The scope and standards of practice guide the nursing profession in competence and performance expectations

The scope and standards of practice guide the nursing profession in competence and performance expectations. The scope of practice for nursing defines the activities that a person licensed as a nurse is permitted to perform while the standards of practice delineate performance expectations for all registered nurses. Review Chapter 3, “The Nursing Workforce,” of The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, located in the Topic 2 Resources, and compare the scope of practice and differentiated practice competencies of licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs).

Review “Scope of Nursing Practice” from Nursing: Scope and Standards of Practice, located in the Topic 2 Resources. Standard 12 of the standards of practice describes the nurse’s role related to education. Explain the role of professional development (life-long learning) in the context of this standard.

Sample Answer

Scope of Practice: LPNs, RNs, and APRNs

Nursing practice is organized across three distinct licensure levels, each with differentiated competencies and scope. Licensed Practical Nurses (LPNs) function under the supervision of RNs or physicians, performing basic care tasks such as vital sign monitoring, medication administration, and wound care. Their scope is primarily task-oriented and confined to stable, predictable patient situations (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). Registered Nurses (RNs) hold a broader scope that includes comprehensive assessment, clinical decision-making, care planning, patient education, and coordination of interdisciplinary teams. RNs are autonomous practitioners who bear accountability for patient outcomes across diverse settings (American Nurses Association [ANA], 2021).

Advanced Practice Registered Nurses (APRNs)—including Nurse Practitioners, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and Certified Nurse-Midwives—operate at the highest level of nursing practice. APRNs possess graduate-level education enabling them to diagnose, prescribe, and manage complex patient populations, often functioning independently or collaboratively with physicians (NASEM, 2021). These differentiated competencies reflect progressive levels of education, clinical expertise, and professional accountability, and are essential to building a nursing workforce capable of addressing health equity disparities.

Standard 12: Education and Professional Development

Standard 12 of the ANA Nursing: Scope and Standards of Practice (2021) addresses the nurse’s obligation to seek knowledge and competency that reflects current nursing practice. This standard positions lifelong learning not merely as a professional courtesy, but as an ethical mandate central to safe, quality care. Professional development is the mechanism through which nurses fulfill this standard, ensuring their clinical knowledge, technical skills, and evidence-based practice remain current in an evolving healthcare landscape (ANA, 2021).

Lifelong learning under Standard 12 encompasses formal education, continuing education units, certification, and participation in professional organizations. Nurses are expected to identify their own learning needs, engage in reflective practice, and apply new knowledge directly to patient care (Dickerson, 2021). This is particularly critical given the rapid advancement of healthcare technology, pharmacology, and genomics. Nurses who actively pursue professional development serve as agents of quality improvement within their institutions, translating education into measurable patient safety outcomes (NASEM, 2021).

Furthermore, lifelong learning supports role advancement across nursing levels. An LPN who pursues education toward RN licensure, or an RN who earns a graduate degree to become an APRN, exemplifies Standard 12 in action—broadening both personal competence and the profession’s collective capacity to meet population health needs. Institutional support for professional development, including tuition reimbursement and protected learning time, is equally essential to sustaining this culture of growth (Dickerson, 2021).

References

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.

Dickerson, P. S. (2021). Continuing nursing education: What nurses need to know. Journal of Continuing Education in Nursing, 52(3), 111–112. https://doi.org/10.3928/00220124-20210216-03

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982

Topic 2 DQ 2

Read the scenario and address the discussion question:

Scenario

Nurse Lope is starting a busy shift in which she was finishing report on Mr. Johnson. During report, Nurse Jim who was finishing his shift also gave Nurse Lope a medicine cup containing three of Mr. Johnson’s unopened medications that he reported were recently retrieved from the medication dispenser. Nurse Lope was told that these were supposed to have been given 30 minutes ago and asked if she could give them during bedside hand-off. As Nurse Lope planned to stay in Mr. Johnson’s room to complete his vital signs and assessment, she agreed with this plan. 

When she opened Mr. Johnson’s electronic medical record to administer these medications, she noticed that these medications were scheduled to be given 3 hours ago. Additionally, one of the medications had a barcode that was not scanning to Mr. Johnson’s chart. Nurse Lope proceeded to administer these medications so that she would not be late on the next round of medications, which included some of the same ones. It was later discovered that the medication that was not scanning was for another patient and should not have been given to Mr. Johnson. 

