Running Head: ASSESSING THE NURSING STANDARDS

Assessing the Nursing Standards of Practice

Gail Luskin
Ferris State University

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Abstract

Nearing the end of a nursing program, it is important to look back and determine how complete
the education received was. Registered nurses must follow the Standards of Professional Nursing
Practice in order to be competent and confident in their practice. These standards hold the nurses
to a higher standard while also helping the nurses to hold themselves to a higher standard
compared to their peers. This paper addresses these standards and how well Ferris State
University has enforced them in our education. After diving into each standard, a plan will be
created to address how the standards will be enforced in my future practice as a registered nurse.

ASSESSING THE NURSING STANARDS

Assessing the Nursing Standards of Practice

Nursing is the protection, promotion, and optimization of health and abilities, prevention
of illness and injury, alleviation of suffering through the diagnosis and treatment of human
response, and advocacy in the care of individuals, families, communities, and populations
(American Nurses Association, 2010, p.1). Nurses are the ones to help bring life into the world
and hold the hand of the life leaving the world. With such an important role, nurses must be held
and hold themselves to a higher standard. The Standards of Professional Nursing Practice are
authoritative statements of the duties that all registered nurses, regardless or role, population, or
specialty are expected to perform competently (ANA, 2010, p.31). As my year of nursing
school at Ferris State University is almost up, I take the chance to look back on what I have
learned in relation to the Standards of Practice each RN is expected to follow.
Standards of Practice
The Standards of Practice describe a competent level of nursing care as demonstrated by
the critical thinking model known as the nursing process (ANA, 2010, p.9). Through the
Standards of Practice, the registered nurse must meet the standards of assessment, diagnosis,
outcomes identification, planning, implementation, and evaluation.
1. Assessment
The standard of assessment involves looking a person holistically, or a physical,
functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental,
spiritual/transpersonal, and economic uniqueness of a person (ANA, 2010, p.32). When a nurse
assesses a patient, they are collecting data on not only their health status, but also on their health
care preferences, attitudes, beliefs, and values. All of this is done using current and appropriate
evidence-based practice.

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Through my education and clinical experience, I have been shown the appropriate ways
of assessing patients. I feel quite confident that I am meeting this standard in my clinical practice
and I hope to be able to transfer what I have learned into my future career. Each patient that I
encounter, I treat with the utmost respect and continually assess their health up until the minute
my shift is over. I want to make sure that each of my patients are treated so that they can obtain
the best health possible and that they are satisfied with the care that I give.
2. Diagnosis
The registered nurse identifies actual or potential risks to the healthcare consumers
health and safety or barriers to health, which may include but are not limited to interpersonal,
systematic, or environmental circumstances (ANA, 2010, p.34). While assessing each patient,
the nurse is expected to follow the standardized classification systems to develop nursing
diagnoses relating to an overall plan of care. Nurses also collaborate with physicians on their
diagnoses to determine the most appropriate plan of care.
One of my favorite things that I have learned in nursing school is the use of nursing
diagnoses. To me, it is almost like a game trying to match a diagnosis to a patient after
holistically assessing them and coming up with a plan of how to promote knowledge,
functioning, or acceptance of health. In my clinical experience, we have been taught to find a
diagnosis for each patient and be willing to modify them as the patient travels through the
healthcare setting. Also, we work with physicians and other providers on their diagnoses and see
if we can develop a plan of care together.
3. Outcomes Identification
Like the standard of diagnosis, outcomes identification involves creating a plan that is
specific to each patient. The registered nurse identifies expected outcomes for a plan

