Running head: SCOPE AND STANDARDS

Scope and Standards of Nursing Practice

Kimberly Nix
Ferris State University

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Abstract
Looking back at my nursing career; I would have never seen my path take me to practice nursing
in a long term care setting. Long term care nursing is slightly different than hospital nursing.
You must follow a set of regulatory guidelines that have been set by the federal government. I
will be referencing to these regulatory guidelines throughout this paper. I will be discussing the
scope and practice of nursing in long term care. I will also be discussing the standards of
professional practice and how they pertain in long term care.

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Nursing Scope and Standards of Practice

The Scope and Standards of Nursing Practice was written with several purposes in mind. The
first purpose was to describe the obligations and duties of the long term care nurse. The second
purpose was to provide guidance to nurses on how to practice. The last purpose was to articulate
the long term care nurse understanding of the commitment to health care (Nursing Scope &
Standards of Practice, 2004).
Standards of Practice
Assessment. In nursing school we learned assessment is the first step in the nursing
process. Working in long term care, you must have keen assessment skills. This is extremely
important due to type of autonomy you experience in this type of setting. I would like to discuss
an example of this. We have a patient who is admitted with the diagnosis of congestive heart
failure. Based on the nursing assessment the nurse knows to put the patient on a fluid restriction,
daily weights, and a low sodium diet. The nurse is practicing within her/his scope and utilizing
appropriate nursing diagnoses. This would coincide with F-tag F 282 Qualified Services in
Accordance With Care Plan, category Resident Assessment (F-Tag List and Regulatory Groups
for Nursing Homes, 2010). This standard is easily attainable and sustainable due to the annual
audits the state maintains.
Diagnosis. There are many types of nursing diagnoses we use in a long term setting. The
patient is admitted with a physician diagnosis that is medically necessary. The nurse then applies
a nursing diagnosis. For example: the patient is 82 years old and is admitted with a medical
diagnosis of post op hip fracture. I would give this patient a couple of nursing diagnoses. Due to
the age of the patient a nursing diagnosis of high risk for fall is applicable. In the long term

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setting we would use interventions such as putting the patient in a low bed, applying an alarm
mat on the floor next to the bed, applying a wheelchair alarm, and documentation of behaviors. I
would also apply a nursing diagnosis of risk for skin integrity due to the surgical site of the
incision. This would coincide with F-tag F 328 Treatment Care for Special Care Needs category
Quality of Care (F-Tag List and Regulatory Groups for Nursing Homes, 2010). As a fairly new
director of nursing, I feel very confident in the nurses and feel they do very well with this
standard.
Outcomes Identification. This standard is another that is easily attained in the long term
care setting. This standard would be identified under F-Tag F 272 Comprehensive Assessment
category Resident Assessment (F-Tag List and Regulatory Groups for Nursing Homes, 2010).
An example of how this standard is attained in the facility I work at; every morning the
interdisciplinary team meets and discusses every patient that lives within the home. The team is
comprised of the administrator, director of nurses, assistant director of nurses, activities
coordinator, social worker, dietary supervisor, and the MDS coordinator. We discuss how the
patient is doing in reference to the goals that were mutually set by the patient and the team. I
think as a whole, we do very well at this standard.
Planning. This standard begins as soon as the patient is admitted to the long term care
facility. The interdisciplinary team meets along with the patient and the patients family. We
discuss what goals and expectations the patient has as well as the goals of the interdisciplinary
team have set. This standard is evaluated weekly and monthly.
Implementation. This standard is achieved on a daily basis. My role as director of
nursing is to ensure we as a facility are compliant with the regulatory guidelines as well as

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ensuring the patients are being cared for appropriately. This standard would be under F-Tag F
353 Sufficient Nursing Staff on 24-hour Basis category Nursing Services (F-Tag List and
Regulatory Groups for Nursing Homes, 2010).

I do believe there is always room for

improvement; I do believe I have met this standard.

Evaluation.

