Running head: NURSING STANDARDS OF PRACTICE 1

Self-Assessment of Nursing Standards of Practice

Jessica DeRuiter
Ferris State University




NURSING STANDARDS OF PRACTICE 2

Self-Assessment of Nursing Standards of Practice
The professional practice of nursing is a highly respected field. As such, students and
nurses alike are expected to follow the professional nursing standards of practice. There are
ethical provisions in which one must strive for as well. The following text exhibits my personal
experiences in meeting these standards and provisions, goals to maintain professionalism, and a
plan to accomplish those in which I have yet to encounter. The American Nurses Associations
(ANA) Nursing: Scope and Standards of Practice and The Code of Ethics for Nursing will be
used to evaluate self.
ANA Scope and Standards of Nursing Practice
Practice Standard 1
Assessment: The registered nurse collects comprehensive data pertinent to the
healthcare consumers health and/or the situation (American Nurses Association [ANA], 2010,
p. 17). I have met this standard time and time again. While assessed by faculty at Ferris State
University, within the classroom, it was determined I could give a proper patient assessment. On
my first day of clinical the instructor verified this by observing my first patient assessment and
assisted me in charting it. Since then assessing patients confidently has been an easy skill and
done now without much thought planning. It has become so routine and can be completed more
efficiently and time effective than when I first began. I am skilled in this practice as I have found
pertinent patient issues in my assessments which were missed by the doctors and nurses. An
example of this is shared with practice standard 2, diagnosis.
Practice Standard 2
Diagnosis: The registered nurse analyzes the assessment data to determine the
diagnoses or the issues (ANA, 2010, p. 17). Nursing diagnosis has been a practice in many
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classes thus far. Students are also expected to come up with one or more nursing diagnoses
pertinent to their patients in the clinical setting. I have completed this standard often and it is one
I feel I am very proficient with.
During my first day of clinical this summer semester my assessments were not matching
up with the previous nurses assessments. I was able to see things that were not otherwise
visualized. For example, they believed and charted that the patient was non-verbal and not able
to be aroused with any stimuli as he was in that state during their assessments. In fact the patient
was verbal and was awake for two and a half hours straight speaking to me and trying to pull out
intravenous lines and a urinary catheter. The patient was confused and lethargic but could be
awoken when sat up and spoken to. I told three different nurses of my findings and worked
alongside physical therapists to get the patient to sit up and hold their own weight on the side of
the bed. I also was able to assess and measure his thigh and diagnose he had some internal
bleeding. His hemoglobin had dropped from 14 to 9 to 6.9. In between each drop he was given 2-
3 units of blood with no improvement.
When the hospitalist came into the room she asked me how the patient was. I informed
her that he was in fact verbal, he was able to be aroused, and had sat up on in the bed multiple
times. She was unaware of this. I also showed her the patients leg, told her the measurements I
had taken and showed her the area I had marked around an enlarging bruise. I brought to her
attention the negative hemoglobin changes and no reorder of blood values after his last blood
transfusion as well as my concern for this patient who, at that time, was a full code. She
immediately applauded my efforts and thanked me. She told me to call the surgeon immediately
and agreed with my assessments and diagnosis. The patients leg in question was 4 inches larger
in circumference then the other. I asked the nurse to call the surgeon as directed by the
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hospitalist. She still thought it not necessary and believed the bruising to be normal. The surgeon
assessed the patient and determined he was in fact bleeding internally and needed immediate
attention. My assessment and diagnosis for this patient proved to be very helpful and may have
even saved their life. I am unaware as to how this particular situation ended as I left the floor
after the surgeon. I am grateful to my instructor for backing up my assessments every step of the
way. It took 2 days but the instructor and I were finally able to catch someones attention on the
matter.
Practice Standard 3
Outcomes Identification: The registered nurse identifies expected outcomes for a plan
individualized to the healthcare consumer or the situation (ANA, 2010, p. 17). In the clinical
setting the students are expected to create nursing diagnoses and come up with time measureable,
attainable goals. I have done this with most patients I have cared for. It is standard practice in
Spectrum Health hospitals to establish goals with the patient daily and record them in the room
for staff and patient to see. If completed the nurse can check it off. I typically sit with the patients
during initial assessment and asked them to help create their own outcomes in hopes that the
likelihood of completion would increase due to their efforts in planning their own care. The
patients and I were almost always able to come up with goals together based on their individual
diagnosis. Success in this planning was based on the patients willingness to participate. This in
turn helped me to develop educational plans and find materials to include for the patients benefit
based on their understanding of, willingness towards, and goals for recovery.
