Standards of Nursing Practice (page 2)
The American Nurses Association (ANA) developed general and specialty specific standards of nursing practice that provide guidelines for nursing practice. These standards are the rules of competent care, and RNs are required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar situations. The American Nurses Association standards consist of three components: (1) professional standards of care define diagnostic, intervention, and evaluation competencies; (2) professional standards identify role functions in direct care, consultation, and quality assurance; and (3) specialty practice guidelines are protocols for specific client populations. The ANA standards are comprised of standards of care and standards of professional practice. The standards of care are based on the nursing process and describe a competent level of nursing care. Standards of professional performance cover quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization.
American Nurses Association standards of care for specialty-specific nursing practice include, but are not limited to: addictions nursing practice, cardiovascular nursing, corrections nursing, faith community nursing, genetics/genomic nursing, gerontological nursing, HIV/AIDS nursing, holistic nursing, home health nursing, hospice and palliative nursing, intellectual and developmental disabilities nursing, legal nurse consulting nursing, neonatal nursing, neuroscience nursing, nursing administration, nursing informatics, nursing professional development, pain management nursing, pediatric nursing, plastic surgery nursing, psychiatric nursing, public health nursing, radiology nursing, school nursing, and vascular nursing. The scope and standards of practice for forensic nursing is due out in 2009.
The ANA, along with its 54 constituent organizations, is the only full-service professional organization representing the nation's 2.9 million registered nurses, but it is not the only nursing organization, nor is it the only one to have standards of care and scope of practice for nurses. Several specialty nursing organizations also provide these guidelines for those nurses within their specialties. The National Association of Pediatric Nurse Practitioners and Associates (NAPNAP) and the Society of Pediatric Nurses (SPN) created unified standards and scope of practice for pediatric nurses; the American College of Nurse Midwives developed standards of care for nurse midwives; and the American Association of Nurse Anesthetists developed the scope and standards of care for nurse anesthetists. JCAHO, an organization that accredits healthcare facilities, sets standards for aspects of nursing care, such as documentation.
Nurses are also held accountable for employer standards of practice, which are frequently written as policies and procedures. For example, hospitals that allow nurses to start intravenous therapy will most likely have standards of practice for that intervention.
State Boards of Nursing and Nurse Practice Acts
All 50 states, the District of Columbia, and U.S. territories Guam, the Virgin Islands, American Samoa, and the Mariana Islands have boards that oversee nurses in their jurisdictions. Boards are appointed by the governor and usually consist of RNs, LPNs, and consumers. State boards may be independent agencies of the state government or part of a department or bureau, such as the department of licensure and regulation. Most boards govern practical, registered, and advanced practice nurses, while others have separate boards for practical nurses. As examples, the Kentucky Board of Nursing governs all nurses; the California Board of Registered Nursing oversees registered and advanced practice nurses, while the California Bureau of Vocation Nursing and Psychiatric Technicians oversees practical nurses. All boards are members of the National Council of State Boards of Nursing (NCSBN), which provides leadership to advance regulatory excellence for public protection.
Nursing boards regulate the practice of practical, registered, and advanced practice nurses in order to promote nursing quality and to protect the health and safety of the public. State boards of nursing are authorized to develop responsibilities, regulations, and rules related to the state nursing practice act and to enforce the rules to obtain and maintain licensure. They also approve nursing education programs, provide nurse practice acts, and handle complaints against nurses.
Boards of nursing are authorized to approve all new nursing education programs within their state. Educational institutions proposing the development of a new nursing education program are required to submit a feasibility study addressing their intent. Typically, the Board provides provisional or initial approval after making a site visit, and then full approval after the program receives the NCLEX results on the majority of the first graduating class that provide evidence that the program meets all state requirements. State board approval is important for nursing programs because it demonstrates that the program meets the state's standards for nursing education. But it is even more important for you because you cannot take the NCLEX exam, and thus be licensed to practice nursing, unless you graduate from a state board-approved nursing program.
State boards of nursing and state nurses associations usually collaborate in the initiation and revision of the state nurse practice act that defines nursing practice in their jurisdiction. These practice acts are state laws that govern nursing practice and, in some areas, nursing education and protecting the safety and welfare of the public. Nurse practice acts usually define the board of nursing's composition, authority, and power; define nursing, as well as its boundaries and scope of practice; identify and protect types of titles; identify types of licenses and their requirements; and identify the grounds for disciplinary action.
Learning About Your State Practice Act
To learn about your area's Nurse Practice Act, contact your state board of nursing.
Consumers and professionals can file a complaint with the state board of nursing when they believe that a nurse has acted in a manner that is illegal or irresponsible in regard to professional nursing practice. The boards and/or another state-delegated agency review all complaints and investigate those who warrant an inquiry. The board may determine that a case does not require action based on board disciplinary policies, or it may determine that no rule or law violations occurred. They may also decide that a complaint requires disciplinary action that may include:
- a fine—a specific amount of money that must be paid to the state
- a reprimand—a formal notice stating that standards have been violated
- probation—a period of time during which the nurse must practice under specified restrictions or conditions that may affect the nurse's job role and setting
- suspension—a period of time during which the nurse's license is suspended and during which the nurse may not practice nursing
- revocation—removal of a nursing license for an unspecified time; may be permanent
- voluntary surrender—nurse is asked to give up license rather than face suspension or revocation
- denial of licensure—the board will not issue a license
Typically, complaint reviews and investigations are kept confidential, but disciplinary action is made public and may be posted on the state board of nursing's Internet site.