2. Call to Action: Nursing Scope and Standards of Practice November 6, Boise, ID Heather Healy, MS, RN, FNP-BC, NEA-BC Nursing Scope and Standards Revision Workgroup

3. Heather Healy BSN – Arizona State University, 1996
MSN – Arizona State University, 2006
Family Practice Nurse Practitioner
CNO, Deaconess Hospital Spokane, WA
Advisory Board Member – Gonzaga SON, Washington State SON and Spokane Community Health Advisory Board
INSERT PIC

4. Conflict of Interest
Insert any COI or disclosures needed: The potential for conflict of interest exists when an individual has the ability to control or influence the CE content (either through planning, implementation or reviewing) and they have a financial relationship with a commercial interest, the products or services of which are pertinent to the content of the educational activity.
I have no conflicts of interest or disclosures to disclose.

5. Learning Objectives The learner will be able to:
Identify three key messages integrated within the definition of nursing
Describe the framework for the Standards of Practice
Address the importance of the Standards of Professional Performance
Name the final decision-maker represented in the professional regulation pyramid

6. The Workgroup was made up of 39 members from all areas of nursing – from the bedside to the boardroom. The group spent over 12 months on bi-weekly conference calls and one in person weekend meeting at ANA headquarters in Maryland. This group came together to share ideas, expertise, and experiences to enhance the 2015 scope and standards of nursing practice. Several members of the group are presenting across the nation to Universities, local business, state associations and specialty organizations.

7. Protection, promotion, and optimization of health and abilities,
Definition of Nursing
Nursing is the:
Protection, promotion, and optimization of health and abilities,
Prevention of illness and injury,
Facilitation of healing,
Alleviation of suffering through the diagnosis and treatment of human response, and
Advocacy in the care of individuals, families, groups, communities, and populations.
This contemporary definition has been modified from that published in the 2003 Social Policy Statement and the 2004 and 2010 Scope and Standards of Practice – with the inclusion of “Facilitation of healing” and “groups”. How do these additions move us toward a more unified future?

8. Nursing: Scope and Standards of Practice, Third Edition
Scope of Practice Statement Describes
Who - All RNs, including graduate level-prepared RNs and advanced practice RNs (APRNs), educated, titled, and actively licensed to practice nursing .
What - The definition of nursing provides a succinct, inclusive, and descriptive characterization of nursing.
A professional organization has a responsibility to its members and to the public it serves to develop the scope and standards of practice for its profession. ANA has long assumed the responsibility for developing and maintaining the scope of practice statement and standards that apply to the practice of all professional nurses and also serve as a template for evaluation of nursing specialty practice.
During our work we also looked to the community to provide input in the development and revision of this work.

9. Nursing: Scope and Standards of Practice, Third Edition
Scope of Practice Statement Describes
When and Where – Whenever there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education – anytime, anywhere.
Why – Nursing’s response to the changing needs of society to achieve positive healthcare outcomes in keeping with nursing’s social contract with and obligation to society.

10. Nursing: Scope and Standards of Practice, Third Edition
Scope of Practice Statement Describes
How – The ways, means, methods, and manners nurses use to practice professionally.
Adherence to the nine provisions of the 2015 Code of Ethics for Nurses With Interpretive Statements
Application of the nursing process
The Scope of Practice Statement reaffirms compliance with the nine provisions of the 2015 Code of Ethics for Nurses With Interpretive Statements.

11. Standards of Professional Nursing Practice
Standards are authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty, are expected to perform
Include Standards of Practice and Standards of Professional Performance
Each standard is accompanied by competencies for all registered nurses, with additional competencies for graduate-level prepared registered nurses and APRNs
The Standards of Professional Nursing Practice provide additional details about the duties of all registered nurses in the language of practice and professional performance standards with accompanying competencies. Those competencies are not an exhaustive listing.

12. This new representation of the Standards of Professional Nursing provides more details than the 2010 version.

13. Standards of Practice Addresses the use of the nursing process
Standard 1 Assessment
Standard 2 Diagnosis (Expanded for APRNs)
Standard 3 Outcomes Identification
Standard 4 Planning
Standard 5 Implementation
Standard 5A Coordination of Care
Standard 5B Health Teaching and Health Promotion
Standard 5C Consultation
Standard 5D Prescriptive Authority and Treatment
Standard 6 Evaluation
1) The Standards – describe a competent level of nursing care as demonstrated by the critical thinking model known as the nursing process. The nursing process encompasses significant actions taken by RNs and forms the foundation of the nurse’s decision – making.
2) Standard 5C Consultation and 5D Prescriptive Authority and Treatment were removed as Standard 5 Implementation was reformatted to also address competencies for RN, Graduate-level Prepared Registered Nurse, and APRNs.

