concerns. [11] Hospital safety goals include:

  • Correctly Identifying Patients
  • Improving Staff Communication
  • Using Medicines Safely
  • Using Alarms Safely
  • Preventing Infection
  • Identifying Patient Safety Risks
  • Preventing Surgery Mistakes

Nurses, students, and staff are expected to integrate these safety goals into daily patient care. Examples include SBAR (Situation, Background, Assessment, and Recommendation) handoff reporting, bar code scanning, and perioperative “time-outs.” Nursing programs also use these goals to guide curriculum and clinical expectations, further discussed in the “Safety” chapter.

Learn More About The Joint Commission and Patient Safety Goals

Explore The Joint Commission website.

Review The Joint Commission’s National Patient Safety Goals.

Joint Commission Center for Transforming Healthcare

The Joint Commission Center for Transforming Healthcare, established in 2008, helps agencies develop solutions for critical safety problems, aiming for zero patient harm. Projects include improving hand hygiene, handoff communications, and safe insulin use. The Center has also emphasized safety culture in healthcare organizations. A safety culture empowers nurses, students, and staff to voice patient risk concerns and report errors, driving patient care improvement and harm reduction. [12] Many agencies have successfully implemented safety cultures, reducing patient harm incidents. An example is incident reporting for medication errors, used by agencies to investigate systemic factors contributing to errors.

Learn More About Safety Culture

Read more about Creating a Safety Culture.

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services (HHS), administers Medicare and partners with states for Medicaid. CMS enforces regulations protecting patient safety in Medicare/Medicaid-funded hospitals. One CMS regulation mandates medication administration protocols, often referred to as “checking the rights of medication administration.” More information is available in the “Administration of Enteral Medications” chapter of the Open RN Nursing Skills textbook. [13]

CMS also enforces quality standards in Medicare/Medicaid-funded organizations, with reimbursement tied to patient outcomes. Higher healthcare-associated infection (HAI) rates lead to reduced reimbursement. Consequently, many agencies have revised policies and procedures to optimize patient outcomes and maximize reimbursement.

Having discussed agencies impacting nursing scope and standards, let’s explore healthcare settings and the healthcare team.

References

  1. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  2. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  3. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  4. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  5. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  6. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  7. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  8. Bostain, L. (2020, June 25). Nursing professionalism begins with you. American Nurse. https://www.myamericannurse.com/nursing-professionalism-begins-with-you/
  9. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  10. The Joint Commission. (n.d.). Retrieved from https://www.jointcommission.org/
  11. The Joint Commission. (n.d.). National patient safety goals. Retrieved from https://www.jointcommission.org/standards/national-patient-safety-goals/
  12. Joint Commission Center for Transforming Healthcare. (n.d.). Creating a safety culture. Retrieved from https://www.centerfortransforminghealthcare.org/why-work-with-us/video-resources/creating-a-safety-culture
  13. This work is derivative of Nursing Skills by Open RN and is licensed under CC BY 4.0.

Healthcare Settings and the Interprofessional Team

Healthcare Settings

Healthcare is delivered across several levels: primary, secondary, and tertiary care, each focusing on different aspects and typically provided in distinct settings.

Primary Care

Primary care emphasizes wellness and disease prevention, including health promotion, education, protection (e.g., immunizations), early screening, and environmental health considerations. Primary care settings include physician offices, public health clinics, school nursing, and community health nursing.

Secondary Care

Secondary care addresses illnesses or injuries requiring medical attention, often termed acute care. It ranges from uncomplicated care like laceration repair or strep throat treatment to complex emergent care, such as head injury management. Secondary care aims to return patients to a state of health and wellness and is provided in physician offices, clinics, urgent care facilities, and hospitals, including specialized units like burn care, neurosurgery, cardiac surgery, and transplant services.

Tertiary Care

Tertiary care focuses on long-term effects of chronic illnesses or conditions, aiming to restore maximum physical and mental function. The goal is to achieve the highest possible level of functioning while managing chronic conditions. For instance, a hip fracture requires secondary care for bone setting but may necessitate tertiary care for regaining strength and mobility post-healing. Patients with incurable conditions like dementia may need specialized tertiary care for daily functioning support. Tertiary care settings include rehabilitation units, assisted living facilities, adult day care, skilled nursing units, home care, and hospice centers.

The Interprofessional Healthcare Team

Regardless of the setting, quality healthcare requires a collaborative team of healthcare professionals delivering holistic, individualized care. Nursing students must understand the roles and contributions of various team members. The healthcare team includes healthcare providers, nurses (LPNs, RNs, and APRNs), unlicensed assistive personnel, and various interprofessional team members.

Healthcare Providers

The Wisconsin Nurse Practice Act defines a provider as “a physician, podiatrist, dentist, optometrist, or advanced practice nurse.” [1] Providers are responsible for ordering diagnostic tests, diagnosing medical conditions, developing treatment plans, and prescribing medications. In hospitals, the medical treatment plan is documented in the “History and Physical” section of the medical record, along with prescriptions (“orders”) for tests, medications, and general care parameters. Nurses should clarify unclear prescriptions to ensure patient safety. Providers typically conduct daily hospital rounds, which nurses and students should attend to understand and contribute to the treatment plan, seek clarification, and ensure clear communication among the provider, nurse, and patient, minimizing follow-up calls.