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individualized to the healthcare consumer or the situation (ANA, 2010, p. 35). The nurse must
consider associated risks, benefits, costs, current scientific evidence, expected trajectory of the
condition, and clinical expertise when formulating expected outcomes (ANA, 2010, p. 35).The
outcomes must be all encompassing of the patients care and realistically obtainable for the
patient and their providers.
After we are assigned a patient, complete assessments, and formulate a diagnosis, we
must create a plan of realistically obtainable goals for the continuation of patient care and
healing. The outcomes that we create are ways that the patient can work towards better health
either by themselves or with our help. I believe that my practice in both clinical and educational
experience has helped me to understand how to develop appropriate outcomes for my patients,
but I can see how this will grow further as I continue in the nursing career.
4. Planning
As I have mentioned before, nurses must come up with a plan that is based off of each
assessment, diagnosis, and realistic outcomes. They can collaborate with the patients care
provider so that there is continuity of care. The registered nurse develops an individualized plan
in partnership with the person, family, and others considering the persons characteristics or
situation, including, but not limited to, values, beliefs, spiritual and health practices, preferences,
choices, developmental level, coping style, culture and environment, and available technology
(ANA, 2010, p.36). This plan addresses goals on regaining health, restoring function,
understanding health or the progression of a disease, and continuing care after discharge based
realistically on each patient.
We have had the opportunity to create care plans on each of our patients that involve
evidence-based practice and allows the patient to be involved in their own health care. I like to

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think that each patient comes to us for help but we wont be around them always, so we need to
create a list of goals that need to be accomplished by the patient or their providers so that they
can get the best out of their health care experience. Just like for outcomes identification, I feel
like I have gotten practice in this experience but I will definitely grow more once I am in the
field. It is also difficult for us because the only people that see the care plans that we create are
our instructors and ourselves. I would have liked to discuss care plans more with each patient
and the patients provider.
5. Implementation
Involved in the implementation of care plans are the coordination of care, health teaching
and promotion, consultation, and prescriptive authority and treatment. The implementation
standard has the nurse partnering with the person, family, significant others, and caregivers as
appropriate to implement the plan in a safe, realistic, and timely manner (ANA, 2010, p.38).
This is where the nurse teaches the plan to the patient and all members directly caring for the
patient so that the plans are understood by everyone and the care is continued. If the patient does
not understand or is not willing to do a portion of the plan, this is where the nurse must modify
the plan to something that is more realistic.
This is where I start to feel not as confident in the standards process. In my clinical
experience, I have implemented the plans of others in the care of the patient lives that I have
touched, but I have never been one to create a plan that is implemented by others. I have been
able to implement certain small goals for my patients in doing things like getting my patients up
to walk more, eat more, or understand circumstances more. Hopefully, I will still be able to
portray confidence and competence when I practice as a registered nurse even though I havent
had much experience with implementing my own care plan.

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6. Evaluation
The evaluation standard of patient care involves conducting a systematic, ongoing, and
criterion-based evaluation of the outcomes in relation to the structures and processes prescribed
by the plan of care and the indicated timeline (ANA, 2010, p.45). This standard involves
stepping back and assessing whether or not the patient is meeting the outcomes described in the
care plan. The nurse uses ongoing assessment data to revise the diagnoses, outcomes, the plan,
and the implementation as needed (ANA, 2010, p.45). The nurse must remember that they work
for the patient, so we have to always be realistic in creating the plan.
There have been a few instances in my clinical experience where I was with a patient and
realized that something was not going to work, so we had to find another way of doing a task. I
do not think that we have talked much about the evaluation of our patient care plans, but I am
hoping that just using common sense and really knowing our patients will help when the time
comes to completing this standard in practice. This standard involves us really getting to know
our patients and being able to read if a plan is working or not.
Professional Performance
Registered nurses are accountable for their professional actions to themselves, their
healthcare consumers, their peers, and ultimately to society (ANA, 2010, p.10). The Standards
of Professional Performance include ethics, education, evidence-based practice and research,
quality of practice, communication, leadership, collaboration, professional practice evaluation,
resource utilization, and environmental health.
7. Ethics
It is an absolute must that each registered nurse delivers care in a manner that preserves
and protects healthcare consumer autonomy, dignity, rights, values, and beliefs (ANA, 2010,

