Standards of Practice
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Avedis Donabedian (1988) said, “Standards are professionally developed expressions of the range of acceptable variations from a norm or criterion.” Concern for the quality of care is a major part of nursing’s responsibility to the public. Therefore, the nursing profession is accountable to the consumer for the quality of its services.
One of the defining characteristics of a profes- sion is the ability to set its own standards. Nursing standards were established as guidelines for the profession to ensure acceptable quality of care (Beckman, 1995). Standards of practice are also used as criteria to determine whether appropriate care has been delivered. In practice, they repre- sent the minimum acceptable level of care. Nurses are judged on generally accepted standards of prac- tice for their level of education, experience, posi- tion, and specialty area. Standards take many forms. Some are written and appear as criteria of pro- fessional organizations, job descriptions, agency policies and procedures, and textbooks. Others, which may be intrinsic to the custom of practice, are not found in writing (Beckman, 1995).
State boards of nursing and professional organi- zations vary by role and responsibility in relation to standards of development and implementation (ANA, 1998; 2011). Statutes written by the gov- ernment, professional organizations, and health- care institutions establish standards of practice. The nurse practice acts of individual states define the boundaries of nursing practice within the state. In Canada, the provincial and territorial associations define practice.
The courts have upheld the authority of boards of nursing to regulate standards. The boards ac- complish this through direct or delegated statutory language (ANA, 1998; 2004; 2011). The American
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34 unit 1 ■ Professional Considerations
Nurses Association (ANA) also has specific stan- dards of practice in general and in several clinical areas (ANA, 2010) (see Appendix 2). In Canada, the colleges of registered nurses and the registered nurses associations of the various provinces and territories have published practice standards. These may be found at www.cna-aiic.ca.
Institutions develop internal standards of prac- tice. The standards are usually explained in a spe- cific institutional policy (for example, guidelines for the appropriate administration of a specific chemo- therapeutic agent), and the institution includes these standards in its policy and procedure manuals. The guidelines are based on current literature and research. It is the nurse’s responsibility to meet the institution’s standards of practice. It is the institu- tion’s responsibility to notify the health-care per- sonnel of any changes and instruct the personnel about the changes. Institutions may accomplish this task through written memos or meetings and in- service education.
With the expansion of advanced nursing prac- tice, it has become particularly important to clarify the legal distinction between nursing and medi- cal practice. It is important to be aware of the boundaries between these professional domains be- cause crossing them can result in legal conse- quences and disciplinary action. The nurse practice act and related regulations developed by most state legislatures and state boards of nursing help to clarify nursing roles at the various levels of practice.
Use of Standards in Nursing Negligence Malpractice Actions When omission of prudent care or acts committed by a nurse or those under his or her supervision cause harm to a client, standards of nursing prac- tice are among the elements used to determine whether malpractice or negligence exists. Other criteria may include but are not limited to (ANA, 1998; 2011):
■ State, local, or national standards ■ Institutional policies that alter or adhere to the
nursing standards of care ■ Expert opinions on the appropriate standard of
care at the time ■ Available literature and research that
substantiates a standard of care or changes in the standard