Nurses

State Nurse Practice Acts define three levels of nurses: Licensed Practical Nurse/Vocational Nurse (LPN/LVN), Registered Nurse (RN), and Advanced Practice Nurse (APRN).

Licensed Practical/Vocational Nurses

The NCSBN defines a Licensed Practical Nurse (LPN) as “an individual who has completed a state-approved practical or vocational nursing program, passed the NCLEX-PN examination, and is licensed by a state board of nursing to provide patient care.” [2] (In some states, LVN is used). LPN/LVNs typically work under the supervision of RNs, APRNs, or physicians. [3] They provide “basic nursing care” to stable and/or chronically ill populations. Basic nursing care, according to the Wisconsin Nurse Practice Act, is “care that can be performed following a defined nursing procedure with minimal modification in which the responses of the patient to the nursing care are predictable.” [4] LPN/LVNs collect patient data, administer medications, and perform procedures within their state’s scope of practice. The Open RN Nursing Skills textbook details skills commonly performed by Wisconsin LPNs.

Wisconsin Scope of Practice for Licensed Practical Nurses

The Wisconsin Nurse Practice Act defines the LPN scope of practice: “In performing basic patient care, the LPN, under RN or provider supervision, shall:

a. Accept only assignments they are competent to perform.

b. Provide basic nursing care.

c. Record care and report patient condition changes.

d. Consult with providers if a delegated act may harm a patient.

e. Perform additional acts:

1. Assist with data collection.
2. Assist with care plan development and revision.
3. Reinforce RN/provider teaching and provide basic health instruction.
4. Participate in meeting basic patient needs with the healthcare team." [[5](#ch1team_ref_5)]
Registered Nurses

The NCSBN defines a Registered Nurse as “an individual who has graduated from a state-approved school of nursing, passed the NCLEX-RN examination and is licensed by a state board of nursing to provide patient care.” [6] Registered Nurses (RNs) utilize the nursing process as a critical thinking model for patient care decisions and clinical judgment. (See the “Nursing Process” chapter for details). RNs may receive delegated tasks from providers and delegate tasks to LPNs and UAPs under supervision.

Wisconsin Scope of Practice for Registered Nurses

  1. General Nursing Procedures. RNs use the nursing process in health maintenance, illness prevention, and care of the ill, including assessment, planning, intervention, and evaluation.

    a. Assessment. Systematic and continual data collection and analysis to formulate a nursing diagnosis.

    b. Planning. Developing a nursing care plan with goals and priorities based on the nursing diagnosis.

    c. Intervention. Implementing the care plan by direct care or supervising delegated acts to LPNs or less skilled assistants.

    d. Evaluation. Determining patient progress toward goals, leading to care plan modification if needed.

  2. Delegated Acts. RNs shall:

    a. Accept only delegated acts with protocols or orders.

    b. Accept only acts they are competent to perform.

    c. Consult providers if a delegated act may harm a patient.

    d. Perform delegated acts under provider supervision.

  3. Supervision of Delegated Acts. RNs shall:

    a. Delegate tasks based on supervisee’s education and abilities.

    b. Provide direction and assistance.

    c. Observe and monitor supervised activities.

    d. Evaluate the effectiveness of supervised acts. [7]

Advanced Practice Nurses

Advanced Practice Nurses (APRNs), defined by the NCSBN as RNs with graduate degrees and advanced knowledge, include certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), certified nurse practitioners (CNPs), and certified registered nurse anesthetists (CRNAs). APRNs can diagnose illnesses, prescribe treatments and medications.

Advanced Practice Nursing Roles [8]

Nurse Practitioners (NPs): NPs work in various settings, conduct physical exams, diagnose and treat acute and chronic illnesses, order tests, prescribe medications, provide health teaching and counseling, and refer patients to specialists. In some states, NPs practice independently; others require physician supervision. NP certifications include Family Practice, Adult-Gerontology (Primary and Acute Care), and Psychiatric/Mental Health.

For NP certification details, visit Nursing World’s Certifications page.

Clinical Nurse Specialists (CNSs): CNSs practice in diverse healthcare settings, mentoring nurses, managing cases, conducting research, designing quality improvement programs, and serving as educators and consultants. Specialties include Adult/Gerontology, Pediatrics, and Neonatal.

For CNS certification details, visit NACNS’s “What is a CNS?” page.

Certified Registered Nurse Anesthetists (CRNAs): CRNAs administer anesthesia and related care before, during, and after procedures, including airway management during emergencies. CRNAs deliver over 65% of anesthetics in the U.S., practicing in operating rooms, dental offices, and surgical centers.

For CRNA certification details, visit NBCRNA’s website.

Certified Nurse Midwives (CNMs): CNMs provide gynecological exams, family planning, prenatal care, manage low-risk labor and delivery, and neonatal care in hospitals, birthing centers, clinics, and homes.

