Running head: SELF ASSESSMENT
1
Self-Assessment of Nursing Standards of Practice
Jacqueline Mulder
Ferris State University
SELF ASSESSMENT
2
Self-Assessment of Nursing Standards of Practice
The Standards of Practice (2010) and the Code of Ethics (2001) are the resources utilized
by the American Nurses Association (ANA) to guide and evaluate professional nursing care. An
important aspect of becoming a great nurse is measuring personal practice against these
standards, and determining areas of excellence and areas of necessary growth. Performing a
nursing self-assessment is important for nurses and patients, and will generally result in the
provision of higher quality nursing care.
ANA Scope and Standards of Practice
A nurse must be guided in practice by a set of standards and regulations in order to
provide the highest quality care. The ANA (2010) is the professional organization for registered
nurses, and “has assumed the responsibility for developing the scope and standards that apply to
the practice of all professional nurses and serve as a template for nursing specialty practice” (p.
1). The scope of practice describes the individuals and tasks that fall within the nurse’s
responsibility, and is applicable for general and specialty nursing practice. The standards outline
the professional requirements and expectations of registered nurses based on their education
level and scope of practice.
Standards of Practice
Assessment. Assessment is a crucial, continual part of nursing practice. Each patient in a
nurse’s care will be assessed in some way, either a head-to-toe assessment, or a specific, focused
assessment. Assessing a patient is the nurse’s way to gather information about the patient’s
health, both physically and holistically (ANA, 2010). A thorough assessment is important for a
nurse to best care for a patient.
SELF ASSESSMENT
3
I have met the standard of assessment throughout clinical experience. Nursing assessment
was the first class in the nursing program, and I have performed assessments in every clinical
rotation. Assessing each patient has been a requirement in clinical practice, and I have done so.
Proper assessments also aid in providing nurses with the most recent information related to
patient status. On a clinical rotation, I was assessing a patient and listening to the heart. I heard
an extra heart sound (S4), though it was not documented in the patient chart. I asked the clinical
instructor and nurse to listen, and they both verified that the patient had an extra heart sound, and
noted it in the chart. Assessment is a great tool in identifying patient issues in order to effectively
treat the disease processes.
Diagnosis. The registered nurse has the responsibility of knowing and understanding the
diagnosis of the patient. An important competency for a nurse is to “identify actual or potential
risks to the healthcare consumer’s health and safety or barriers to health” (ANA, 2010, p. 34). In
alignment with this standard, the nurse will diagnose the pertinent nursing care considerations for
the patient. The nurse utilizes the medical diagnosis as a guideline for the nursing diagnoses.
I have met the outcome of diagnosis by identifying priority nursing diagnoses for
patients, and implementing care based on the diagnoses. Through completing clinical paperwork
each week, I have learned about the medical diagnoses of patients, the disease processes. The
nursing diagnoses related to the diseases and injuries are a guide to provide the highest quality
nursing care. For example, a patient had an infection that spread to his bone. The most important
nursing diagnosis was risk for sepsis, and the patient had already triggered the sepsis alert in the
computerized patient chart. The patient had orders for continuous intravenous antibiotics, in
order to treat and prevent the spread of the infection. I was responsible for the care of three
patients that day, and I prioritized the nursing diagnosis of risk for sepsis. I kept track of the time
SELF ASSESSMENT
4
the antibiotic was due, and hung a new one immediately after the previous antibiotic had
finished.
Outcomes Identification. The nurse identifies the outcomes desired in patient care. The
nurse collaborates with the interdisciplinary team that is responsible for the total care of the
patient (ANA, 2010). The nurse displays competence by creating daily goals for a patient, and
working with the patient in goal setting. The nurse discusses the desired goals of the patient, and
also the desired medical goals. The nurse will create goals with the patient that are specific,
measurable, accurate, reasonable, and time-oriented. The nurse also adjusts the identified
outcomes based on the changes in health status of a patient (ANA, 2010).