Practice Standard 4
Planning: The registered nurse develops a plan that prescribes strategies and
alternatives to attain expected outcomes (ANA, 2010, p. 17). Planning is very much associated
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with outcomes. When the patient and I agreed on an outcome and developed measureable, time
sensitive, attainable goals I was then able to create a plan for completion. This plan was
developed with the patient if they were willing to participate. In the planning stage doors were
opened for both the patient and I to learn. I completed this standard with the help of the patients
and hospital staff. I frequently asked questions of the nurses, doctors, physical therapists, my
instructors, and others when it came to learning to establish these plans.
Practice Standard 5
Implementation: The registered nurse implements the identified plan (ANA, 2010, p.
17). I was able to achieve this with patient cooperation. After setting goals and developing a
plan, the implementation sometimes proved to be the most difficult part based on the patients
willingness and drive to complete the plan created. For example, a patient assigned to me
recovering on the medical surgical floor was not able to go home until supplemental oxygen was
no longer needed. The doctor did not want to discharge the patient until breathing effectively on
their own was no longer tiring. A goal toward discharge and effective breathing was set. The
plan was to slowly decrease the oxygen and practice activities of daily living (ADL) and walking
with each decrease while monitoring blood oxygen levels and using an incentive spirometer
frequently. The patient was able to walk the halls and perform ADLs without supplemental
oxygen after two days due to our set goals and practice.
Standard 5A. Coordination of Care: The registered nurse coordinates care delivery
(ANA, 2010, p. 17). In relation to the above standard (5) this was completed. I worked with the
patient to schedule the implementation and accomplished the goals.
Standard 5B. Health Teaching and Health Promotion: The registered nurse employs
strategies to promote health and a safe environment (ANA, 2010, p. 18). I completed this
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standard throughout clinical and can use the previous example to justify. I have printed
educational materials to give to the patient about the use of an incentive spirometer and spoke
with the patient about getting up and walking along with deep breathing to increase lung strength
and prevent pneumonia. While walking around we used both a walker and a gait belt to prevent
falls and maintain patient safety.
Standard 5D. Prescriptive Authority and Treatment: The advanced practice
registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in
accordance with state and federal laws and regulations (ANA, 2010, p. 18). This standard I
cannot meet entirely as I am not authorized as a student to do so. I was able to view tasks and
complete some of them from the patients electronic medical record but was unable to establish
or view orders. Some tasks were available to students for completion but not all.
Practice Standard 6
Evaluation of Care: The registered nurse evaluates progress toward attainment of
outcomes (ANA, 2010, p.18). I have met this standard in a limited way. I was able to evaluate
goals and see progress on patients if I kept the same patient both days of clinical. There are many
patients I think about regularly and wonder about progress for them. I will never know how their
situations turned out. I am able to see progress through charting frequently. From admission until
discharge I have read doctor and nurses notes and saw both positive progress and negative.
I have evaluated patient pain levels and reassessed them after interventions. I have
assessed patients frequently and encouraged many to create and meet goals towards healing.
Practice Standard 7
Ethics: The registered nurse practices ethically (ANA, 2010, p. 18). I have
met this standard by maintaining patient confidentiality, practicing and being aware of a
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patients 5 rights of medication administration, being honest when I dont know
something and then researching it. I follow the scope and standards to the best of my
ability and refrain from wrong doing and dishonesty in practice, class, and my personal
life.
Practice Standard 8
Education: The registered nurse attains knowledge and competence that reflects current
nursing practice (ANA, 2010, p. 18). I have met this standard thanks to the education I have
received from Ferris State University pertaining to evidence based practice. I am learning
through student centered learning as well as educating myself in the hospital based on each case I
work on and in my home while studying. I work with a medical team to absorb knowledge from
them and practice under their supervision to achieve competence.
Practice Standard 9
Evidence-Based Practice Research: The registered nurse integrates research findings
into practice (ANA, 2010, pg. 18). I have completed standard 9 as evidenced above. Students in
my simulation class at Ferris State were instructed to aspirate on intramuscular (IM) injection
before administering and taught that it was evidence based practice in our simulation lab. While
in the field I explained the steps of intramuscular injection to the health department nurse. She
was very upset that students were still being taught old methods so the nurse and I researched
the centers for disease control and prevention (CDC) books to find their recommendation. The
practice of aspiration is now not recommended during IM injection. I researched the best practice
and have implemented it in practice. The experience was a great example for me for future
research and practice.