For CNM certification details, visit AMCB Midwife’s website.

Unlicensed Assistive Personnel

Unlicensed Assistive Personnel (UAPs), defined by the NCSBN as “any unlicensed person, regardless of title, who performs tasks delegated by a nurse,” include certified nursing aides/assistants (CNAs), patient care assistants (PCAs), patient care technicians (PCTs), state tested nursing assistants (STNAs), nursing assistants-registered (NA/Rs), or certified medication aides/assistants (MA-Cs). UAP certification varies by jurisdiction. [9]

CNAs, PCAs, and PCTs in Wisconsin assist patients with daily tasks like bathing, dressing, feeding, and toileting in hospitals and long-term care facilities. They may also collect vital signs, weight, and input/output data as delegated by the nurse. The RN remains accountable for delegated task completion and documentation by UAPs.

Interprofessional Team Members

Nurses, as care coordinators, ensure all multidisciplinary team contributions advance patient outcomes. Interprofessional team member roles are detailed below.

Interprofessional Team Member Roles [10]

Dietitians: Assess, plan, implement, and evaluate dietary interventions for patients needing regular or therapeutic diets. They provide dietary education and collaborate with the team for patients with dietary needs due to conditions like dysphagia.

Occupational Therapists (OTs): Assess, plan, implement, and evaluate interventions to enhance patients’ independence in daily living activities like bathing, grooming, eating, and dressing. They provide adaptive devices and assess home safety for modifications like ramps and grab rails. OTs work in homes, hospitals, and rehabilitation centers.

Pharmacists: Ensure safe medication prescribing and dispensing, providing a resource for nurses’ medication questions. They ensure correct medication and dosing and provide guidance for safe and effective medication use.

Physical Therapists (PTs): Assess, plan, implement, and evaluate interventions related to patients’ functional abilities in strength, mobility, balance, gait, coordination, and range of motion. They supervise exercises and teach the use of assistive devices. PTs work in homes, hospitals, and rehabilitation centers.

Podiatrists: Provide care for foot problems, often working with diabetic patients for nail care and foot care to prevent complications.

Prosthetists: Design, fit, and supply artificial limbs, adjusting them for proper fit, comfort, and function.

Psychologists and Psychiatrists: Provide mental health services and psychological support to patients and families affected by mental health disorders.

Respiratory Therapists: Treat respiratory conditions, managing oxygen therapy, ventilators, CPAP/BiPAP, administering respiratory medications, performing pulmonary hygiene, and assisting with respiratory diagnostics and emergencies.

Social Workers: Counsel patients, provide psychological support, arrange community resources, and ensure care continuity post-discharge.

Speech Therapists: Assess, diagnose, and treat communication and swallowing disorders like expressive aphasia and dysphagia. They assist patients with communication devices and swallowing strategies.

Ancillary Department Members: Nurses collaborate with ancillary departments like laboratory and radiology. Clinical laboratory departments perform tests aiding diagnosis and treatment, staffed by medical technologists. Radiology departments use imaging like X-rays, CTs, MRIs, and ultrasounds for diagnosis and treatment. [11]

Chain of Command

Nurses consult with other nurses and team members for patient decisions, communicating concerns through the agency’s chain of command. The chain of command is a hierarchy of reporting relationships, establishing accountability, authority, and decision-making power. For example, an RN may consult a charge nurse, then a nurse supervisor, director of nursing, and VP of nursing. In long-term care, an LPN typically consults an RN/charge nurse, then the director of nursing. Nursing students should always consult their instructor before escalating concerns through the chain of command.

Nurse Specialties

RNs can obtain certifications as nurse specialists, recognizing specialized knowledge and skills. Certification is formal recognition of expertise demonstrated by meeting specialty standards.

Common Nurse Specialties

Critical Care Nurses: Care for patients with serious, complex, acute illnesses requiring intensive monitoring and therapies, often in hospital ICUs.

Public Health Nurses: Promote and protect population health using nursing, social, and public health sciences, often in health departments.

Home Health/Hospice Nurses: Provide nursing services for chronically ill and end-of-life patients and their families at home.

Occupational/Employee Health Nurses: Provide workplace health screenings, wellness programs, minor treatments, and disease/medication management, focusing on health promotion, prevention, and protection from workplace hazards.

Oncology Nurses: Care for cancer patients, administering chemotherapy and providing follow-up care in hospitals, clinics, and homes.

Perioperative/Operating Room Nurses: Provide pre- and post-operative care and assist with surgical procedures in hospitals and surgical centers.

Rehabilitation Nurses: Care for patients with temporary and permanent disabilities in inpatient and outpatient settings.

Psychiatric/Mental Health Nurses: Specialize in mental health, caring for individuals with psychiatric disorders in hospitals, clinics, and private practices.

School Nurses: Provide health assessments, interventions, and follow-up in schools, ensuring health policy compliance and student health and safety.

Other specialties include maternal-child, neonatal, pediatric, and gerontological nursing. [12]

Now, let’s explore nursing education levels and the NCLEX licensure exam.