I have met this outcome through clinical experience by goal setting with patients. As a
general rule throughout clinicals in the hospital setting, I begin the day by discussing the
patient’s goals for the day, and checking the board in the patient’s room to identify the main
goals. For example, I cared for a patient who was in constant pain, and the main goal for the day
was to keep the pain level below a five on the numeric pain scale of one to ten. The patient was
alternating between taking Norco every six hours, and Dilaudid every four hours. I was aware of
the times the pain medicine was due, and responded quickly to the patient’s requests for pain
medicine. Another patient in my care was a post-operative patient whose goal was to ambulate
one lap in the hallway. Each time I entered the patient room, I offered to walk with the patient. In
the late afternoon, the patient was ready and I walked two laps with the patient, achieving the
goal for the day.
Planning. The registered nurse takes an active part in planning care for the patient that
results in the outcomes identified by the previous standard. The nurse “uses strategies in the plan
that address each of the identified diagnoses or issues” (ANA, 2010, p. 36). The nurse develops a
SELF ASSESSMENT
5
plan with the input of the patient, family, and other health care providers. The third and fourth
standards of nursing care are often intertwined, because nurses use outcome identification in the
planning of holistic care for a patient. The nurse displays competence by prioritizing the highest
level needs to be addressed, and planning care based on the most urgent needs.
I have met this goal through planning care for patients throughout the clinical day,
identifying patient needs, and prioritizing care by level of importance. I arrive at clinicals
between 6:30 and 6:45 in order to look at the patient charts before obtaining report. I plan
assessments and medications, as well as important nursing interventions that are due throughout
the day. For example, I learned in morning report that a patient was having a procedure done at
10 AM, and needed an IV in place and morning medications before going. I planned care for this
patient by performing the patient assessment first, ensuring the patient did not receive breakfast
(because the patient was NPO for the procedure), inserting a 20-gauge IV, and giving the patient
medications before the patient needed to leave for the procedure.
Implementation. The nurse exhibits competency by implementing the strategies
identified through planning and outcome identification. The nurse is in charge of implementing
many tasks throughout the day, and is in charge of a large amount of patient care activities. The
nurse utilizes knowledge and technology to provide holistic care for patients, and acts as an
advocate for patients (ANA, 2010). I have met this standard by implementing patient care,
planning patient activities, and meeting patient outcomes through implementation of quality care.
Evaluation. An important part of providing holistic care is evaluating the patient. The
registered nurse is responsible for evaluating the care provided for a patient, and ensuring the
highest quality care is provided. The nurse assesses the patient, evaluates patient status, and
documents assessment findings. The nurse collaborates with the patient and the interdisciplinary
SELF ASSESSMENT
6
team to evaluate effectiveness of patient plan of care (ANA, 2010). I have met this standard
through evaluation of the care I provide for patients in post-conference and post-clinical
assessments, and also through evaluating the patient status throughout the day.
Ethics. The registered nurse is responsible for providing safe and ethical health care to
all patients. The Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) is used to
guide ethical nursing practice. The nurse advocates for the patients while protecting their rights
and confidentiality (ANA, 2010). I have met this standard for practice in nursing, and will
elaborate each of the provisions in the Code of Ethics section of the paper.
Education. The registered nurse “attains knowledge and competence that reflects current
nursing practice” (ANA, 2010, p. 49). Gaining formal education is an important step in
preparation to become a registered nurse. The nurse not only gains education prior to becoming a
nurse, but also continues learning throughout his or her career. I am currently meeting this
standard by obtaining my Bachelor’s of Science in Nursing at Ferris State University. I plan to
continue gaining education throughout my practice as a registered nurse through attending
seminars and staff teaching on continuing education.
Evidence-based Practice and Research. The registered nurse incorporates evidencebased practice into clinical practice. The nurse is responsible to stay updated on recent research
findings, and incorporate those research findings into practice appropriately (ANA, 2010).