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p.47). The nurse must recognize family as an integral part in the patients healthcare team,
uphold confidentiality within legal and regulatory parameters, help the patient develop selfdetermination and informed decision making, using a therapeutic relationship with the patient,
resolve ethical issues within the healthcare team, and takes appropriate action and speaks up
when there something arises that is hazardous to the patient (ANA, 2010, p.47). Nurses are
always charged with the responsibility of being advocates for our patients.
Personally, I have always believed that ethics is one of the most important aspects of
patient care. In class, we have been told how many hats nurses wear when caring for their
patients. Sadly, this is one of the first times we have actually been told to open our Scope and
Standards of Practice book. In presentations, we have been told that there are these standards of
practice, but we havent really gone through them. This is why I really appreciate this assignment
because how else will we know what standards we, as future nurses, will be held to.
8. Education
The registered nurse is expected to demonstrate a commitment to lifelong learning
through self-reflection and inquiry to address learning and personal growth needs (ANA, 2010,
p.49). The nurse is expected to gain education that will help them continue through their career
with competence and confidence. Nursing is not a field that you go to school for a few years and
then you wont need to learn anything else for the rest of your life. You must be willing to
continue education because the healthcare field is continually changing and new ideas are always
changing evidence-based practice.
I believe that even though we have only had a short time in nursing school, we are
prepared to be open to continuing education. Since we are getting a lot of information in a short
period of time, we must be willing to gain knowledge while in the work place. Once we each

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pick our fields of nursing that we want to work in, we will lose some of the knowledge that we
find not needed in order to obtain new information from our educators and peers.
9. Evidence-Based Practice and Research
A nurse must utilize current evidence-based nursing knowledge, including research
findings, to guide practice (ANA, 2012, p.51). The healthcare field is continually changing, so
each nurse must be open to new and appropriate ways of doing things. Nurses must also move
away from thinking well, we have always done it this way and be more willing to research for
themselves the best and proven way of patient care. A big portion of nursing is teamwork, so
once new knowledge is found, nurses must share with each other in order to provide the
continuity of effective care.
It seems like in every class we have had to write papers or create presentations on
evidence-based practice. I believe that research is a major portion of the bachelor degree process.
In the clinical setting, we see nurses using tasks and equipment that has been proven to be
beneficial for providing appropriate patient care. Also, we hear about how the nurses continually
meet with the nursing educator to discuss newly found research. I am excited to experience
evidence-based practice in my nursing practice and I am willing to change if a better way of
doing things is found. Ferris has been good at keeping our minds on the use of evidence based
practice in patient care.
10. Quality of Practice
As I pointed out earlier, the patients do not work for the nurses. Nurses must contribute
and maintain excellent quality patient care. They must always be analyzing factors related to
quality, safety, and effectiveness (ANA, 2010, p.52). Not only are nurses supposed to

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continually assess their patients, but they must also assess the nursing practice as a whole. The
best nurses use creativity and innovation to enhance nursing care (ANA, 2010, p.52).
In class we are told about the quality of practice standard, but I feel that I have noticed
this more within the clinical setting. It would have been nice to go into a discussion on this topic
more so that we can determine how we can be better providers of quality care. I hope to learn
more about this when I get into my own nursing practice. We can all contribute to excellent
quality of practice because each and every one of our patients will be affected if we cannot give
exceptional care.
11. Communication
The registered nurse communicates effectively in a variety of formats in all areas of
practice (ANA, 2010, p.54). Nurses cannot get anything done if they do not communicate with
their patients, colleagues, and patient family members. It is the nurses responsibility to provide
information in an easy to understand way so that the understanding and continuity of patient care
is what is focused on. They must also be flexible to be able to get their point across with those
who have different communication skills.
The registered nurse seeks continuous improvement of communication and conflict
resolution skills (ANA, 2010, p.54). We are told a lot about therapeutic communication, but we
only recently have been given examples of what that really is. I would have appreciated more
discussion in our classes about therapeutic communication and in our simulation lab, I would
have liked to have been able to practice calling the provider without getting yelled at for doing it
wrong. I feel pretty competent on what to say to the patient, but I do not always know what to
say to the physician or healthcare provider. When I am at clinical, some doctors are receptive of
students while others are not interested in discussing the care plan with us.