A nursing home is evaluated at least annually to ensure that the set

regulatory guidelines are being met and attained. The state visits all nursing homes to ensure
they are complying with the rules and regulations. If we have deficits in any of the F-Tags, we
would receive a citation. We would then have 21 days to be compliant. The federal government
must also survey all nursing homes. This is usually done every 5 years or more often if they
have concerns.
Standards of Professional Performance
Quality of Practice. This standard associated F-tag F 520 Facility Maintains Quality
Assurance Committee category Administration (F-Tag List and Regulatory Groups for Nursing
Homes, 2010). This committee is composed of the same team members as the interdisciplinary
team with additional members comprised of a pharmacist, medical director, and the quality risk
director. This committee meets monthly and quarterly. At these meetings we discuss staffing
opportunities/deficiencies, medication errors, falls, psychotropic medications, and any other
concerns/issues that are going on in the facility. I believe we have met and exceeded this
standard. Our facility takes pride in going above and beyond for the safety of our patients. We
always stay abreast of the most current best practices and strive to achieve them.
Education. My role as director of nurses requires a registered nurse degree. This could
either be an associates degree or a bachelors degree. The facility I work at has recently required

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director positions and above to have their masters degree. The masters degree could be in
either business or nursing. At this time, I am unsure which degree I will be achieving. I am
intrigued by obtaining my masters degree in nursing. The nurse aides are regulated by F-Tag F
494 Nurse Aide Registry Verification category Administration (F-Tag List and Regulatory
Groups for Nursing Homes, 2010). The nurse aides are required by the state to be certified.
They must also have annual competencies determined by the facility in which they are employed
by.

A nursing home can either have registered nurses or licensed practical nurses as staff

nurses.

The facility must maintain a nurse competency annually based on the high risk

procedures and the patient population. For example; our facility had a patient who needed
peritoneal dialysis. To ensure the safety of the patient and the nurses, we had an outside agency
whose expertise was in dialysis; come to the facility and in-service all the nurses on the policy
and procedure of administering dialysis. The F-Tag associated with nursing is F354 Use of
Charge Nurse & Registered Nurse category Nursing Service (F-Tag List and Regulatory Groups
for Nursing Homes, 2010). I think I do very well in this standard. I am very consciences of the
nurses and ensure they have the right tools to perform their job effectively. I provide monthly
staff meetings to inform staff of pertinent information regarding our facility. They also provide
me with feedback with any concerns they may have.
Professional Practice Evaluation
Collaboration.

This standard is extremely important especially in a nursing home

setting. It takes a team approach in caring for our patients. It is also important that everyone on
the team actively participates in the discussion of the patient. For example; a collaborative
discussion transpired and a patients discharge date had been set for Friday. This discussion was
conducted on Monday of the same week. Physical therapy was working with the patient and

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explained to the patient they were doing very well and the therapist thought they could move the
patients discharge date up to Thursday. This was not discussed with the collaborative team.
Thursday morning the patient was ready to be discharged due to the therapys recommendations.
The rest of the team was confused as to why the discharge date as changed. This is just one
example of why collaboration is important. The F-Tag associated with this standard is F154
Informed of Health Status/Medical Condition category Residents Rights (F-Tag List and
Regulatory Groups for Nursing Homes, 2010). I do not think this standard is fully met. There is
always room for improvement when it comes to collaboration. Collaboration is an attainable
standard and is necessary for the safety of our patients.
Ethics. This standard is has an impact on our everyday nursing career. We are faced
with some sort of ethical dilemma on a daily basis. I would like to share an experience I had
with a recent patient. The patient was a young 62 year old female with a diagnosis of multiple
sclerosis. She was alert and oriented to person place and time. She was her own person. She
was under the care of Hospice in our facility. She expressed to me one day she felt like she was
not getting enough oxygen, she was on 3 liters per nasal cannula. She also had a diagnosis of
chronic obstructive pulmonary disease. She requested to have her oxygen turned up to 5 liters. I
explained to her that her lungs were not healthy enough to blow off the carbon dioxide and she
would keep that gas inside her lungs. I went on to explain all the ramifications of turning up her
oxygen. She explained to me that she understood that, but didnt want to feel like she was
suffocating. I turned up her oxygen two when she felt comfortable. She eventually went to sleep
and passed away comfortably, on her terms. This is just one example of an ethical issue we are
faced with on a day to day basis. This standard could fall under many F-Tags including F155
Right to Refuse Treatment category Resident Rights (F-Tag List and Regulatory Groups for

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Nursing Homes, 2010). I truly do not think this standard will ever be completely met. It is a
standard that we all will strive to make the right ethical decision.
Resource Utilization. There are many resources utilized in the nursing home setting.
When a patient is ready to be discharged we must ensure the patient has everything they need to
be successful at home.