Research is the basis for clinical practice, and the nurse must utilize research findings
appropriately to ensure highest quality nursing care.
I have met this standard by implementing evidence-based practice into nursing care. I use
evidence-based practice daily in the clinical setting. During medication passes, I identify the
patients with two forms of identification (name and birth date), and verify the five patient rights
SELF ASSESSMENT
7
(patient, drug, dose, route, time). I also utilize evidence-based practice in performing nursing
procedures. I use sterile technique when inserting catheters, and always sterilize the hub of IV’s
sites before injecting medications.
Quality of Practice. The nurse plays a vital role in providing quality nursing care. The
nurse “collects data to monitor quality and effectiveness of nursing practice, and analyzes quality
data to identify opportunities for improving nursing practice” (ANA, 2010, p. 52). Nurses
evaluate the quality of practice outside of direct patient care, in order to provide the highest
quality direct patient care.
I have met this outcome by identifying quality nursing both inside and outside of
clinicals, and evaluating nursing practice in order to make improvements. I wrote a paper in
nursing theory class that evaluated the quality and safety of utilizing antimicrobial catheters in
order to reduce catheter-associated urinary tract infections. In the clinical setting, the instructor
and I evaluate the quality of patient care I provide throughout the rotation, and consider potential
improvements to patient care. I take suggestions from the clinical instructor and implement them
in the next clinical rotation.
Communication. Communication is vital for effective nursing practice. The registered
nurse displays competent communication skills by communicating effectively with patients,
family members, and members of the interdisciplinary care team. The nurse analyzes his or her
communication skills, and seeks opportunities for improvement (ANA, 2010).
I have met this outcome by communicating effectively with patients and the nursing care
staff. For example, I typically take the responsibility for administering pain medication if a
patient is painful. I make sure to update the board when administering pain medication under the
supervision of the clinical instructor, and tell the nurse that I have administered the medication so
SELF ASSESSMENT
8
the nurse knows the task has been done. I also communicate with the nurse other tasks I am able
to take care of and document, such as patient turns, visual checks, medication administration
under supervision of the clinical instructor, etc. I communicate with the patient, and listen to his
or her concerns and expectations.
Leadership. The registered nurse shows leadership skills through providing the highest
quality care for his or her own patients, demonstrating accountability for his or her actions. The
nurse advocates for patients, and provides accountability for the care given to patients that he or
she is not directly caring for (ANA, 2010). The nurse demonstrates leadership in the field of
nursing by continually seeking advancements in the nursing field, and seeking improvements in
quality of care and safety of patients.
I have partially met this standard of practice in clinical experience. I meet part of the
standard through demonstrating accountability for my actions to the clinical instructor, nurses,
and peers. I do not meet this standard because I have not held a leadership position as a
registered nurse, and have not made important decisions or implemented care for a patient. I
currently do not have the scope of practice to hold a leadership position, but I plan to meet this
outcome by working hard in a role as a registered nurse, and accepting responsibility in a
leadership position when the opportunity is presented.
Collaboration. The registered nurse collaborates with the many individuals involved in
the care of a patient, as well as with the patient and patient’s family. The purpose of
collaboration is to utilize multiple sources to produce the best patient outcomes. The nurse
collaborates with patients to establish a positive, caring relationship, which also promotes
positive outcomes (ANA, 2010).
SELF ASSESSMENT
9
I have not met this outcome because I have not had many opportunities to collaborate
with individuals in the care team. During clinicals, I assist the nurse in many ways, performing
assessments, nursing tasks, and administering medications. I am not involved in the decision
making process for the patients, and do not interact with physicians or other nurses. I will meet
this standard when I am a registered nurse by collaborating with all members of the
interdisciplinary team, and advocating for the highest quality care for all my patients. I will
discuss the desired health care outcomes with the patients, and collaborate with the necessary
individuals to meet those outcomes.