Discussion Question

Outline the concept of professional accountability as it pertains to nursing. Examine the actions of Nurse Jim and Nurse Lope. Discuss how you would approach this scenario if you were in Jim’s and Lope’s position. Based on your analysis of how nurses demonstrate accountability in clinical practice, the nursing process, and evidence-based practice, explain how you would handle this situation if you were the nurse manager overseeing Jim and Lope.

Professional Accountability in Nursing

Professional accountability in nursing refers to the obligation nurses bear for their clinical decisions, actions, and omissions—and the willingness to answer for those outcomes to patients, employers, the profession, and the public. The American Nurses Association (ANA, 2021) defines accountability as accepting responsibility for one’s own practice and the resulting outcomes. Accountability is not merely institutional compliance; it is an ethical cornerstone embedded in the Code of Ethics for Nurses, which holds that nurses must provide care that reflects current standards of practice and prioritizes patient safety above convenience or time pressure (ANA, 2015).

Accountability also intersects directly with the nursing process: nurses are expected to assess, plan, intervene, and evaluate based on accurate data—and cutting corners at any step undermines this foundational framework.

Analysis of Nurse Jim’s Actions

Nurse Jim demonstrated a significant breach of professional accountability. He removed medications from the dispenser but failed to administer them within the scheduled timeframe. Rather than documenting the omission, reporting it through proper channels, or investigating why the medications were delayed, he transferred the responsibility to an oncoming nurse during shift change—a setting already known to be a high-risk period for medication errors (Härkänen et al., 2019). Handing off a medicine cup without verifying each medication against the patient’s chart bypasses the five rights of medication administration entirely. Jim’s actions reflect avoidance of accountability rather than transparency, and created a cascading safety risk for Mr. Johnson.

Analysis of Nurse Lope’s Actions

Nurse Lope’s breach was arguably more serious because she had direct warning signs and proceeded anyway. She identified two clear red flags: the medications were scheduled three hours earlier than reported, and one medication’s barcode would not scan to Mr. Johnson’s chart. Barcode medication administration (BCMA) systems exist precisely to prevent wrong-patient and wrong-drug errors, and a failed scan is an unambiguous stop signal (Rodziewicz et al., 2023).

Instead of pausing and investigating, Nurse Lope prioritized schedule management over patient safety. This decision reflects a failure to apply the nursing process—specifically the assessment and evaluation phases—and a departure from evidence-based practice standards. Administering an unverified medication that could not be reconciled to the patient’s chart is indefensible under any professional standard.

How I Would Approach This as Jim and Lope

In Jim’s position, I would have documented the late medication administration, notified the charge nurse, and completed an incident report acknowledging the delay before leaving the shift. I would not have transferred unverified medications to another nurse. As Nurse Lope, upon discovering the scheduling discrepancy and the failed barcode scan, I would have held the medications, notified the charge nurse and pharmacist, and verified each drug independently before any administration. Patient safety must always take precedence over staying on schedule. Transparency and escalation are the accountable responses when uncertainty arises.

Nurse Manager Response

As the nurse manager, my response would operate on three levels: immediate safety, individual accountability, and systems improvement. First, I would ensure Mr. Johnson received appropriate medical evaluation for the incorrectly administered medication and complete a thorough incident report per institutional policy. Second, I would conduct separate, non-punitive but direct conversations with both Jim and Lope, reviewing the specific points at which professional standards were not met and providing education on BCMA protocols, medication reconciliation, and the ethical obligation to report rather than defer errors (Rodziewicz et al., 2023).

If patterns of unsafe practice existed, formal disciplinary steps would follow per policy. Third, at the systems level, I would analyze whether shift change workflows, staffing ratios, or medication dispenser access contributed to this event, and advocate for process improvements such as structured handoff checklists and reinforced barcode scanning compliance training. Accountability in nursing management means addressing both individual practice and the environment in which that practice occurs (ANA, 2021).

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.

Härkänen, M., Turunen, H., Saano, S., & Vehviläinen-Julkunen, K. (2019). Medication errors: What hospital reports reveal about staff views. Nursing Management, 22(3), 14–19. https://doi.org/10.7748/nm.2015.e1289

Rodziewicz, T. L., Houseman, B., & Hipskind, J. E. (2023). Medical error reduction and prevention. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499956/