Practice Standard 10
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Quality of Practice: The registered nurse contributes to quality nursing
practice (ANA, 2010, p. 18). I can say that I have contributed to quality care to the best
of my abilities. I have not met this standard as I am not yet a registered nurse and I cannot
say that I give quality care in general as I am still in the learning process. I give upmost
care to the best of my abilities but as I am still learning, I cannot categorize myself with
the quality standards of practicing, experienced nurses.
Practice Standard 11
Communication: The registered nurse uses a wide variety of communication skills in
all areas of practice (ANA, 2010, p. 19). I have met this standard as I communicate with my
body language and verbal language when listening to a patient. While conferencing with patients
and families I am very aware of my body language as well as verbal pertaining to messages I
may be sending. Such as not crossing my arms and active listening when being spoken to.
I also use the nurses progress notes as well as the adult patient care summary to chart
important pieces of each case so that all working with that patient may see. It is important to
communicate face to face but I also understand that if you did not chart it, you did not do it.
Therefore, I try to communicate verbally with the care team as well as through the electronic
medical record.
Practice Standard 12
Leadership: The registered nurse demonstrates leadership in the professional
practice setting and the profession (ANA, 2010, p. 19). I have met this standard. I tend
to take the lead in many groups I work in. I am not typically appointed this role but end
up being the unspoken leader. I would rather be totally involved in a group assignment or
situation and feel the outcome is my responsibility. I have not been a registered nurse in a
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leadership role of a floor or patient. I have led care for patients when the nurse is busy
and ask for assistance when necessary. I have also led groups in class and clinical to
complete various assignments.
Practice Standard 13
Collaboration: The registered nurse collaborates with healthcare consumer, family, and
others in the conduct of nursing practice (ANA, 2010, p. 19). I have not met this standard. I can
say that I have collaborated with healthcare consumer, family, and others separately but never all
together. Each patient care scenario has been completely different one from the next in the
clinical setting. One case previously mentioned above, where I spoke with many nurses, physical
therapists, the hospitalist, and the surgeon is the closest I have come to meeting with all parties
involved. I left every day before the family arrived and was never able to speak with or hear their
input and wishes, nor talk with them about care. It is the nurses job to collaborate with the
whole team and I have not been privileged with this task as I am yet a student.
Practice Standard 14
Professional Practice Evaluation: The registered nurse evaluates her or his
own nursing practice in relation to professional practice standards and guidelines,
relevant statutes, rules, and regulations (ANA, 2010, p. 19). I have met this standard as I
have been educated on and expected to evaluate myself throughout this learning process
in the classroom as well as clinical setting. This paper alone completes this standard 14.
Students are also required to assess their learning experience and actions throughout each
clinical experience in order to complete the term.

Practice Standard 15
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Resource Utilization: The registered nurse utilizes appropriate resources to
plan and provide nursing services that are safe, effective, and financially responsible
(ANA, 2010, p. 19). In the clinical setting I have completed this standard frequently. I
plan the assessment and bath at the same time. I change the linen and observe the patient
for skin breakdown and risks of it. By doing this I am keeping the patient safe and saving
the hospital money by preventing nonpayment due to a hospital acquired bedsore or
ulcer.
I also educate and promote the patients to use an incentive spirometer and
deep breathing techniques. I listen to their lungs and evaluate the use of the spirometer
for accuracy. This is financially responsible as a spirometer, and my time to observe use,
is cheaper and safer than a patient developing pneumonia in the hospital.
I use a gait belt for patients who are a fall risk. I also clean the patients rooms
to prevent falls, and recycle all necessary supplies to save money and the environment. I
am careful to not grab more supplies the needed in order to not waste any.
Practice Standard 16
Environmental Health: The registered nurse practices in an environmentally safe and
healthy manner (ANA, 2010, p. 19). I have met this standard as I use universal precautions for
each and every patient and nurse. I wash my hands on entering and on exiting the patients room.
I use the sanitation wipes to frequently clean my stethoscope and shoes. If a patient is in isolation
I use the hospitals stethoscope and leave a pen in the room so that I do not use any of my
supplies on an isolation patient as well as another patient. I use a new probe cover every time I
take a temperature and educate the patients on good hygiene practices. I am aware of the
locations of the clean utility, soiled utility, and material safety data sheets (MSDS) for each floor
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I practice on.
