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Self-Assessment of Nursing Standards of Practice and Code of Ethics


Jamie Wertz
Ferris State University

STANDARDS OF PRACTICE AND ETHICS

Self-Assessment of Nursing Standards of Practice


Nurses are held accountable for their actions according to the standards of care
developed by the American Nurses Association (ANA). The 16 practice standards and
nine ethical standards written by the ANA provide a roadmap to excellence in nursing if
followed. As I near graduation, its important to reflect upon and gain understanding of
each standard of practice and ethical code to ensure I am competent enough to care for
my patient population. Working on a Neuroscience unit as a nurse technician and
practicing in other areas of nursing throughout clinical has only solidified my passion for
Neuroscience and its where I want to focus my career goals. This paper is a selfassessment of my journey through nursing school, analyzing standards I have met, those I
have not met yet, and a plan as to how I will achieve competency.
Standards of Practice
Assessment
Nurses are constantly conducting assessments. We are at the forefront of patient
care. Therefore, its crucial to perform an assessment and gather data to generate a
baseline status of each patient to decipher systematic changes of improvement or
deterioration in regard to his or her condition. Assessment prioritizes data collection
based on the healthcare consumers immediate condition, or the anticipated needs of the
healthcare consumer or situation (American Nurses Association [ANA], 2010, p. 32).
Assessing a patient is a standard I meet every single time I walk into my patients room.
At the beginning of each clinical shift with each of my patients, I conduct a thorough,
systemic assessment. I use subjective and objective data to guide my assessment by
asking the patient questions and observing their behaviors as I inspect each system from

STANDARDS OF PRACTICE AND ETHICS

head-to-toe. Sometimes assessments need to be performed more frequently than others,


based on each patients individualized need or medical diagnosis. Assessments also allow
me to develop the best plan of care for my patient based on my findings. I have
discovered through practice that constantly assessing my patients is the best way I can
prioritize and provide the greatest care possible for my patients.
Diagnosis
After completion of my morning assessment, specifically, I am able to create
nursing diagnosis or validate ones that have already been made by another healthcare
professional (ANA, 2010). Each diagnosis created enables me to communicate actual or
potential risks and safety concerns or barriers in my patients daily plan of care. I have
also met this standard of practice in my clinical settings. Once I complete my
assessments, I chart my findings in a program called I-View and then my diagnoses are
developed to facilitate achievement of expected outcomes and plan for each of my
patients.
Outcome Identification
The registered nurse identifies expected outcomes for a plan individualized to
the healthcare consumer or the situation (ANA, 2010, p. 35). Once a diagnosis has been
made, registered nurses collaborate with the patient, his or her family members or
caregivers, and/or healthcare providers to establish realistic and desirable outcomes based
on the patients health status at that time (ANA, 2010). I also meet this standard in the
clinical setting by developing measurable, timely outcomes for each of my patients
within his or her interdisciplinary team of care. These outcomes help provide assurance in
continuity of care throughout all aspects of the patients situation. I am constantly

STANDARDS OF PRACTICE AND ETHICS

working with the patient to set new goals throughout their plan of care and I have found it
to be most beneficial to include my patients in the development of each goal. For
example, when I work on the Medical-Surgical unit, its important to get my patients up
and moving as soon as possible to prevent complications in their recovery. I set a goal
with one particular patient to ambulate three times daily in the hallway with staff
assistance. Prior to ambulating with my patient for the first time post-op, she stated she
was experiencing some dizziness upon sitting up at the edge of the bed. Once her
dizziness subsided, we tweaked decided to adjust her goal of walking in the hallway to
getting out of bed and walking to the bathroom and sitting up in the chair for 30 minutes.
Later in the afternoon that day, we reevaluated her condition and were able to complete
our first goal by walking in the hallway three times by the end of my shift.
Planning
The registered nurse develops a plan that prescribes strategies and alternatives at
attain expected outcomes (ANA, 2010, p. 36). The planning process begins after the
outcomes have been identified based on the patients nursing diagnoses derived from the
assessment. The registered nurse collaborates with the patient, their family members,
healthcare professionals and all other individuals involved in the patients care to develop
an individualized plan of care based on the needs and health status of the patient (ANA,
2010). This care plan guides this interdisciplinary team in providing continuity of care, a
direction in the path of the patients care, and enables them to create modifiers according
to ongoing assessment findings and outcome identifiers (ANA, 2010). I have achieved
the standard of planning in my clinical setting by assisting in the development and
implementation of care plans. For example, I had a patient who presented with a