Professional Practice Evaluation. The nurse “evaluates his or her own nursing practice
in relation to professional practice standards and guidelines, relevant statutes, rules, and
regulations” (ANA, 2010, p. 59). A registered nurse displays competency through continually
evaluating care, and identifying his or her strengths and weaknesses in every aspect of direct and
indirect patient care. The nurse accepts and utilizes constructive criticism from peers and staff to
improve nursing practice.
I have met this standard through assessing my knowledge of professional nursing
practice, and evaluating my strengths and weaknesses. The clinical instructors evaluate my
progress each semester, and evaluate my practice against the standards for professional nursing
practice. I have performed various self assessments in classes, such as a self assessment of
biases, and also through writing this self assessment paper.
Resource Utilization. The nurse utilizes the most effective resources to provide the
highest quality nursing care. The nurse appropriately incorporates the use of technology to
produce the best patient outcomes (ANA, 2010). The nurse maintains cost-effectiveness by only
using appropriate resources. The nurse uses time, energy, and equipment efficiently.
SELF ASSESSMENT
10
I have met this outcome by using appropriate resources to provide quality nursing care to
patients. For example, I group care when a patient is in isolation, and perform the assessment and
medication administration at the same time. I also try to anticipate patient needs, so I do not use
excessive gowns and gloves by entering and exiting the patient room multiple times. I also
effectively use my time and energy, focusing on completing tasks and care for one patient before
entering the room of the next patient. I also effectively utilize resources by documenting at the
patient bedside, so I am able to ask questions during and after an assessment.
Environmental Health. The registered nurse is aware of the environment in which he or
she practices, and reduces the risks to self and patients. The nurse assesses the environment for
safety, and promotes a healthy environment by reducing the environmental risks (ANA, 2010).
Establishing an environment that promotes health and healing is an important part of a patient’s
health care.
I have met this standard through learning about the various environments in which I
provide care, and reduce the environmental risks for the patients. An example of this is the policy
at Spectrum Health to wash in and wash out of patient’s rooms. I wash my hands before and after
providing care for patients, in order to reduce germs and prevent the spread of infections. I also
wear gloves when handling medications and providing personal hygiene care to patients.
Code of Ethics
Provision One
Provision one states that “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, para. 1). I have met this provision
SELF ASSESSMENT
11
by treating all patients respectfully, regardless of their personal qualities and attributes. For
example, I cared for an alcoholic patient who was experiencing severe withdrawals. He was
lashing out at me, and other staff. Regardless of his actions, I treated him with the same dignity
and respect as I would any other patient. I responded quickly to his pain medicine requests,
performed thorough assessments, and assisted him to ambulate and toilet. Although the patient
was challenging, I learned and grew through providing his care.
Provision Two
Provision two discusses the importance of prioritizing patient interests, and the
responsibility of the registered nurse to be completely committed to caring for the patient in
every aspect of care (ANA, 2001). The nurse collaborates with the patient and health care
providers to provide optimal health outcomes. The nurse must establish boundaries within the
scope of his or her practice to ethically meet this provision.
I have met this provision through prioritizing patient care in clinical practice. During
morning report, I listen to the aspects of patient care that are highest priority, and make sure to
complete those tasks in a timely manner. For example, I took care of a burn patient that needed a
dressing change at 10 AM. In order to reduce the risk for infection, I completed other patient
care tasks such as assessments and medications, so I was ready to assist the nurse with the
dressing change promptly at 10 AM. I also made a point to finish other patient tasks before the
dressing change, to complete important care for other patients.
Provision Three
Provision three outlines the responsibility of the nurse to maintain privacy and
confidentiality of patients. The nurse acts as an advocate for patients by continually ensuring the
SELF ASSESSMENT
12
highest level of care and protection is provided (ANA, 2001). The nurse ensures quality and
safety of health care provided to a patient.
I have met this provision by maintaining the privacy and confidentiality of patients. I act
in accordance with HIPAA, and do not discuss patient information outside of clinicals. For
example, I shred patient documents and anything with patient name and information when
leaving clinicals. Also, I advocate for patients and ensure safety by providing the best possible
care.
