ANA SCOPE & STANDARDS
What is the difference between scope of practice and standards of practice?
Scope describes the boundaries and nature of nursing practice; standards describe the expected professional level of nursing practice.
A nurse realizes a patient does not understand the procedure they are about to undergo.
What professional responsibility should the nurse demonstrate?
Advocacy and communication—the nurse should address the knowledge gap and ensure concerns are communicated appropriately.
A patient becomes newly confused.
Question:
Is this a finding that should be investigated?
Yes. New confusion can represent an acute change in condition and requires assessment.
Scenario:
A medical-surgical RN completes a head-to-toe assessment, identifies new crackles and increasing oxygen requirements, and documents the findings.
Question:
Which ANA Standard is most directly demonstrated?
Standard 1 — Assessment
Scenario:
A NICU RN performs a neonatal assessment and recognizes findings that are abnormal for the infant's gestational age.
Question:
Which ANA Standard is being demonstrated, and what makes this specialty-specific?
Standard 1 — Assessment.
The standard is the same, but the nurse must possess specialty knowledge to appropriately assess a neonatal patient and recognize what is abnormal for that population.
Which ANA standard begins the nursing process?
Standard 1 — Assessment
A nurse receives an incomplete handoff about a high-risk patient.
What should the nurse do?
Clarify the missing information rather than assuming or proceeding without necessary information.
Which patient should the nurse assess first?
A. Patient requesting a blanket
B. Patient with new chest pain
C. Patient requesting discharge paperwork
D. Patient needing routine medication
B — Patient with new chest pain.
Scenario:
A nurse identifies that a patient's respiratory status is worsening. The nurse develops an appropriate plan, implements interventions, communicates with the provider and respiratory therapist, and reassesses the patient.
Question:
Identify at least four ANA standards demonstrated.
Possible answers:
Scenario:
An OB RN recognizes a concerning fetal heart-rate pattern, communicates the finding, initiates appropriate interventions within the nurse's role, and evaluates the fetal response.
Question:
Identify three ANA standards demonstrated.
Possible answers:
Teaching point:
The ANA standards provide the professional framework; OB-specific knowledge and competency determine how the nurse applies that framework.
Which six ANA standards are associated with the nursing process?
A UAP is assigned a task but the patient becomes unstable.
Who remains responsible for recognizing the change and ensuring appropriate action?
The RN, who must assess the patient and respond appropriately.
A patient has:
Question:
What should the nurse recognize?
Potential clinical deterioration/shock requiring immediate assessment and escalation.
Scenario:
An ICU nurse recognizes that a patient's condition is deteriorating and believes the current treatment plan may no longer be appropriate. The nurse communicates concerns to the provider and advocates for a change in treatment.
Question:
Which professional-performance standards are demonstrated?
Possible Answers:
An OR nurse identifies a break in sterile technique during a surgical procedure and immediately communicates the concern to the team.
Question:
Which ANA professional-performance standards could apply?
Scenario:
A nurse advocates for a patient, collaborates with the healthcare team, communicates concerns, and participates in quality improvement.
Question:
Are these simply expectations or are they reflected in ANA professional standards?
They are reflected in the ANA Standards of Professional Performance, including advocacy, communication, collaboration, and quality of practice.
A nurse discovers they made a medication error. What is the professional response?
Assess the patient, take appropriate immediate action, notify the appropriate individuals, follow organizational reporting requirements, and participate in follow-up/evaluation.
A patient develops sudden shortness of breath. The nurse obtains abnormal vital signs and recognizes deterioration.
Question:
What comes next?
Take appropriate immediate action, escalate/communicate the change, implement interventions within the nurse's role, and reassess the patient.
Scenario:
An ED nurse has four patients with different levels of acuity. The nurse uses assessment findings to prioritize care, initiates appropriate interventions, communicates concerns, and reassesses patients.
Question:
How does this scenario demonstrate the ANA Scope and Standards rather than simply “good time management”?
The nurse is applying the nursing process and professional standards:
Assessment → Diagnosis → Outcomes → Planning → Implementation → Evaluation
while also demonstrating clinical judgment, communication, collaboration, advocacy, and quality of practice.
Scenario:
A nurse has been an RN for five years but transfers from ICU to NICU.
The nurse says “I already know the ANA standards, so I don't need specialty orientation.”
Question:
Why is this incorrect?
Knowing the ANA standards provides the professional foundation, but it does not establish competence in a specific specialty.
The nurse must develop competency related to:
Scenario: A new first year nursing student says, “ANA standards are just paperwork requirements.”
Question:
How would you correct this statement?
The ANA Scope and Standards describe professional nursing responsibilities and competencies that guide how nurses assess, make decisions, communicate, advocate, collaborate, implement care, and evaluate outcomes.
Scenario:
A nurse notices a recurring patient-safety problem but says “I'm new, so it's not my place to speak up.” What professional principles challenge this thinking?
Advocacy, accountability, communication, ethics, leadership, and quality improvement.
Scenario:
A new graduate RN is caring for a patient who suddenly reports feeling “something is very wrong.” The patient is pale and diaphoretic. The RN notes a heart rate of 124, respiratory rate of 30, blood pressure of 88/54, and a new change in mental status.
Question — Select All That Apply
Which actions demonstrate appropriate clinical judgment by the RN?
A. Perform an immediate focused assessment.
B. Compare the patient's current findings with their baseline.
C. Wait for the next scheduled set of vital signs before intervening.
D. Recognize the findings as potential clinical deterioration.
E. Prioritize the patient over routine, non-urgent tasks.
F. Communicate the change in condition and escalate appropriately.
G. Document the findings and continue routine care until the provider evaluates the patient.
H. Reassess the patient after interventions to determine whether the condition is improving.
Scenario:
A new graduate RN is caring for a patient in the ICU who develops a sudden change in condition. The nurse assesses the patient, identifies the priority problem, initiates appropriate interventions, communicates the change to the healthcare team, and reassesses the patient.
Question — Select All That Apply
Which ANA Standards of Practice and Professional Performance are demonstrated in this scenario?
A. Standard 1 — Assessment
B. Standard 3 — Outcomes Identification
C. Standard 5 — Implementation
D. Standard 6 — Evaluation
E. Standard 8 — Advocacy
F. Standard 10 — Communication
G. Standard 11 — Collaboration
H. Standard 17 — Resource Stewardship
B — Outcomes Identification: Could be appropriate if the scenario specifically states that the nurse establishes a measurable expected outcome, but it isn't explicitly demonstrated in this scenario.
H — Resource Stewardship: Not directly demonstrated.
Which actions demonstrate appropriate application of the ANA Scope and Standards to specialty nursing practice?
A. Recognize that general RN licensure does not automatically establish competency in every specialty intervention.
B. Review applicable specialty standards, organizational policies, and competency requirements.
C. Perform the intervention because another experienced RN says, “You'll be fine.”
D. Seek appropriate guidance, supervision, or assistance when competency has not been established.
E. Consider the patient's specific condition, population, and level of acuity when determining the appropriate nursing response.
F. Assume that competency in one specialty automatically transfers to another specialty.
G. Maintain responsibility for practicing within established competence while continuing to develop specialty knowledge and skills.
H. Use the ANA Standards of Practice to guide professional nursing responsibilities while applying specialty-specific knowledge and competencies.
A, B, D, E, G, and H