Code of Ethics for Nurses
Ethical Provision 1
The nurse, in all professional relationships, practices with compassion and respect for
the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of
social or economic status, personal attributes, or the nature of health problems (American
Nurses Association [ANA], 2001, p. 1). I have completed this provision. I have worked with
patients from all walks of life. I have worked with many different races, ages, and cultural
groups and each time I treated them all with equal respect and maintained their dignity and
privacy the best I could. I try to prevent patients from being exposed and keep their doors and
curtains closed whenever I am asking personal questions and during hygiene and assessments.
I have had patients with a history of drug abuse, sexually transmitted diseases, contact
precautions due to resistant organisms. I have cared for a patient who would not hold her
newborn, had patients with religious practices and patients without, patients with insurance,
patients without insurance, patients who are students, unemployed, and employed. With each
patient comes a new challenge and experience. I keep an open mind and provide professional
care without bias or discrimination.
Ethical Provision 2
The nurse's primary commitment is to the patient, whether an individual, family, group
or community (ANA, 2001, p. 1). I have met this provision and can use a previous example to
justify. The patient I cared for whom was bleeding internally could not advocate for himself as
he was confused and sedated with pain medications most of the time. I went in his room
frequently to make sure he was clean and warm and assessed for alertness. I monitored his
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wound and made him and my other patient of the day priority over all else I had going on. I have
missed lunch and dinner breaks and have held my bladder for hours longer than I would have
liked to. I know that I must take care of myself, and I do most days, but sometimes the patient
takes priority of all of my clinical time.
Ethical Provision 3
The nurse promotes, advocates for, and strives to protect the health, safety and rights of
the patient (ANA, 2001, p.1). I have met this provision with most patients. Students in the
clinical setting are required to educate our patients on something pertaining to their
circumstance. In educating the patient I am promoting and providing means for protecting their
health and safety. By washing my hands before going into a room and on exit and using sterile
technique when necessary I am protecting the patients health and safety. I respect the patients
right to privacy and maintain confidentiality as well as practice the 5 rights on each medication
administration. I advocate for the patients as mentioned in provision 2.
Ethical Provision 4
The nurse is responsible and accountable for individual nursing practice and determines
the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum
patient care (ANA, 2001, p. 1). I have not met this provision as I am not yet a professional
nurse nor am I given the authority to delegate tasks. I have witnessed this done by the nurse to
other nurses and nurse assistants but have no experience with it personally. Once a registered
nurse I will be granted authority to delegate tasks to aides to better manage nursing duties. For
example, I will assist with the patients bath long enough to give meds and the patient assessment
and leave the majority of the hygiene to the aide when necessary. In doing this I will be able to
get to the next patient more quickly. I will also delegate most situations of vital signs and meal
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assistance to the aide so that I can be available for more important tasks.
Ethical Provision 5
The nurse owes the same duties to self as to others, including the responsibility to
preserve integrity and safety, to maintain competence, and to continue personal and professional
growth. (ANA, 2001, p.1). I have not completely met this standard as I make the patient
priority over my needs. It is not safe for me to place the patient over my urge to void and
nutritional needs. I provide safety to myself and others through the use of frequent hand
washing. Each patient provides a new experience and opportunity for growth. I look to my
clinical instructor, physicians, nurses, the patient, and other resources to further educate myself
and maintain growth.
Ethical Provision 6
The nurse participates in establishing, maintaining and improving health care
environments and conditions of employment conducive to the provision of quality health care
and consistent with the values of the profession through individual and collective action (ANA,
2001, p.2). I have met this standard as I frequently spend down time organizing and re-stocking
the work environment. Keeping everything cleaned and stocked improves the environments and
makes the job easier for all employees. When rooms are stocked quality can be met more easily
thanks to timeliness and organization. The hospital hires staff to keep the rooms stocked but
everyones job is made easier when all employees work as a team and take on other tasks when
necessary.
Ethical Provision 7
The nurse participates in the advancement of the profession through contributions to
practice, education, administration and knowledge development (ANA, 2001, p.2). I have not
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yet met this standard as I am not employed to contribute ideas on advancement of the profession.
When I am a professional nurse I will remember to help educate the student nurse as often as
possible. I personally had some rather difficult experiences working with nurses whom did not
want a student to shadow them. This is a policy that the hospital can change to improve practice,
education, administration, and knowledge development. If each nurse was happy and willing to
educate the students the entire experience would improve for all involved.