Provision Four
The nurse takes full responsibility of care provided for patients. The registered nurse
must make appropriate decisions regarding patient care, and delegate actions to the appropriate
personnel if the action is not within the scope or ability of the nurse (ANA, 2001).
I have not met this provision, because I have not yet taken full responsibility for the care
of the patient. I take responsibility of the nursing care that I provide, including medication
administration, assessments, and nursing tasks that are assigned to me by the nurse or clinical
instructor. Since I do not yet have a full scope of nursing practice, I do not make decisions on
behalf of the patient. I am not fully responsible for making decisions for patients, but I plan to
fulfill this provision when I become a registered nurse by becoming responsible for patient
decisions. I will act as an advocate for patients in speaking with other health care providers, and
making decisions in collaboration with the patients and families.
Provision Five
The registered nurse is responsible to care for self in the same way that he or she cares for
peers and patients. The nurse must practice to ensure patient safety, but also to ensure safety of
SELF ASSESSMENT
13
self. The nurse must not place self in compromising situations, and must act in integrity and hold
self to high moral standards (ANA, 2001).
I have met this standard by taking care of myself in the same manner that I provide care
for patients. For example, I wear gloves when in contact with medications and bodily fluids. I
thoroughly wash my hands several times throughout the day, and adhere to Spectrum Health’s
wash in-wash out policy of washing hands when entering and exiting patient rooms. I also
maintain practice safely by adhering to contact precautions, and using proper protective
equipment when entering an isolation room. I also care for myself outside of the clinical setting
through adequately preparing for clinicals. I sleep at least seven hours the night before clinicals,
and eat a large breakfast to have the energy to provide quality patient care.
Provision Six
Provision six outlines the responsibility of the nurse to create and maintain a positive,
caring environment for patients. The nurse is responsible to practice safely, and influence peers
to act in a safe manner as well. The nurse contributes to the improvement of a health care
environment through providing safe, ethical, and quality nursing care (ANA, 2001).
I have met this provision by practicing safely and developing a caring environment for
patients. For example, each morning I introduce myself to each patient, and take a few minutes
to talk with him or her about the night, pain, and goals for the day. Establishing a caring
relationship upon first meeting is important, because a foundation of mutual trust and respect is
essential to a positive patient-caregiver relationship. I discuss the patient goals for the day and
long-term goals, in order to assist in achieving those goals.
Provision Seven
SELF ASSESSMENT
14
Provision seven states that “the nurse participates in the advancement of the profession
through contribution to practice, education, administration, and knowledge development” (ANA,
2001, para. 7). The nurse serves as a leader both in advancing the knowledge and practice of
nursing as a professional field. The nurse implements advancements in care to provide the best
possible nursing care to patients.
I have not yet met this provision because I have not made any contributions to the field of
nursing. I have studied the most recent evidence-based practice, and implement the best practice
into clinical nursing care. I have not held a leadership position yet, but plan to fulfill this role by
holding a nursing leadership position once I gain experience as a registered nurse. I also plan to
study the advancements in the nursing field, and implement those advancements into nursing
practice.
Provision Eight
The nurse is responsible for providing the best care to patients, and responding to the
imminent needs of the patient. The nurse works with the interdisciplinary team to provide safe,
effective, high quality care. The nurse identifies threats to the safety of a community, and
educates patients and families about the pertinent safety threats (ANA, 2001). I have met this
outcome by identifying the imminent needs of patients, and responding to the most important
needs. I also work with the nurse to ensure safety is continually provided to patients.
Provision Nine
Provision nine states that “the profession of nursing, as represented by associations and
their members, is responsible for articulating nursing values, for maintaining the integrity of the
profession as its practice, and for shaping social policy” (ANA, 2001, para. 9). The nurse must
adhere to his or her own set of values and moral standards, and must practice with integrity.