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12. Leadership
The standard of leadership involves the nurse to demonstrate leadership in the
professional practice setting and the profession (ANA, 2010, p.55). Each nurse has the
responsibility placed on their shoulders to place themselves accountable for the care given to
each patient. They want to progress the exceptional care given to patients in their workplace and
are interested in helping their colleagues value patient care as well.
The registered nurse treats colleagues with respect, trust, and dignity (ANA, 2010,
p.55). I do not think that this is something that I have learned while studying at Ferris; I believe
that this is more something that I was just taught while growing up. I do find it sad that I have
noticed how clique-y the nursing field is. Ferris professors, students, and the nurses that we
shadow at clinical do not seem to have a lot of respect for each other. I promise to do my best to
be a leader in my profession and I am sure that I will get stronger as my practice continues in the
workplace.
13. Collaboration
Collaboration in the workplace is just as important as communication. The registered
nurse communicates with the healthcare consumer, the family, and healthcare providers
regarding healthcare consumer care and the nurses role in the provision of that care (ANA,
2010, p.57). The nurse must share their knowledge and be accepting of the knowledge of others
so that the patient gets the best care possible. They often tend to be the middle man between the
patient and the physician or provider. Nurses also adhere to standards and applicable codes of
conduct that govern behavior among peers and colleagues to create a work environment that
promotes cooperation, respect, and trust (ANA, 2010, p.57).

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Before coming to Ferris, I knew that collaboration was important because I have been on
many sports teams and work teams in my life in which we would not have gotten anything done
without teamwork. While at Ferris, I have collaborated with my fellow students on numerous
projects and when needing help with a patient at clinical. I would have liked more collaboration
with the physicians or providers of my patients, but as I have said before, some were just not
interested in discussing the care plan with students.
14. Professional Practice Evaluation
The nurse evaluates her or his own nursing practice in relation to professional practice
standards in relation to professional practice standards and guidelines relevant statutes, rules, and
regulations (ANA, 2010, p.59). This standard involves the nurse to stand back and take a look at
his or her practice. Did they make sure to give each patient exceptional care? They need to help
their coworkers see any areas in which they are lacking, but they also need to be willing to
accept constructive feedback on their own performance.
Looking back on my career at Ferris, I can say that I have tried my hardest to be the best
student nurse possible. There have been times in which I have failed, but there have been times
in which I believe that I have excelled. I have taken to heart the feedback from my instructors
and peers. This standard will be better experienced in my future nursing practice.
15. Resource Utilization
A nurse utilizes appropriate resources to plan and provide nursing services that are safe,
effective, and financially responsible (ANA, 2010, p.60). This standard involves delegation of
care to the appropriated staff, advocating for better resources, modifying practices, and assisting
patients and their families to find appropriate services and resources. Nurses must work together
to find the most appropriate resources for their patients. The patients might be unsure of where to

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go to find information on their diagnoses and outcome goals, so it is the nurses responsibility to
help them find the information.
In clinical, we are tasked with giving each patient education on diagnoses, health
promotion, or medical procedures. This helps us to learn the resources that we are provided in
the facility and give those resources to our patients so that they can become more knowledgeable
on their own care. I am sure that each facility has different resources, but it is our responsibility
to become familiar with what is available so that every patient gets the best care and options
available. This standard will be developed more as I develop my practice.
16. Environmental Health
It is the responsibility of each registered nurse to attain knowledge of environmental
health concepts, such as implementation of environmental health strategies and to promote a
practice environment that reduces environmental health risks for workers and healthcare
consumers (ANA, 2010, p.61). Florence Nightingale was the one that came up with the idea
that environment affected how a person attains good health. Each nurse needs to take the
findings of Nightingale to heart in the care of each patient.
In classes, we have been taught about Nightingale and community health so that we can
transfer those ideas into practice. In clinical, we have experienced how to make a patients
environment as comfortable as possible and what to do to comfort a patient when the
environmental stimulus is overwhelming. I feel that Ferris and my clinical experience has trained
me well in keeping in mind the environmental factors that affect patient care.
Professional Development Plan
Goals