References

  1. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  2. NCSBN. Retrieved from https://www.ncsbn.org/
  3. NCSBN. Retrieved from https://www.ncsbn.org/index.htm
  4. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  5. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  6. NCSBN. Retrieved from https://www.ncsbn.org/index.htm
  7. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  8. Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press. https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health
  9. NCSBN. Retrieved from https://www.ncsbn.org/index.htm
  10. Burke, A. (2020, January 15). Collaboration with interdisciplinary team: NCLEX-RN. RegisteredNursing.org. https://www.registerednursing.org/nclex/collaboration-interdisciplinary-team/#collaborating-healthcare-members-disciplines-providing-client-care
  11. This work is derivative of StatPearls by Bayot and Naidoo and licensed under CC BY 4.0.
  12. Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press. https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-health

Nursing Education and the NCLEX Examination

Paths to Becoming a Nurse

Everyone aspiring to nursing has a personal story about their motivation. What’s yours? Perhaps a lifelong dream to be a flight nurse, or inspiration from a nurse who helped you or a loved one during childbirth, illness, or end-of-life care. Regardless of the reason, becoming a nurse requires two key steps: graduating from an approved nursing program and passing the National Council Licensure Examination (NCLEX).

Nursing Programs

Several types of nursing programs are available. To become a Licensed Practical Nurse (LPN), complete a one-year program, pass the NCLEX-PN exam, and apply to your state board of nursing for licensure.

To become a Registered Nurse, you can pursue a two-year Associate Degree in Nursing (ADN) or a four-year Bachelor of Science in Nursing (BSN). ADN graduates often pursue BSN or higher degrees, with many hospitals requiring ADN nurses to complete a BSN within a specific timeframe. A BSN is typically required for military nursing, case management, public health, and school nursing. A less common RN pathway is a three-year hospital-based diploma program, historically the most common route. Diploma programs are being replaced by college degrees, with only a few states still offering this option. [1] After completing a diploma, ADN, or BSN program, graduates must pass the NCLEX-RN exam to apply for RN licensure from their state’s Board of Nursing.

NCLEX Examination

Passing the National Council Licensure Examination (NCLEX) is mandatory for nursing licensure. RN candidates take the NCLEX-RN, while LPN/LVN candidates take the NCLEX-PN.

The NCLEX-PN and NCLEX-RN are adaptive, computerized exams administered at testing centers. They assess entry-level nursing knowledge, skills, and abilities crucial for safe and effective practice. NCLEX exams are regularly reviewed and updated based on surveys of new graduate nurses every three years.

Both NCLEX exams are variable-length and adaptive, adjusting difficulty based on your responses. The NCLEX-RN can range from 75 to 265 questions (15 unscored pretest items) with a six-hour time limit. The NCLEX-PN ranges from 85 to 205 questions (25 unscored pretest items) with a five-hour limit. [2]

The Next Generation NCLEX (NGN), implemented in 2023, uses the Clinical Judgment Measurement Model to assess clinical judgment and decision-making. While the Nursing Process remains foundational, the NGN uses new terminology like “recognize cues,” “analyze cues,” “create a hypothesis,” “prioritize hypotheses,” “generate solutions,” “take actions,” and “evaluate outcomes.” [3] Many case studies and learning activities now incorporate NGN terminology.

NGN also includes new question formats like case studies, enhanced hot spots, drag-and-drop ordering, multiple responses, and embedded answers within text paragraphs. These changes aim to better evaluate clinical judgment and decision-making to ensure public safety by assuring competent entry-level nurses. [4] Sample NGN questions are available online, and similar question types are integrated into this textbook’s learning activities.

Learn More About the NCLEX

For more information, visit the NCLEX & Test Plans website.

Review sample Next Generation NCLEX questions at https://www.ncsbn.org/NGN-Sample-Questions.pdf.

Nurse Licensure Compact

The Nurse Licensure Compact (NLC) allows nurses to hold a single multistate license, enabling practice in their home state and other compact states. As of 2020, numerous states have enacted NLC legislation.

Learn More About the Nurse Licensure Compact

For more information, visit the Nurse Licensure Compact website.

Advanced Nursing Degrees

After RN licensure, nurses can pursue advanced degrees to expand career opportunities.

Master’s Degree in Nursing

A Master of Science in Nursing (MSN) requires additional coursework beyond a BSN, with specializations like Nurse Educator and Advanced Practice Nurse (APRN). MSN-related certifications include Certified Nurse Educator (CNE), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). Certifications require exams and continuing education. APRN scope of practice is state-defined.

Doctoral Degrees in Nursing

Doctoral nursing degrees include the Doctor of Philosophy (PhD) and Doctor of Nursing Practice (DNP). PhD nurses focus on research, often teaching and conducting research in universities. DNP nurses focus on clinical practice, often in advanced practice, leadership, or academic roles.

Lifelong Learning

Regardless of nursing role or education level, nursing practice evolves rapidly with new evidence-based practices. Nurses must commit to lifelong learning for safe, quality patient care. Many states require continuing education for RN license renewal, while others rely on healthcare organizations for educational standards and requirements.