STANDARDS OF PRACTICE AND ETHICS

reddened coccyx. The nursing diagnosis was risk for impaired skin integrity. The
outcomes developed acknowledged the patient being pressure ulcer free while regaining
integrity of her skin. The planning process enabled me to generate an every two-hour
repositioning schedule with the patient as well as placement of a Mepilex dressing on her
reddened coccyx to prevent skin deterioration.
Implementation
The registered nurse implements the plan of care in a timely manner in
accordance with patient safety goals (ANA, 2010, p. 39). The standard of
implementation has also been met in my clinical setting experience. Through the
collaboration with my assigned nurse on the Medical-Surgical unit, we were able to
implement interventions outlined in the structured plan of care for our patient diagnosed
with a CVA or Stroke. Since the patient was ordered to be on bed rest and presented with
flaccidity on his left side, it was important to implement the techniques of repositioning
every two hours and passive range of motion (ROM) exercises in his left upper and lower
extremities. A stroke packet was also given to and explained to the patient and his wife
for their personal reference and guidance, as well as education on safety standards for the
patient such as activity assistance of dangling at the bedside with a maximum two staff
assist and a gait belt.
Evaluation
Evaluation occurs after interventions have been implemented in the patients plan
of care. The registered nurse evaluates progress toward attainment of outcomes (ANA,
2010, p. 45). On-going assessments are conducted in order to evaluate goals and
outcomes. The data collected from each assessment can be used toward modifying care

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plans, diagnoses, or outcomes as needed for the patient by the registered nurse (ANA,
2010). In order to provide the best care for my patients, I have to meet, and have met, this
standard in the clinical setting daily. If I am not competent in my assessment abilities, I
could potentially alter the patients outcome in a negative way. Therefore, I collaborate
with my nurse instructor to communicate assessment findings and modify my patient care
plans according to the results.
Standards of Professional Performance
Ethics
The registered nurse delivers care in a manner that preserves and protects
healthcare consumer autonomy, dignity, rights, values, and beliefs (ANA, 2010, p. 47).
Nurses assist their patients in informed decision-making while maintaining a therapeutic
and professional relationship (ANA, 2010). I meet this standard every day in my practice.
I maintain patient confidentiality, protect my patients rights and dignity, as well as serve
as an advocate for my patients by putting them at the center of the care I provide by
putting their needs or concerns first.
Education
The registered nurse attains knowledge and competence that reflects current
nursing practice (ANA, 2010, p. 49). Nurses are better prepared to perform to the
highest standards of the profession if they are well-versed in skills, the setting, roles,
advocacy, specialty, etc. The nurse demonstrates a commitment to lifelong learning and
participates in ongoing educational opportunities to advance their knowledge (p.49).
Nurses maintain a record of their continuing education throughout their nursing career. I
have met this standard of practice thus far in my nursing career, but I always have room

