Nursing specialization involves focusing on nursing practice in an identified specific area within the entire field of professional nursing. A defined specialty scope of practice statement and standards of professional practice, with accompanying competencies, are unique to each nursing specialty. These documents help assure continued understanding and recognition of nursing’s diverse professional contributions. The purpose of this article is to demystify the process for specialty nurses who are creating or revising their specialty nursing scope and standards of practice. We provide best practices for the developmental process based on our recently published scope and standards of specialty nursing practice. The conclusion provides strategies to disseminate scope and standards documents to appropriate stakeholders.
Key words: scope and standards of nursing, specialty nursing, nurses, professional nursing, best practices, American Nurses Association, addictions nursing, school nursing, correctional nursing, psychiatric mental health nursing, intellectual and developmental disabilities nursing
Associatednursingspecialtyorganizationsaredesignatedstewardsofspecialtynursingknowledgeandseekpublicationofthespecialtynursingscopeofpracticestatementandstandardstodelineateandguidethatuniquepractice.Registerednursesatthenationalandinternationallevel,aswellasotherstakeholdersengagedinlegal,regulatory,administrative,education,andresearchactivities,valuescopeandstandardsdocuments.Thesedocumentshelptoassurecontinuedunderstandingandrecognitionofthediverseprofessionalcontributionsofnurses.
BestPracticesforScopeandStandardsDevelopment/Revision
UtilizingStructuresandProcessestoInitiatetheProcess
ANAhaspublishedaresourcethatoutlinesrecommendedstepsfordevelopmentofspecialtynursingscopeandstandardsdocuments,AcknowledgementofSpecialtyNursingStandardsofPracticeandAcknowledgmentofPracticeStandards(
- Who?Identifynumbersofnurses,professionalorganization/society,andeducationalpreparation.
- What?Explaintheuniquecontributionsofgeneralistandadvancedpracticeregisterednurses.
- When?Determinewhenthesespecialtynursesareneeded.
- Where?Describepracticeenvironmentsinsufficientdetailtounderstandspecialtypractice.
- Why?Determinewhatnicheorgapisfilled;thehistoricalperspectiveofthedevelopmentofthespecialty;currentissuesandfuturetrendsinhealthcarethatpointtotheneedforthespecialty.
- How?Identifytheprocesstobecomethistypeofnursespecialist,includingdevelopmentthroughformaleducation,continuingeducation,andpracticeexperiences.AddressuseofthenursingprocessandtheCodeofEthics(
ANA,2015).
NursingspecialtyorganizationsmayelecttopartnerwiththeANAinthisprocess.Inthiscase,theorganizationscollaboratethroughouttheprocessofreviewandrevision,leadingtotheintendedoutcomeofafinalapprovalbytheANABoardofDirectors.
Significantchangesintheevolvinghealthcareandnursingpracticeenvironmentsrequirethatspecialtynursingstandardsbereviewed,revisedasnecessary,andresubmittedtoANAforacknowledgmentatleasteveryfiveyears,ormorefrequentlyifwarranted(
IdentifyingLeadWriterfortheProcess
Historically,leadersinnursingspecialtyorganizationshaveundertakentheactualwritingoftheirscopeandstandardsinvariousways.Forexample,theANAconvenedthecorrectionalnursingworkgroup,andtheANAstaffservedasthecustodianofthecorrectionalnursingscopeandstandardsdocument.TheANAcompiledsmallgroups’writingoutputs,andcreateddraftdocumentsforreviewbytheentireworkgroup.Theworkgroup’sdraftdocumentforpubliccommentwaspostedbytheANA.ThegroupthenfinalizedthedocumentforsubmissiontotheANAreviewprocess.
Somenursingspecialtyorganizationsintentionallymaintaintheleadwriterwhodirectedthedevelopmentofearliereditions(e.g.,IntellectualandDevelopmentalDisabilitiesNursing:ScopeandStandardsofPractice,
ConveningExpertswithSpecificRolesandFunctions
Contributorstotheprocessofcreatingaspecialtyscopeandstandardsdocumentaresoughtinvariousways.ThebroadestapproachisviaanANAcallformemberparticipation,includingmessagestostatenursesassociationsandorganizationalaffiliates.Thisstrategycangeneratealargenumberofnursesinthespecialty,yetrequiresaselectionprocesstoidentifythemostqualifiedvolunteers.Thespecialtyorganization’sboardofdirectorsmayalsosolicitvolunteers,anapproachrecentlyusedbyAPNAandISPN,witheachorganizationselectingfiveparticipantsthatrepresentedthevariouseducationallevelsandfociforpsychiatricmentalhealthnursing.