Now, let’s examine legal and ethical considerations in nursing.

References

  1. NCSBN. (2019). 2018 NCLEX examination statistics 77. https://www.ncsbn.org/2018_NCLEXExamStats.pdf
  2. NCSBN. (2019). NCLEX & Other Exams. https://www.ncsbn.org/nclex.htm
  3. NCSBN. (2021). NCSBN Next Generation NCLEX Project. https://www.ncsbn.org/next-generation-nclex.htm
  4. NCSBN. (2021). NCSBN Next Generation NCLEX Project. https://www.ncsbn.org/next-generation-nclex.htm

Legal and Ethical Considerations in Nursing

Legal Responsibilities

As previously discussed, nurses can face disciplinary actions or license revocation for violating their state’s Nurse Practice Act. Nurses can also be legally liable for negligence, malpractice, or breaches of patient confidentiality.

Negligence and Malpractice

Negligence is a broad term indicating “conduct lacking in due care, carelessness, and deviation from reasonable standard of care.” [1] Malpractice is a more specific term concerning the standard of care in a professional context. [2]

To prove negligence or malpractice in court, the following must be established:

  • Duty owed to the patient.
  • Breach of duty.
  • Foreseeability of harm.
  • Causation (the breach directly caused the injury).
  • Injury.
  • Damages (quantifiable losses due to the injury). [3]

To prevent negligence or malpractice lawsuits and license jeopardy, nurses and students must adhere to scope and standards of practice from state Nurse Practice Acts, the ANA, and employer policies. Examples of nursing negligence include: [4]

  • Failure to Assess: Inadequate assessment for potential nursing problems beyond medical diagnoses, e.g., not assessing fall risk.

  • Insufficient Monitoring: Inadequate monitoring of conditions requiring frequent checks, like fall risk or confusion.

  • Failure to Communicate:

    • Lack of Documentation: Unrecorded assessments or actions are legally considered undone.
    • Lack of Provider Notification: Failure to promptly report patient condition changes to healthcare providers. Documentation must include date, time, notified person, and follow-up actions.

  • Failure to Follow Protocols: Not adhering to agency or state reporting rules, such as suspected abuse reporting.

Patient Confidentiality

Patient confidentiality is a critical legal aspect, protected by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA, enacted in 1996, protects Protected Health Information (PHI) in electronic records and third-party insurance environments. HIPAA has two main rules: the Privacy Rule, governing PHI use and disclosure, and the Security Rule, setting standards for electronic PHI confidentiality, integrity, and availability. HIPAA extends beyond medical records to all patient information shared with healthcare team members directly involved in care.

HIPAA regulations apply to student nurses from their first patient interaction. HIPAA violations can lead to nursing program discipline or expulsion for students and job loss or lawsuits for nurses.

Common HIPAA Violations and Prevention [5]

  1. Gossiping: Discussing patients in public areas like hallways or break rooms where conversations can be overheard. Discuss patient care confidentially with instructors in private settings as a student, and only with directly involved healthcare team members professionally.
  2. Mishandling Records: Leaving computers unlocked or unsecured paper charts accessible to unauthorized individuals. Never share passwords, always lock computers when leaving them unattended, and secure paper charts. Never remove records or include patient names on paperwork leaving the facility.
  3. Unauthorized Access: Accessing medical records of acquaintances or family members without direct patient care responsibility. Facilities monitor electronic record access and hold individuals accountable. This rule applies even after student rotations end; continued access is prohibited.
  4. Sharing Information with Unauthorized People: Sharing medical information without written patient consent. Always obtain permission before sharing information, even with family members. Confirming or denying patient admission status can be a breach.
  5. Minors’ Information: Generally, parents have access to minors’ health information until age 18, with exceptions for minor-initiated care like birth control or abortion. After 18, parental access requires written consent, even if parents provide insurance or housing. Always verify permission before sharing patient information.
  6. Unencrypted Communication: Texting or emailing patient information on unencrypted devices. Use only approved, encrypted devices for electronic PHI transmission and verify correct recipients.
  7. Social Media: Never post patient-related information, facility details, or even general work-day comments on social media. HIPAA violations on social media can result in job termination and professional repercussions. [6, 7, 8]

Social Media Guidelines

Nurses, students, and healthcare team members must exercise extreme caution on social media platforms like Facebook, Instagram, and Twitter. Never post patient or agency-related information; violations can lead to job loss, legal action, and student discipline. Even “private” group posts can become public.

The American Nurses Association (ANA) provides social media principles for nurses: [9]

  • Do not transmit identifiable patient information online.
  • Maintain ethical patient-nurse boundaries online.
  • Recognize that postings can be viewed by patients, colleagues, and employers.
  • Utilize privacy settings and separate personal and professional online information.
  • Report content that could harm patient privacy or rights to authorities.
  • Participate in developing organizational online conduct policies.

