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Nursing Standards of Practice

     By McMahon & Associates Certified Legal Nurse Consultants

PhoneCall Dianne McMahon, Certified Legal Nurse Consultant at (866) 466-1519

Standards of practice (standards of care) are guidelines used to determine what a nurse should or should not do. Standards may be defined as ď a benchmark of achievement which is based on a desired level of excellenceĒ. Standards of care (SOCís) measure the degree of excellence in nursing care and describe a competent level of nursing care.
A standard is a model of established practice that is commonly accepted as correct. The care provided by nurses is guided by standards of care. Standards of care were developed and implemented to define the quality of care provided. They are the basis for nursing care and draw on the latest scientific data from nursing literature. Clinical, administrative and academic experts have contributed to the development of standards of nursing practice.

All standards of practice provide a guide to the knowledge, skills, judgment and attitudes that are needed to practice safely. The standards are based on the premise that the registered nurse is responsible for and accountable to the individual patient for the quality of nursing care he or she receives. SOCís provide a means of determining the quality of care which an individual receives regardless of whether intervention is provided solely by a registered nurse or by a registered nurse in conjunction with other licensed or unlicensed personnel.

The standards of practice shall:
1. Be considered as the baseline for quality nursing care
2. Be developed in relation to the law governing nursing practice
3. Apply to the registered nurse practicing in any setting
4. Govern the practice of the licensee at all levels of practice

Federal and state laws, rules and regulation and other professional agencies/organizations help define standards of practice. They are developed by professional organizations, usually at the national level, to establish norms for the average practitioner. The ANA and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have established nationally recognized standards of care. These standards can hold nurses accountable, regardless of their area or state of practice. SOCís can be found at a national, state and local level. The trend is toward national SOCís. All levels of expertise, from new graduate to experience nurse, should be able to meet these expectations of practice.

A standard of care holds a person of exceptional skill or knowledge to a duty of acting as would a reasonable and prudent person possessing the same or similar skills or knowledge under the same or similar circumstances. Standards of care may serve as guidelines when evaluating nursing care for possible negligence. They define acts that are permitted to be performed or prohibited from being performed. SOCís give direction to the nurse Ė defining what should or should not be done for patients.

Any nurse who does not meet accepted standards of care runs a risk of being found negligent. Nurses who give competent care based on their education will seldom be involved in malpractice. Most legal actions against nurses arise because a patient claims the nurse breached a standard of care and that the breach resulted in harm to the patient. Malpractice (negligence on the part of a healthcare professional) is one legal action that a nurse may be charged with for failing to meet the standards of care.

Nurses have been held accountable for inappropriately administering medications, failing to protect the patient from harm (i.e. patient who receives burns from warming measures, patient who falls out of bed), and failing to monitor equipment that later causes harm to the patient. Not adhering to the state regulations related to the delegation of nursing tasks to non-nursing, unlicensed personnel and erroneous patient identification can also be the basis of legal liability related to nursing standards of care.

According to SOCís, a licensed nurse shall, in a complete, accurate and timely manner, report and document nursing assessments or observations, the care provided by the nurse for the client, and the clientís response to that care. Nurses assume a liability risk if they fail to monitor a patient or to recognize changes in a patientís condition. Failure to recognize the significance of changes or to communicate them clearly and promptly to the attending practitioner could endanger the patient.

Nursing standards are important because they:
1. Outline what the profession expects of its members
2. Promote, guide, and direct professional nursing practice important for self-assessment
and evaluation of practicing nurses
3. Aid in developing a better understanding and response for the various and
complementary roles that nurses have

Professional standards ensure that the highest level of quality in care is promoted. Standards provide a method to assure that clients are receiving high-quality care, that the nurse knows the essentials to provide nursing care, and measures are in place to determine whether the care meets these standards. SOCís reflect both the caring and professional expectations of nursing. Meeting the standard of care involves being technically competent and keeping up to date with nursing SOCís.

By virtue of these standards, society holds nurses and those under their supervision accountable for their actions. The law generally views a standard as that practice which has general recognition and conformity among professionals. A professional nurse supervises, teaches and directs those involved in nursing care. Guidelines are essential to monitor how the nurse performs professionally. Excellent nursing practice is a reflection of ethical standards.

The sphere of a nurseís accountability is to the client, the employing agency, and the profession. Standards are agreed-upon levels of excellence and describe the responsibilities for which nurses are accountable. The regulatory practice framework has the primary intent of protecting the public. Competent nursing care is an important part of the healthcare delivery system. Provision of high-quality care consistent with established standards is critical.

The nurse is responsible and accountable for the quality of nursing care given to clients. The single most important protective strategy for the nurse is to be a knowledgeable and safe practitioner of nursing and to meet the standards of care with all patients. Nurses are empowered by the SOC and the trust of the physician and the patient to ensure quality care.

Todayís practicing nurse must be aware of nursing standards, legal issues in nursing, legal limits of nursing and legal liabilities. Otherwise, he or she could be the first person to be penalized from a legal standpoint. Legal responsibilities in nursing practice are growing in importance day by day. Legal accountability is an essential concept of professional nursing practice that can pose a threat to a nurseís career if he or she is uninformed of the law. Legal issues confronting practicing nurses today are legion. The nurse need not view the law not with apprehension but as a helpful adjunct to the practice of nursing.

ABOUT THE AUTHOR: Dianne McMahon, Certified Legal Nurse Consultant
The author has over 20 years of nursing experience in the clinical and academic setting. She is a certified legal nurse consultant. She has a bachelor's degree in nursing from the University of Colorado.

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While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.