Ethical Provision 8
The nurse collaborates with other health professionals and the public in promoting
community, national and international efforts to meet health needs (ANA, 2001, p.2). I have
met this standard through my service learning projects. I was able to collaborate with health
professionals at a clinic to provide care in the community and reach out to underserved
populations. I was able to provide care and promote education and healing to those in need. I was
able to provide health needs internationally as I worked to raise money for people suffering from
loss and illness due to poverty and floods in Nepal. I signed up to go to Nepal on a mission trip
where I would have contributed skills rather than money alone to the care of others. I was unable
to go but have high hopes to go on a trip in November and plan to help those in need locally and
internationally as often as I can as a professional nurse.
Ethical Provision 9
The profession of nursing, as represented by associations and their members, is
responsible for articulating nursing values, for maintaining the integrity of the profession and its
practice, and for shaping social policy (ANA, 2001, p. 2). I have not yet met this standard as I
am not part of a professional association nor am I a member of an organization other than
student. I hope to be part of nursing organizations once I am licensed. I hope to maintain my
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values and grow in knowledge and help spread it and my experience to others.
Professional Development Plan
Goals
In order for me to improve my skills, professionalism, and meet all the nursing standards
I must establish goals for myself. I hope to find a career in pediatrics and promote continuing
education to staff as well as provide a great atmosphere promoting student learning and patient
healing by the year 2020.
I hope to improve my communication skills to be able to connect with all members of the
healthcare team. I want to set a goal to work with informatics to improve patient care,
employment, and organization of the company. Improving communication will help me maintain
many standards such as coordinating care, health promotion, as well as providing communication
to the family, the patient, and members of the team. I hope to begin meeting this goal a year after
graduation once I am established somewhere and still continuing my education.
I will set a goal to not forget my struggle from the admission process, to working a full
time job during school to pay for books, transportation fees and tuition. I will not forget the
struggle in maintaining enrollment while pregnant and caring for an infant. I will not forget how
hard I had to work to get this far and will never forget how I will feel the moment I am handed
my diploma as well as the moment I pass my board exam. I want to remember the hard times to
better appreciate the good and I want to always push myself to complete my goals as the
outcome is almost always worth the fight. If I continue to possess this drive I believe I can
accomplish much in my career. This goal is one that will surpass my education and employment
years.
Action Plan
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I hope to use my current supervision and leadership certificate and continue my education
to achieve a doctorate in nursing to lead an organization or floor. With this education I can better
manage a floor and promote change and improvement on it. I have leadership skills that seem to
come naturally and would like to improve those skills in order to promote quality care and
change for the better in regards to patient care, student learning, and employment for all.
To improve communication I will gain insight overtime. I hope to be led by other
managers and instructors who set a good example. I will also learn to improve communication
through the advancement of my education through maintaining a doctorate in nursing.
I will be reminded of my struggle every time I see a young pregnant woman, every time I
pick up a nursing book, and every time I work with student nurses. I have learned much and can
relate to others and encourage them to meet their goals as well. I will also keep my diploma close
and my values closer. I have a passion for the professional field of nursing and cannot wait to
make a difference in the lives of those in need.
Evaluation Plan
To evaluate my outcomes I will determine the timeliness of my goals and whether or not
I have achieved them within the allotted time. If by 2020 I have not been able to lead change and
am not working on my doctorate I will have to reevaluate my goals and timeline. If I have not
met any goals in the given time I will reevaluate my goals entirely to see if the time of
completion is achievable and my situation allows for it. I will know if I am making a difference
based on patient outcomes, my reputation in the organization, and the attitudes of those I work
with.

Conclusion
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This journey has taught me much and I cannot wait to put my skills into practice. I have
met most all standards and am impressed with Ferris State Universitys staff and clinical
program for making it possible for me to do so. The skills I learn in the clinical field cannot be
taught through books alone. The experiences and insight I have gained into the field of nursing
will follow me throughout my career and I look forward to see where this profession will take
me. Or better yet where I will take it.
















References
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American Nurses Association (2001). Code of ethics for nurses with interpretive statements.
Silver Spring, MD: American Nurses Association.
American Nurses Association. (2010). Nursing: Scope and standards of practice
(2nd ed.). Silver Spring, MD: American Nurses Association.