SELF ASSESSMENT
15
I have met this provision by adhering to a set of moral standards that I value. I treat each
patient with dignity and respect, and care for each individual as a person and not as a problem. I
have adhered to the standards set forth by the ANA, and practice with integrity. I have reflected
on my clinical practice as a nursing student, and believe I have displayed competency in moving
forward as a graduate and obtaining my registered nurse licensure.
Professional Development Plan
Goals
Professional goal setting is an important aspect of continually growing and developing as
a nurse. The first professional goal I desire to obtain is a bachelor’s of science degree in nursing,
followed by obtaining a registered nursing licensure. Secondly, I want to obtain a nursing job to
gain two to five years of experience, and obtain a leadership position at some point in the job. I
hope to find a job that I enjoy right away, but I will seek other job offers if the first place of
employment is not satisfying. My third and most long-term goal is to obtain a doctorate of
nursing practice (DNP) within ten years.
Action Plan
I have met a majority of the standards for nursing practice and ethical considerations
outlined in the paper. For the standards and provisions that I have not met or have partially met, I
discussed the reasoning why the items were not satisfactorily met. I also outlined how I plan to
meet them in future nursing practice. I have created three professional goals, and will detail a
plan to meet the goals.
The first and foremost goal of my professional nursing career is to graduate with a
bachelor’s of science in nursing, and become a licensed nurse. I plan to follow through with the
fifth and sixth semesters of nursing school, completing all coursework and clinical work to the
SELF ASSESSMENT
16
best of my abilities. I will graduate in December 2014, and study for the NCLEX examination. I
will complete 100 practice NCLEX questions per day, until I consistently answer 75 questions
per day correctly. When I am prepared, I will enroll to take the examination. I hope to pass upon
first attempt, but if I do not succeed I will continue to take the examination until I have passed.
I will reach the second goal through a process of searching for desired nursing jobs. I
want to work in Grand Rapids or Ann Arbor, so I will search and apply for jobs in both of these
cities. After sending in numerous applications, I hope to receive some interview opportunities. I
will interview for the jobs, and take the job offer that is most suitable for me.
I will begin making progress towards the third goal by researching requirements for DNP
school, and finding schools that offer the program. I will take the Graduate Record Examination
(GRE) because most schools require a GRE score for application. I will apply to various DNP
schools, and interview at schools that offer me interviews. Upon acceptance to a graduate DNP
program, I will complete the program. I will meet this goal by graduating the DNP program.
Evaluation Plan
I will evaluate my progress towards each goal throughout my education and career as a
nurse. If I graduate from nursing school and pass the NCLEX exam, I will meet the first
professional goal. If I do not pass the exam, I will continue to study and re-take the exam (using
either the same process, or refining and improving the process) until I pass. Meeting the second
goal will be evaluated by the attainment of a desirable job. If I obtain a desirable job, I will meet
the second goal. The third goal will be evaluated by whether or not I successfully complete a
graduate DNP program. I will meet the goal through graduating from a DNP program.
SELF ASSESSMENT
17
Conclusion
I have met a majority of the nursing standards of practice, and provisions of the code of
ethics. I have gained a lot of valuable knowledge throughout clinical and classroom experience,
and have grown immensely in nursing practice. I have not fully met the standards of leadership
and collaboration, because I have not held a leadership position in nursing. I also do not meet
these standards because I do not make patient decisions in collaboration with the patient and
interdisciplinary team. I plan to meet these standards during my career as a registered nurse by
taking leadership opportunities, and advocating on behalf of patients in making decisions. I have
not yet met provision four of the code of ethics, because as a student I do not take full
responsibility for all aspects of patient care. I plan to meet this provision when becoming a
registered nurse and taking responsibility of all patient care. I have not met provision seven
because I have not made significant contributions to the field of nursing, but I plan to work
towards improving practice in the future. I have met or have a plan to meet each of the standards
and provisions in the field of nursing.
SELF ASSESSMENT
18
References
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. (2n ed.) Silver
Spring, MD: American Nurses Association.