ANA social media tips for nurses and students: [10]

  • Maintain online professionalism.
  • Do not share patient information or photos gained through the nurse-patient relationship.
  • Maintain professional boundaries online; avoid online contact with patients.
  • Avoid disparaging remarks about patients, employers, or coworkers online.
  • Do not take patient photos or videos on personal devices.
  • Promptly report confidentiality or privacy breaches.

Learn More About Social Media in Nursing

Review the ANA’s Social Media Principles.

Watch the Social Media Guidelines for Nurses video from the NCSBN.

Code of Ethics

Beyond legal considerations, nursing practice is guided by ethical principles.

Morality encompasses personal values and conduct within communities. Ethical principles are general guides for decision-making, including beneficence (doing good), nonmaleficence (avoiding harm), autonomy (individual control), and justice (fairness). A code of ethics outlines a profession’s obligations, values, and ideals.

The American Nurses Association (ANA) Code of Ethics for Nurses guides ethical nursing care and decision-making. [11] The Code serves to:

  • State ethical values, obligations, duties, and professional ideals.
  • Establish the profession’s non-negotiable ethical standard.
  • Express nursing’s commitment to society. [12]

The ANA Code of Ethics includes nine provisions.

ANA Code of Ethics Provisions [13]

The nine provisions of the ANA Code of Ethics are summarized below. The full code is available at Nursingworld.org.

Provision 1: Practice with compassion and respect for every person’s dignity, worth, and unique attributes.

Provision 2: Primary commitment is to the patient (individual, family, group, community, or population).

Provision 3: Promote, advocate for, and protect patient rights, health, and safety.

Provision 4: Maintain authority, accountability, and responsibility for nursing practice, making decisions consistent with optimal care.

Provision 5: Uphold same duties to self as to others, including health, safety, integrity, competence, and professional growth.

Provision 6: Contribute to ethical work environments conducive to safe, quality healthcare.

Provision 7: Advance the profession through research, standards development, and health policy.

Provision 8: Collaborate with professionals and the public to protect human rights, promote health diplomacy, and reduce disparities.

Provision 9: Maintain profession’s integrity and social justice principles through professional organizations.

ANA Center for Ethics and Human Rights

The ANA Center for Ethics and Human Rights assists nurses in navigating ethical conflicts and complex decisions in practice.

Learn More About Nursing Ethics

For more information, visit the ANA Center for Ethics and Human Rights.

Check Your Knowledge

Interactive Quiz 1

Interactive Quiz 2

References

  1. Missouri Department of Health & Senior Services. (n.d.). Negligence and malpractice. https://health.mo.gov/living/lpha/phnursing/negligence.php#:~:text=Negligence%20is%3A,a%20particular%20set%20of%20circumstances.
  2. Missouri Department of Health & Senior Services. (n.d.). Negligence and malpractice. https://health.mo.gov/living/lpha/phnursing/negligence.php#:~:text=Negligence%20is%3A,a%20particular%20set%20of%20circumstances.
  3. Missouri Department of Health & Senior Services. (n.d.). Negligence and malpractice. https://health.mo.gov/living/lpha/phnursing/negligence.php#:~:text=Negligence%20is%3A,a%20particular%20set%20of%20circumstances.
  4. Vera, M. (2020). Nursing care plan (NCP): Ultimate guide and database. https://nurseslabs.com/nursing-care-plans/#:~:text=Collaborative%20interventions%20are%20actions%20that,to%20gain%20their%20professional%20viewpoint.
  5. Patterson, A. (2018, July 3). Most common HIPAA violations with examples. Inspired eLearning. https://inspiredelearning.com/blog/hipaa-violation-examples/
  6. Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4(2), e29475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/
  7. American Nurses Association. (n.d.). About ANA. https://www.nursingworld.org/ana/about-ana/
  8. American Nurses Association. (n.d.). Scope of practice. https://www.nursingworld.org/practice-policy/scope-of-practice/
  9. American Nurses Association. (n.d.). Social media. https://www.nursingworld.org/social/
  10. American Nurses Association. (n.d.). Social media. https://www.nursingworld.org/social/
  11. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
  12. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
  13. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/

Professional Nursing Organizations

The Role of Professional Organizations

Besides the ANA’s Nursing: Scope and Standards of Practice and Code of Ethics for Nurses, numerous professional nursing organizations offer specialized standards and promote continuous quality improvement. These organizations significantly guide the nursing profession.

Examples of Professional Nursing Organizations

American Nurses Association

As previously mentioned, the American Nurses Association (ANA) guides nursing practice through publications, the Scope and Standards of Practice, and the Code of Ethics. The ANA also publishes The American Nurse, a monthly journal for members.

American Nurses Credentialing Center

The American Nurses Credentialing Center (ANCC) credentials organizations and individual nurses, offering certifications in specialized nursing knowledge and accrediting continuing nursing education programs. ANCC accreditation recognizes high-quality continuing education and competency programs.

Learn More About the ANCC

For more information, visit the American Nurses Credentialing Center website.

National League for Nursing

The National League for Nursing (NLN) focuses on promoting excellence in nursing education. The NLN sets standards, evaluates nursing programs, supports faculty development, funds research, and publishes Nursing Education Perspectives. [1]

Learn More About the NLN

For more information, visit the National League for Nursing website.

