Nursing Care: Standard of Care

A standard of care is a legal concept that all nurses should become familiar with and understand. This concept is used to depict a standard or measure of behavior that describes how a nurse is expected to act or professionally conduct him- or herself according to an accepted reasonable practice of nursing care.

Standards of care and practice can be published within a state’s administrative code, and are generally defined within each state’s or territory’s jurisdiction. For example, in the state of Indiana, RNs and LPNs have a defined responsibility to apply the nursing process and to act in a specific manner as a member of the registered nursing profession.

Standard of care: The degree of care, expertise, and judgment exercised by a reasonable person under the same or similar circumstances.

RNs are mandated to function within the legal boundaries of nursing based on their knowledge of the statutes and rules governing nursing (Indiana Administrative Code, 2013). Therefore, it is imperative for nurses to be aware of and fully understand the rules and statutes that govern nursing practice in their state or territory.

Nursing behaviors, including acts, knowledge, and practices that fail to meet defined minimal standards of acceptable current practice that could endanger the health, safety, and welfare of the public, represent unprofessional nursing conduct in Indiana (Indiana Administrative Code, 2013). Nurses should conduct themselves with the degree of care, skill, and knowledge that reasonably competent nurses would exhibit in comparable situations.

It is important to note that the standard of care represents a minimum level of practice that a nurse must stay within to avoid being found negligent or guilty of malpractice. Nurses must exercise good judgment using their nursing education to the best of their ability under the circumstances. In addition, a standard of care can be used to compare the performance of a nurse with another in the same specialty.

Standards of Care for Particular Areas of Nursing Practice

In malpractice actions, the adequacy of a nurse’s performance is based on a professional standard that is then compared with the performance of other nurses in the same specialty area. This type of comparison allows nurses to be compared more accurately with the performance of their peers.

For example, neonatal intensive care nurses determine the standard of care for other neonatal intensive care nurses. The conduct of a surgical nurse would not be compared with the conduct of a public health nurse. Standards of care apply to specific areas of nursing practice.

Malpractice actions are premised on allegations of failure to comply with a professional standard of care or performance. If a nurse’s actions fall below the accepted professional standard of care, he or she may be found guilty of malpractice.

It is extremely important for nurses to be familiar with and understand the professional standard of care that applies to their practice area. There are various layers of accountability for nursing practice ranging from broad national/general practice guidelines to narrow specialty- and state-specific guidelines. Nurses can go to their professional organization’s website to determine appropriate standards of care for particular practice settings also called standards of practice. For example, nurses can visit the ANA website to access information concerning appropriate standards of care and practice.

It is important to note that the Standards of Professional Nursing Practice are duties that are common to all RNs regardless of their role, specialty, or population that nurses are expected to perform with competence. These standards are used as evidence of standard or care with the understanding that standards are context dependent and vary upon clinical circumstances.

For example, the application of standards could be different during a natural disaster such as a hurricane than a regular day. The ANA published the third edition of Nursing: Scope and Standards of Practice in 2015. The ANA states that “the public has a right to expect RNs to demonstrate professional competence throughout their careers”.

The ANA’s Scope and Standards of Nursing Practice provides and outlines the expectations of the professional role for RNs including scope of practice and standards of professional practice and related competencies. The Scope and Standards also provide new information that can be incorporated into state nurse practice acts, which provide another layer of accountability. Rules and regulations promulgated by states that are specific to that state’s nurse practice

CONTEMPORARY PRACTICE HIGHLIGHT

EMPHASIS ON PATIENT SAFETY

Since the Institute of Medicine (IOM) released its report To Err Is Human: Building a Safer Healthcare System (IOM, 2000), which revealed only 55 percent of patients received recommended care, reporting that approximately 98,000 died each year due to medical errors, there has been a renewed interest in patient safety and standards of care.

In 2010, the U.S. Department of Health and Human Services, Office of Inspector General (2010). reported that below standard hospital care resulted in approximately 180,000 Medicare deaths. In 2013, the Journal of Patient Safety reported that deaths from preventable harm may be as high as 210,000–400,000.

This would make medical errors the third leading cause of death in the United States. Medication errors, in particular, provide an example of highrisk situations that can result in a breach of standards of care and patient safety while exposing nurses to potential liability. Fully engaging patients and their advocates during hospital stays, listening to patients to identify harms, and transparency in accountability will be necessary to decrease patient harm.

Official Resources for Determining Standards of Practice and Care

A variety of resources for nursing practice standards exist. Nurses may wish to use different resources depending on the states in which they decide to practice. In addition, standards are interpreted and applied differently depending on the state of jurisdiction. In malpractice actions, courts rely on some or all of these resources to help determine the applicable standard of care in each individual case. Some of these resources include:

State statutes and administrative codes

  • Nurse practice acts (a listing of resources concerning nurse practice acts can be found at http://www.ncsbn.org)
  • American Nurses Association (a listing of specialty care nursing standards and scopes of practice can be found at http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/
  • The Joint Commission (www.jointcommission.org)
  • State and federal case law and published opinions by judges
  • Hospital policies
  • Specialty nurse organizations, for example:
    • American Association of Critical Care Nurses (http://www.aacn.org)
    • Association of Public Health Nurses (http://phnurse.org)
    • American Association of Nurse Practitioners (https://www.aanp.org)

Conclusion:

It is critically important for RNs to understand how and why nursing practice is regulated. By understanding the basic concepts of nursing regulation, licensure, certification, and standards of care, RNs are empowered with the necessary skills to provide safe nursing care. State nurse practice acts vary from state to state and territories, and nurses must be aware of their governing nurse practice act when delivering and/or delegating care.

As nursing continues to advance, and with the emergence of the field of telehealth, it is becoming increasingly important for nurses to understand that the care they deliver across state lines is affected by varying state laws and the regulatory process.

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