EnsuringIncorporationofFoundationalDocuments
SpecialtynursingorganizationsundertakingarevisionhavetraditionallyincorporatedconceptsandcontentfromthefoundationaldocumentsoftheANAintheirscopeandstandards.ThesefoundationaldocumentsmayincludetheCodeofEthics(
Asthedocumentevolves,smallgroupsmaybedesignatedtocarefullyreviewdraftsforspecificcontenttoensurethatthenursingspecialtyorganization’sscopeandstandardsdoesactuallybuilduponthesesourcedocuments.AnexemplarofsuchworkistheCorrectionalNursing:ScopeandStandards,SecondEdition(
EstablishingaRealisticTimeline
AddressingStrategiestoOvercomeBarriers
Evenwiththebestplan,thereareoftenbarriersthatcanimpedeatimelyoutcomefortheprojectofacollaborativegroup.Previouscontributorstoworkgroupsidentifiedthefollowingbarriersandpotentialstrategiesrelatedtotimeconstraints,thewritingprocess,andlogistics.
PromotingFacilitatorsforSuccess
Atrackrecordofstrong,effectiveorganizationalskillsoftheleadauthorwasinvaluablefacilitatorforsuccess.Effectivestrategiesincludeddevelopingaprojectplanwithtargetedactivities,identifyingresponsiblepersons,andsettingrealistictargetdatesforcompletion.Leadwritersweremindfulofmatchingwritingassignmentstothespecificexpertiseandstrengthsofgroupmembers.Forexample,historianswereimportantfortellingthestoryofthedevelopmentofthenursingspecialty.
Asgroupmemberscontributedtheirrespectivewritingassignments,leadauthorsassumedtheroleofmeldingtheworksintoacohesiveworkingdocument.Thisroledrewontheleadauthors’editorialskillstoensurethatthefinalproductwas,asonesaid,“in‘onevoice,’yettheworkofseveralcontributors.”Atvariousstagesofthedevelopmentprocess,leadauthorskeptANAstaffapprisedofthedevelopmentofthedocumentandsoughtguidanceasneeded.Additionally,ANAstaffprovidedpreliminaryreviewsofthedocumentpriortosubmissiontothefirstlevelofANAreview,theCommitteeonNursingPracticeStandards.
RespondingtoReviewerFeedback
TherewereinstanceswhenCNPSrecommendationswerenotacceptedbythewritinggroup.Theseareasofdifferenceprovidedtheopportunityforthewritinggrouptomakerevisionsinthedocumenttofurtherclarifymemberpositionand/orprovidefeedbacktoCNPSmembersexplainingtherationalefornotacceptingtherecommendation.Thus,itisimportanttoengageindialoguewiththereviewerstoensurethatthefinaldocumentinfactrepresentsthescopeandstandardsofthenursingspecialty.
Conclusion:DisseminatingtheScopeandStandards
Clearstatementsofthescopeofspecialtynursingpracticeandstandardsofspecialtypracticeandprofessionalperformancehelpassurecontinuedunderstandingandrecognitionofnurses’diverseprofessionalcontributions.Thus,itiscriticaltoinformvariousstakeholdersofthesepublications.Potentialstrategiesfordisseminationinclude:
- Usesocialmediatoinformmembersofthespecialtyorganization,thelargernursingcommunity,thespecialtyfield,andotherstakeholdersaboutthescopeandstandardsdocument.Thismayincludepressreleases,socialmediaannouncements,emailblasts,andpostingsonwebsites.Mobileandweb-basedapplicationsareanothermechanismtodisseminateinformationandprovideeasyandtimelyaccesstotheseessentialdocuments.
- Presentthescopeandstandardsdocumentatlocal,national,andinternationalconferences.Furtherwaystodisseminatethisinformationincludetheuseofwebinars.Attendancecanbeincreasedbyprovidingcontinuingeducationcredits.
- Capitalizeontheuseofthenursingspecialtyorganization’sjournal.Thismightincludeanannouncementaboutthescopeandstandardsdocumentandhowtoobtainit.Journaleditorscansolicitmanuscriptsthatillustratehowspecialtynursingscopeandstandardsareessentialforlegal,regulatory,administrative,education,andresearchactivities.
- Submitarticlesaboutthescopeandstandardsdocumenttootherspecialtyjournalsspecifictothefieldandnursing.Forexample,giventheprevalenceofindividualswithcomorbidpsychiatric/mentalhealthdisordersandsubstanceusedisorders,nursesineachspecialty(PMHMHandaddictions)shouldbecognizantoftheirrespectivescopeandstandards.
- Recommendthe scopeandstandardsdocument asrequiredreadingfornursesenteringthespecialty.Forexample,theDelawareSchoolNurseComprehensiveInductionProgram(
DelawareDepartmentofEducation,n.d.)provideseachnewschoolnurseacopyoftheSchoolNursing:ScopeandStandardofPractice( ANA/NASN,2011).Thenewschoolnurse’sself-assessment,basedonthecompetencies,isusedtoplanhis/hermentoringexperience.Thesepublicationscanalsoberequiredascoursereadingsbynurseeducatorsinhighereducation.Inadditiontothefoundationaldocument,Nursing:ScopeandStandardsPractice( ANA,2010b),thespecialtydocumentsarevaluabletopre-licensurestudentsseekingtolearnaboutthevariousnursingspecialties;registerednursesenteringorengagedinthespecialtypractice;andtograduatenursingstudentsastheyseekadditionaleducationalpreparationinaspecialtynursingpractice. - Establishstrongpartnershipsformarketingstrategieswithorganizationsthatcanpromotesalesofthescopeandstandardsdocument.TheANApublicationsdivisionwillhaveakeyroleinthis,yetnursingspecialtyorganizationsshouldalsopromotesaleoftheirscopeandstandardsdocumentsatconferencesandmeetings,aswellasthroughtheirwebsite.