Accreditation Commission for Education in Nursing

The Accreditation Commission for Education in Nursing (ACEN) accredits nursing education programs meeting quality standards. ACEN accredits technical colleges in systems like the Wisconsin Technical College System. Nursing students may provide feedback to ACEN site visitors during program evaluations.

Learn More About ACEN

For more information, visit the ACEN Accreditation website.

Commission on Collegiate Nursing Education

The Commission on Collegiate Nursing Education (CCNE) ensures the quality of baccalaureate, graduate, and residency nursing programs.

Learn More About CCNE

For more information, visit the CCNE Accreditation website.

National Student Nurses’ Association

The National Student Nurses’ Association (NSNA) mentors nursing students, promoting professional standards, ethics, and leadership skills. [2] NSNA hosts national conventions and publishes Imprint journal.

Learn More About NSNA

For more information, visit the National Student Nurses’ Association website.

Specialty Nursing Organizations

Numerous specialty organizations offer certifications, scope of practice documents, and position statements in specific nursing areas. [3]

Explore Specialty Nursing Organizations

Academy of Medical-Surgical Nurses

Wound, Ostomy and Continence Nursing

Perioperative Nursing

Association of Women’s Health, Obstetric, and Neonatal Nurses

Watch: AMSN Video

Watch the AMSN YouTube video by the former president of the Academy of Medical-Surgical Nurses on important nursing issues. [4]

References

  1. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  2. National Student Nurses’ Association. (n.d.). About us. https://www.nsna.org/about-nsna.html
  3. American Nurses Association. (n.d.). Scope of practice. https://www.nursingworld.org/practice-policy/scope-of-practice/
  4. AMSN 6). MSNCB. (2020, May 6). AMSN…The Present. [Video]. YouTube. https://youtu.be/unRSCXdhCgk

Quality and Evidence-Based Practice in Nursing

Commitment to Quality Care

The ANA, professional nursing organizations, and federal agencies continuously strive to enhance patient care quality. Nurses must also be individually committed to providing quality care based on current evidence-based practices.

Quality of Practice

One of the ANA’s Standards of Professional Practice is “Quality of Practice,” emphasizing safe, effective, efficient, equitable, timely, and person-centered nursing care. [1] Quality is defined as “the extent to which nursing services for healthcare consumers, families, communities, and populations improve desired outcomes and align with evolving nursing knowledge.” [2] Every nurse is responsible for quality care by adhering to established standards and incorporating evidence-based practices. Quality is a collective responsibility, requiring the entire healthcare team’s dedication. For instance, preventing pressure injuries through two-hourly turning of immobile patients requires consistent effort from all staff. Quality initiatives can be formalized, such as unit-based reviews of patient fall data and intervention implementation. Lifelong learning beyond formal education is essential to maintain current evidence-based practices.

Learning quality nursing practice begins in nursing school. The Quality and Safety Education for Nurses (QSEN) project encourages future nurses to continuously improve healthcare system quality and safety. QSEN’s vision is to “inspire healthcare professionals to prioritize quality and safety as core values.” [3] Nurses and students are expected to participate in quality improvement (QI) initiatives, identifying areas for change and implementing solutions. Quality improvement involves collective efforts to optimize patient outcomes, system performance, and professional development. [4] Nursing students can contribute to quality improvement by participating in QI initiatives.

Learn More About QSEN

For more information, visit the QSEN project website.

Evidence-Based Practice in Nursing

Evidence-based practice is part of the ANA’s “Scholarly Inquiry” Standard. It’s defined as “a lifelong problem-solving approach integrating best research evidence, clinical expertise, patient assessment data, healthcare resources, and patient/family preferences.” [5]

Evidence-based practice means basing patient care on research and expertise, not just tradition. An example is using peppermint for nausea relief. Historically used for upset stomachs, peppermint’s efficacy was questioned due to lack of scientific evidence. However, in 2016, nurse researchers Lynn Bayne and Helen Hawrylack developed a peppermint inhaler and found it 93% effective in relieving nausea. [6]

Nursing students should adopt evidence-based practice by using credible resources for patient care preparation. This textbook provides hyperlinks to reliable sources for this purpose.

References

  1. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  2. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  3. QSEN Institute. (n.d.). Project overview. http://qsen.org/about-qsen/project-overview/
  4. Batalden, P. B., & Davidoff, F. (2007). What is “quality improvement” and how can it transform healthcare? BMJ Quality & Safety, 16(1), 2–3.
  5. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  6. ChristianaCare News. (2016, May 16). Nurse researchers develop peppermint inhaler to relieve post-op nausea. https://news.christianacare.org/2016/05/nurse-researchers-develop-peppermint-inhaler-to-relieve-post-op-nausea/

Learning Activities

Apply Your Knowledge

Test your understanding of this chapter with the following learning activities:

  1. As a nursing student in a Critical Care Unit (CCU) clinical rotation, you are assisting a critical care nurse caring for a patient with persistently low blood pressure. The nurse steps away for a call, instructing you to increase intravenous (IV) medication if the systolic blood pressure drops below 90 mmHg. What is your appropriate response?