14. Standard 5 Implementation
The registered nurse implements the identified plan.
Competencies
The registered nurse:
Partners with the healthcare consumer to implement the plan ….
Integrates interprofessional team partners in implementation of the plan ….
Demonstrates caring behaviors to develop therapeutic relationships.
Provides culturally congruent, holistic care that ….
Uses evidence-based interventions and strategies to achieve ….
Integrates critical thinking and technology solutions to implement ….
Delegates according to the health, safety, and welfare of ….
Documents implementation and any modifications ….
See how Standard 5 Implementation is presented. The short title is followed by the succinct standard statement. The Competencies list that follows addresses the registered nurse, graduate-level prepared registered nurse, and APRN or advanced practice registered nurse levels.

15. Standard 5 Implementation - Continued
Additional Competencies for the Graduate-level Prepared Registered Nurse
In addition to the competencies of the registered nurse, the graduate-level registered nurse:
Uses systems, organizations, and community resources to lead effective change and implement the plan.
Applies quality principles while articulating methods, tools, ….
Translates evidence into practice.
Leads interprofessional teams to communicate, collaborate, ….
Demonstrates leadership skills that emphasize ethical ….
Serves as a consultant to provide additional insight and potential solutions.
Uses theory driven approaches to effect organizational or system change.
Note the statement that the graduate-level prepared registered nurse is expected to demonstrate the competencies of the registered nurse as well as those identified as additional competencies for this level.

16. Standard 5 Implementation - Continued
Additional Competencies for the Advanced Practice Registered Nurse
In addition to the competencies of the registered nurse and the graduate-level prepared registered nurse, the advanced practice registered nurse:
Uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.
Prescribes traditional and integrative evidence-based treatments, therapies, and procedures that are compatible with the healthcare consumer’s cultural preferences and norms.
Prescribes evidence-based pharmacological agents and treatments according to clinical indicators and results of diagnostic and laboratory tests.
Provides clinical consultation for healthcare consumers and professionals related to complex clinical cases to improve care and patient outcomes.

17. Standards of Professional Performance
Standard 7 Ethics
Standard 8 Culturally Congruent Practice - NEW
Standard 9 Communication
Standard 10 Collaboration
Standard 11 Leadership
Standard 12 Education
Standard 13 Evidence-based Practice & Research
Standard 14 Quality of Practice
Standard 15 Professional Practice Evaluation
Standard 16 Resource Utilization
Standard 17 Environmental Health
The Standards of Professional Performance have been reordered and include the new Standard 8 Culturally Congruent Practice following Standard 7 Ethics.

18. Standard 8 Culturally Congruent Practice
The registered nurse practices in a manner that is congruent with cultural diversity and inclusion principles.
Competencies
The registered nurse:
Demonstrates respect, equity, and empathy in actions and interactions with all healthcare consumers.
Participates in life-long activities to understand cultural preferences….
Creates an inventory of one’s own values, beliefs, and cultural heritage.
Applies knowledge of variations in health beliefs, practices, ….
Identifies the stage of the consumer’s acculturation….
Considers the effects and impact of discrimination and oppression ….
Uses skills and tools that are appropriately vetted for the culture, ….
Additional competency statements ….
Standard 8 Culturally Congruent Practice has been included in light of the increasing importance of health and wellness, person-centered care, and interprofessional teams in today’s healthcare delivery system.

19. Professional Practice Regulation
This Professional Practice Regulation diagram in the Scope of Practice statement and its accompanying description are intended to help you appreciate the complexities of nursing practice regulation, beginning at the base with the profession’s contribution and then culminating with self-determination by the registered nurse.

20. Added Resources & Content
Appendix A – Nursing: Scope and Standards of Practice, Second Edition (2010)
Appendix B – Nursing’s Social Policy Statement: The Essence of the Profession (2010)
Appendix C – ANA Position Statement: Professional Role Competence (2014)
Appendix D – The Development of Essential Nursing Documents and Professional Nursing
Appendix E – Selected Nurse Theorists
Appendix F – Culturally Congruent Practice Resources
Added content serves to supply a better appreciation of the history, content and context related to Nursing: Scope and Standards of Practice, 3rd Ed.

21. Special thanks …
Elizabeth (Libby) Thomas, Chairperson – for her insight, laughter and support as we pulled this work together – she always kept us on track and on time
Carol Bickford, ANA Staff – Content editor – for her tireless commitment to detail and to the written word. Carol was an inspiration to all of us
Mary Jo Assi, Eric Wurzbacher and Yvonne Humes for keeping us moving forward and providing input, resources and expertise just when we needed it.

22. Here’s the cover of the print version.

23. Publication Format Print Version Part of Essentials Package
Electronic Version Available
Institutional Purchase for Intranet Posting or

24. Call to Action – RAISE the bar
Reading Nursing: Scope and Standards of Practice, 3rd Ed
Assessing the document and contemplating what it means to you and your practice
Integrating Scope and Standards of Practice, 3rd Ed into practice by developing culturally congruent care in every situation and setting
Sharing the word and encouraging other nurses to integrate Scope and Standards of Practice, 3rd Ed into practice
Excelling in using knowledge and conducting and applying research to achieve the highest quality, evidence-based care
Every scope and standards of practice discussion is incomplete without an action plan.

25. So…What Actions Will You Complete? What Questions Remain?
Heather Healy, MS, RN, FNP-BC, NEA-BC /