Authors
Email:
Dr.FinnellisAssociateProfessorandDirectoroftheMaster’sandtheDoctorofNursingPracticeProgramsatJohnsHopkinsUniversitySchoolofNursinginBaltimore,MD.ShewastheleadwriterforthesecondeditionoftheAddictionsNursing:ScopeandStandardsofPractice.SheisacurrentmemberoftheAmericanNursesAssociationCommitteeonNursingPracticeStandardsandGuidelines.
Email:
Ms.ThomasisaschoolhealthconsultantanddeveloperandmanageroftheDelawareComprehensiveInductionProgramforSchoolNurses.ShewasleadwriterforSchoolNursing:ScopeandStandards(2005and2011).SheisapastmemberoftheAmericanNursesAssociationCommitteeonNursingPracticeandStandardsaswellasacurrentmemberoftheANACodeofEthicsRevisionSteeringCommitteeandthechairoftheANANursing:ScopeandStandardsRevisionSteeringCommittee.
Email:
Dr.NehringisDeanandProfessoratEastTennesseeStateUniversityCollegeofNursinginJohnsonCity,TN.ShewastheleadwriterforthesecondeditionoftheIntellectualandDevelopmentalDisabilitiesNursing:ScopeandStandardsofPractice.
Email:
Dr.McLaughlinisAssistantDean,InnovativeClinicalEducationatUniversityofCalifornia,LosAngeles.AsofJune2015,shewillbeAssociateHospitalDirector,ColoradoMentalHealthInstituteatFortLogan,Denver,CO.ShewastheleadwriterforthesecondeditionofthePsychiatric-MentalHealthNursing:ScopeandStandardsofPractice.
Email:
Dr.BickfordisSeniorPolicyAdvisorintheDepartmentofNursingPracticeandWorkEnvironmentattheAmericanNursesAssociation.Inthatrole,shedirectsthespecialtynursingrecognitionprogramandspecialtyscopeandstandardsofpracticedevelopmentandreviewprogram.Sheprovidesvariousleadershipandsupportservicesforthedevelopmentandrevisionofspecialtynursingscopeandstandardsofpracticedocuments.
AmericanNursesAssociation(ANA).(inpress).Scopeandstandardsofpractice(3rded).SilverSpring,MD:AmericanNursesAssociation(ANA).(2015).Codeofethicsfornurseswithinterpretivestatements.SilverSpring,MD:
AmericanNursesAssociation(ANA).(2010b).Nursing’ssocialpolicystatement:Theessenceoftheprofession.SilverSpring,MD:
ArticlepublishedMay31,2015
References
American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Nursesbooks.org.
American Nurses Association (ANA). (2010a). Recognition of a nursing specialty, Approval of a specialty nursing scope of practice statement, and Acknowledgment of specialty nursing standards of practice. Retrieved from www.nursingworld.org/MainMenuCategories/Tools/3-S-Booklet.pdf. (under revision)
American Nurses Association (ANA). (2010b). Nursing’s social policy statement: The essence of the profession. Silver Spring, MD: Nursesbooks.org.
American Nurses Association/American Association on Intellectual and Developmental Disabilities. (ANA). (2013). Intellectual and developmental disabilities nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org.
American Nurses Association/International Nurses Society on Addictions. (2013). Addictions nursing: Scope and standards of nursing practice. Silver Spring, MD: Nursesbooks.org.
American Nurses Association/American Psychiatric Nurses Association/International Society of Psychiatric Mental Health Nurses. (2014). Psychiatric mental health nursing: Scope and Standards. Silver Spring, MD: Nursesbooks.org.
American Nurses Association/Correctional Nursing. (2014). Correctional nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org.
American Nurses Association/National Association of School Nurses. (2011). School nursing: Scope and standards of practice. Silver Spring, MD: Nursesbooks.org.
Delaware Department of Education. (n.d.). Comprehensive induction program for school nurses. Retrieved from www.doe.k12.de.us/Page/494
Suthers, L.R. (1917). The school nurse. New York, NY: G.P. Putnam’s Sons. Available here: https://books.google.com/books?id=I98HOfRxGDoC&printsec=frontcover&dq=the+school+nurse&hl=en&sa=X&ei=CtU-VaiBC47HsQScqIHYDA&ved=0CDwQ6AEwAg#v=onepage&q=the%20school%20nurse&f=false