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My main goal in life is to become a pediatric oncology nurse and help to make the lives
of children with cancer better. Through my practice, I hope to be confident in the first set of the
Standards of Practice by the end of my first year as a registered nurse. These standards include
assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. The
Standards of Practice are those that are what really makes or breaks a nurse, so my goal is to
have developed an excellent performance related to these standards. Practice should come with
each and every individual that I meet. The Standards of Professional Performance might involve
more time developing confidence in. They involve more practice, so I hope to gain confidence
within my first five years of being a registered nurse. Through continuing education, I will also
gain more knowledge and experience in ethics, evidence-based practice and research, and
environmental health. Collaboration and communication are assessed and reassessed with each
person that I work with, so these standards will be met more of as a continuation throughout my
career. Leadership and quality of practice are standards that will also continue to be developed
throughout my career, but I hope to be proficient within my first three years of being a registered
nurse. One day, I hope to become a Nurse Practitioner and will then gain more of a manager
position that will develop along with the leadership standard. Research utilization will vary
depending on where I choose to work and will also change along with the technology of the
facility.
Action Plan
It is hard to fully develop an action plan for gaining knowledge and competence in these
standards because they include a lot of growth throughout the nursing career. Recently, I have
been looking into a graduate nursing program through St. Judes Childrens Hospital. This
program will immerse me into childhood cancer care and will give me continuing education and

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current evidence-based practice within the first eight months of working there. They also provide
current and inclusive resources to both their care providers and their patient families. As stated
previously, I will gain confidence in the Standards of Practice within the first year of me being a
registered nurse. The competency will come from meeting each patient and from my supervisors
giving me feedback on what I am doing right and wrong. I have actually considered volunteering
with an ethics committee so that I can gain more knowledge on the specifics of childhood cancer
ethics. I plan on gaining competency by my fifth year of being a registered nurse. If I do become
a Nurse Practitioner by year ten, I will gain more education, evidence-based practice and
research, leadership, collaboration, and environmental health knowledge. Just being in a field
that I enjoy and am interested in will help me be more interested in developing these standards. I
believe that St. Judes will give me the confidence and competency to be the best nurse possible.
The competency that comes from the professional practice evaluation will come from evaluating
myself each month and sooner if needed; this will also continue throughout my practice.
Evaluation Plan
The way that I shall evaluate my progress in obtaining my goals will be to ask my
supervisors and coworkers to give me constructive feedback on my patient care monthly, or
when needed. Looking to others will give me an unbiased opinion on what I am doing wrong and
what I am doing right. I will also take a day at the end of each month to think about my actions
and collaborations that have taken place. During this time I will ask questions about if I have
found the right resources for my patients and their family members, if I have communicated
effectively with my coworkers, and if I have used the most current evidenced-based practice.
Also, I will attend all of the education conferences that are made available to me and
communicate with the nurse educator on the floor if there ever is a question that arises. The

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evaluation process will have to be a continual progression of collaboration with those around me
and an internal look at how I am feeling about my progress. This process will continue until I
retire from nursing and I look forward to being open to all experiences that arise.
Conclusion
My education here at Ferris State University has been excellent in both the classroom and
clinical setting. Though there are some things lacking, I feel prepared to go into the workforce
and be an exceptional nurse. Ferris has also given me the confidence and competence to be able
to ask questions of my superiors and coworkers on what I feel I am missing so that I can give my
patients the best care possible. I am grateful for all of the instruction and support that I have
gotten from my instructors and fellow students. This assignment is appreciated by not only
myself, but by the other students as well because now we have a clearer picture of what is
expected of us when we graduate. It is good to see what standards that I will be held to, so that I
can hold myself to a higher standard as well. My passion is to help people obtain their best health
but if they cannot, then I want to be there for them until the very end. Many people are alive
today because of the exceptional care of nurses, and I hope to be one of those nurses.

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References
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver
Spring, MD: Author.