STANDARDS OF PRACTICE AND ETHICS

for improvement. Nursing is a profession that never stops advancing and improving.
Being well educated will be crucial to being successful and being the best advocate for
my patients throughout my career. I plan to seek out learning experiences and attend
nursing or health care conferences in order to keep up on the every-changing healthcare
environment.
Evidence-Based Practice and Research
The registered nurse integrates evidence and research findings into practice
(ANA, 2010, p. 51). This standard will always be an on-going practice in the nursing
profession. The healthcare system is always evolving and keeping up with the latest
research findings. I have also met this standard, but will also continue to meet this
standard throughout my nursing career. As new research in the medical field brings about
new ways to practice within the various healthcare settings, evidence-based practice
enables nurses to provide the best quality of care. A simple example of evidence-based
research that I use every day in practice is hand washing. Research proves that hand
washing prevents nosocomial infections. This standard of practice will be an ongoing,
lifelong practice in my nursing career.
Quality of Practice
The registered nurse demonstrates quality by documenting the application of the
nursing process in a responsible, accountable and ethical manner (ANA, 2010, p. 52).
Quality in nursing is a standard I apply to my clinical experience daily. Without quality in
practice, there can be no improvements, no outcomes met. Information I gather from my
continuous assessments is documented in through a program called I-View. Each shift, I
provide necessary care to my patients based on assessment findings that enable me to

STANDARDS OF PRACTICE AND ETHICS

carry out the plan of care. Goals and outcomes are communicated with the patients and
families, interventions are planned, the plan then gets implemented into the care, and
evaluations are obtained. Some strategies in the future I could use to improve my quality
of practice would include assisting in the development of policies or guidelines within the
organization I work for.
Communication
The registered nurse communicates effectively in a variety of formats in all areas
of practice (ANA, 2010, p. 54). Nurses convey information to healthcare providers,
patients, family members, colleagues and other members of the medical interdisciplinary
team (ANA, 2010). Nurses are constantly interacting with a variety of individuals
throughout their shifts to ensure their patients needs are put first. Communication is one
of the most important aspects of a nursing career. I have met this standard through
communication with physicians; pharmacists; occupational, physical and speech
therapists; patients and their families or caretakers; nursing assistants; dietary personnel;
radiology; and patient transport personnel. For example, I work on a medical-surgical
unit so I am constantly communicating with and educating my patients on the importance
of getting up and walking around after surgery and using the incentive spirometers in
order to prevent pneumonia. In my experience, communication is one of the hardest
aspects of this profession and is a standard I will always be working to improve upon.
Leadership
The registered nurse demonstrates leadership in the professional practice setting
and the profession (ANA, 2010, p. 55). Accountability in the quality of care for every
patient is at the forefront of leadership. I feel I am heading in the right direction of

STANDARDS OF PRACTICE AND ETHICS

leadership but I do not possess the knowledge yet in order to be a good leader. I currently
display leadership qualities by collaborating with fellow classmates, health professionals
and being a team player. My passion for nursing and my desire to learn as much as I
possibly can enables me to participate in an ongoing commitment to continuous, lifelong
learning and education (ANA, 2010, p. 55).
Collaboration
The registered nurse collaborates with the healthcare consumer, family, and
others in the conduct of nursing practice (ANA, 2010, p. 57). Nurses collaborate with
the interdisciplinary healthcare team, patients and family members, which enables them
to produce positive outcomes. I meet this standard as I participate in I-Rounding, a
collaborative technique where the physician, nurse, pharmacy and care manager round
together to each patient room and discuss their plan of care together, at once. This allows
the patient to ask any questions they may have regarding their care with all of us in one
place. Communication is an important component of this standard. Collaboration creates
a work environment engaged in teamwork, respect, trust, conflict management and
conflict resolution (ANA, 2010). This is another standard that I will constantly be
practicing in my nursing career.
Professional Practice Evaluation
The registered nurse evaluates her or his own nursing practice in relation to
professional practice standards and guidelines, relevant statutes, rules and regulations
(ANA, 2010, p. 59). In order to identify strengths and weaknesses in ones nursing
profession, the nurse must continuously self-evaluate and reflect on the care he or she
provides. As a student nurse, I feel I have met this standard as I am constantly seeking