The social worker is instrumental in this standard. She makes the

referral to the local agencies and follows through with the type of services the patient may need.
For example; a patient that was in the nursing home for rehabilitation services due to hip surgery
is ready for discharge. The patient may need home health care, meals on wheels, in home
physical therapy, and a chore worker. The social worker will have all these services set up prior
to the patient discharging home. This standard is easily met due to the collaboration of the
patient and the social worker.
Leadership. In a nursing home setting the leadership consists of a Medical Director,
Administrator, and a Director of Nursing. The regulatory F-Tag for this standard is F490
Facility Administered Effectively category Administration (F-Tag List and Regulatory Groups
for Nursing Homes, 2010). I believe I have fully met this standard as well as the facility has met
this standard.
Professional Development Plan
Goals
I have many goal and aspirations in my nursing career. I have explained each standard as
it pertains to my current position in nursing. I have been in this current position for a little over a
year. My most important goal at this time is to learn the rules and regulatory guidelines in the
nursing home setting. I must become an expert in this field. I would also like to obtain

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certification in Director of Nursing in Long Term Care Certification DON-CLTC. The

requirements for this certification include: at least 2 years experience as a registered nurse in a
long term setting complete the independent study module, and pass the exam with 80%. I am
currently certified as a Certified Medical Surgical Registered Nurse. My ultimate goal in my
career is to become chief nursing officer. I strive for this goal because I like to make a difference
and mentor nurses.
Action Plan
My first goal will be achievable by learning all the F-Tag s and regulatory groups for
nursing homes. This goal will take hard work and dedication. Reading all the F-Tags is very
time consuming and interpretive. I have started on this goal and am happy to report that I am
half way through the F-Tags. This goal should be achieved in the next two months. This goal
will be evaluated by knowing and understanding the F-Tags without referencing the textbook.
My second goal is to obtain my certification in long term care. This goal requires a
minimum of two years working as a nurse in a long term care setting. I have been in this
position for a little over a year, so I have less than a year before I can achieve this goal. This
goal will be achieved my obtaining my certification in long term care. I will be eligible to sit for
this exam January 2015. My goal is to be certified by February 2015.
My last goal is to continue my education and become chief nursing officer. I am
currently enrolled and on track to obtain my bachelors degree with an expected graduation date
of December 2014. I plan to continue my education to obtain my masters degree in nursing.
My anticipated graduation date will be May 2017.

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Conclusion
I began my nursing career when I was a senior in high school. Ironically I started as a
nurse aide in the very facility I am now director of nursing. After graduating nursing school, my
goal and admiration was to be the best medical surgical nurse I could be. I never pictured myself
in management. As the opportunities arose for advancement, I took the challenge and havent
stopped. I believe I have excelled in my profession and have gained the respect of my peers. I
take pride in achieving the standards of practice in nursing and welcome all new challenges I
have to come.

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References
Nursing Scope & Standards of Practice. (2004). Silver Spring.
F-Tag List and Regulatory Groups for Nursing Homes. (2010, January 15). Retrieved January 2014, from
Nursing Home Pro: www.nursinghomepro.com

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Grading Rubric for

Self-Assessment of Competency regarding Standards of Practice
STANDARDS OF PRACTICE
DESCRIPTION AND ANALYSIS OF CURRENT BEHAVIORS
Description of standards
Supportive evidence (met or unmet)
Goals: Articulates clear professional goals which reflect a plan
to attain and maintain competency in each standard. These
must be specific and measurable! Refer to information on nursing
care plans re: writing clear & measurable goals to receive full credit
for this section!
Action Plan: for goals; to include actions and timelines that are
consistent with the goal statements
Evaluation Plan: to measure progress toward goals. This must be
specific and measurable!
APA checklist submitted with name of course peer who proofed.
(Points will earned if no APA errors by course instructor)
TOTAL POINTS
STANDARDS & APA CRITERIA
Writing: Analysis & Plan is presented with accuracy, precision,
clarity, relevance, depth, breadth, logic and personal significance.
Sentence structure, paragraphing, headings, spelling, typing,
grammar, neatness
APA: title page, running head, headers, abstract, margins, font
size, and references: citations in text & reference page.
FINAL POINTS EARNED

POINTS
POSSIBLE
25
25

15

15
15
5
100

Up to
30 point
deduction
100

POINTS
AWARDED