  2. During a medical-surgical unit clinical rotation, you join staff nurses for lunch in the breakroom. You overhear a nurse loudly complaining about a patient and discussing sensitive patient information. What is an appropriate response?

Interactive Scenario 1

Interactive Scenario 2

Interactive Scenario 3

Interactive Scenario 4

Glossary of Nursing Terms

Advanced Practice Nurse (APRN): An RN with a graduate degree and advanced knowledge, including certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), certified nurse practitioners (CNPs), and certified registered nurse anesthetists (CRNAs). APRNs can diagnose and treat illnesses and prescribe medications. [1]

ANA Standards of Professional Nursing Practice: Authoritative statements of duties expected of all RNs, regardless of role, population, or specialty. These standards describe competent nursing practice using the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. [2]

ANA Standards of Professional Performance: Standards describing competent professional behavior, including ethics, advocacy, respectful practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, evaluation, resource stewardship, and environmental health. [3]

Basic nursing care: Care performed following a defined nursing procedure with predictable patient responses and minimal modification. [4]

Board of Nursing: State-specific licensing and regulatory body setting standards for safe nursing care, defining scope of practice, and issuing licenses.

Chain of command: Agency hierarchy defining reporting relationships, accountability, authority, and decision-making.

Code of ethics: Normative moral guidance for nurses regarding obligations, values, and ideals, making professional values explicit.

Dysphagia: Impaired swallowing.

Ethical principle: General guide or truth for clinical judgment, including beneficence (do good), nonmaleficence (do no harm), autonomy (individual control), and justice (fairness).

Evidence-based practice: Problem-solving approach integrating research evidence, clinical expertise, patient data, resources, and patient preferences. [5]

Expressive aphasia: Impaired ability to form words and speak.

Licensed Practical Nurse/Vocational Nurse (LPN/LVN): An individual completing an approved nursing program, passing the NCLEX-PN, and licensed to provide patient care. [6]

Malpractice: Specific term referring to standard of care and professional caregiver status. [7]

Morality: Personal values, character, and conduct within communities. [8]

Negligence: Conduct lacking due care, carelessness, and deviating from reasonable standard of care. [9]

Nurse Licensure Compact (NLC): Allows nurses to hold a multistate license for practice in home and compact states.

Nursing: Integrates caring art and science, focusing on health protection, promotion, optimization, illness/injury prevention, healing facilitation, and suffering alleviation through compassionate presence. Nursing includes diagnosis, treatment of human responses, and advocacy for individuals, families, groups, communities, and populations. [10]

Nurse Practice Act (NPA): State legislation regulating nursing practice, defining licensure requirements and scope of practice.

Patient confidentiality: Protecting patient’s Protected Health Information (PHI), accessible only to directly involved healthcare team members.

Primary care: Care promoting wellness and preventing disease, including health promotion, education, and early screening.

Protocol: Detailed written plan for a therapy regimen. [11]

Provider: Physician, podiatrist, dentist, optometrist, or advanced practice nurse. [12]

Quality: Extent to which nursing services improve outcomes and align with evolving knowledge. [13]

Registered Nurse (RN): Graduate of an approved nursing school, passing NCLEX-RN, and licensed to provide patient care. [14]

Safety culture: Agency culture empowering staff to report risks and errors, driving patient care improvement.

Scope of practice: Services qualified professionals are competent and licensed to perform.

Secondary care: Care for illnesses or injuries requiring medical attention.

Tertiary care: Care addressing long-term effects of chronic conditions, aiming to restore maximum function.

Unlicensed Assistive Personnel: Unlicensed individuals performing delegated tasks, including CNAs, PCAs, and PCTs. [15]

References

  1. NCSBN. Retrieved from https://www.ncsbn.org/index.htm
  2. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  3. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  4. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  5. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  6. NCSBN. Retrieved from https://www.ncsbn.org/index.htm
  7. Missouri Department of Health & Senior Services. (n.d.). Negligence and malpractice. https://health.mo.gov/living/lpha/phnursing/negligence.php#:~:text=Negligence%20is%3A,a%20particular%20set%20of%20circumstances.
  8. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
  9. Missouri Department of Health & Senior Services. (n.d.). Negligence and malpractice. https://health.mo.gov/living/lpha/phnursing/negligence.php#:~:text=Negligence%20is%3A,a%20particular%20set%20of%20circumstances.
  10. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  11. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  12. Wisconsin Administrative Code. (2018). Chapter N 6 standards of practice for registered nurses and licensed practical nurses. https://docs.legis.wisconsin.gov/code/admin_code/n/6.pdf
  13. American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.
  14. NCSBN. Retrieved from https://www.ncsbn.org/index.htm
  15. NCSBN. Retrieved from https://www.ncsbn.org/index.htm

Comments

No comments yet. Why don’t you start the discussion?

Leave a Reply

Your email address will not be published. Required fields are marked *