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feedback from my professors and clinical instructors regarding my performances. After


graduation, I plan to continue to evaluate my strengths and weaknesses in my
professional practice. Thus far, I am aware of the skills, communication techniques,
knowledge and other areas of clinical nursing I feel confident in and those I need to
continue to develop in. The feedback I receive now in my student nursing career will be
taken with me into my professional nursing career and will enable me to keep pushing
myself in my personal growth and development so I can be the best nurse to my patients.
Resource Utilization
The registered nurse utilizes appropriate resources to plan and provide nursing
services that are safe, effective, and financially responsible (ANA, 2010, p. 60). Resource
utilization enables patients to make informed decisions regarding the care they wish to
receive. Nurses recognize patient needs, potential for harm and desired outcomes while
considering quality, safety, cost and effectiveness of care (ANA, 2010). I have met this
standard by utilizing resources available in the clinical setting. For example, technology
provided by the organization has enabled me to obtain vitals, chart assessments, look up
and administer medications, obtain lab values and read diagnostic examinations.
Environmental Health
The registered nurse practices in an environmentally safe and healthy manner
(ANA, 2010, p. 61). Safety in the workplace is vital to quality of care. Reducing
environmental health risks is another standard of care that nurses help provide. Nurses
also participate in the creation of strategies to promote health in the communities they
serve (ANA, 2010). I have met this standard and continue to meet this standard with my
patients in isolation environments. Personal protective equipment (PPE), such as isolation

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gowns and gloves, need to be worn while entering a patient room if the patient has an
isolation precaution related to a positive Methicillin resistant Staphylococcus aureus
(MRSA) infection. I educate the patients family members and visitors on the importance
of washing their hands before and after entering the room, as well as wearing a gown and
gloves in order to prevent the spread of MRSA to themselves and others around them.
Code of Ethics
Ethics Provision One
The nurse practices with compassion and respect for the inherent dignity, worth,
and unique attributes of every person (ANA, 2015, p. 1). Care is provided to each
patient regardless of social or economic status, the depth of health problems or individual
characteristics. I have met this provision of ethics and continue to meet it daily as I care
for patients of various backgrounds, setting aside bias or prejudice. Respect and dignity
are to be given to all individuals regardless of any factors that contribute to their status of
health.
Ethics Provision Two
The nurses primary commitment is to the patient, whether an individual, family,
group, community, or population (ANA, 2015, p. 5). Nurses should always put their
patients, as well as all other populations at the forefront of care. When I care for a patient,
I care for their loved ones as well. I achieve this standard each time I am assigned patient
to care for. Caring for a patient means caring for every aspect that is involved in their
lives.
Ethics Provision Three

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The nurse promotes, advocates for, and protects the rights, health, and safety of
the patient (ANA, 2015, p. 9). Patient safety is one of the most important components in
providing competent nursing care. One of the most important roles a nurse possesses is
advocacy. I have met this standard by always putting safety first while providing care to
my patients. I work with a large population of patients who have had a stroke. Left- and
right-sided weakness is a major concern for these individuals because they cannot utilize
both upper and lower extremities equally as they could the day before they had the stroke.
Using a gait belt and assisting these patients up with two nursing staff is crucial in
prevention of a fall. Safety should always be a priority in nursing to prevent further
injuries or conditions from worsening.
Ethics Provision Four
The nurse has authority, accountability, and responsibility for nursing practice;
makes decisions; and takes action consistent with the obligation to promote health and to
provide optimal care (ANA, 2015, p. 15). Nurses determine tasks that can be delegated
to other members of the team such as fellow nurses for drug passes or nursing technicians
for assistance with activities of daily living (ADLs) if they fall behind during their shift. I
have met this ethical standard by practicing delegation on the units I work on. I am not
one to ask for help easily, but if I am behind in my day and one patient needs medication
while the other needs to use the bathroom, I will ask the nursing technician to assist our
patient to the bathroom while I pass medications. Delegation allows me to provide more
quality and efficient care. Also, I meet this standard through documentation. Every time I
document an assessment, a task, an activity, or an hourly round, for instance, I am taking
ownership and responsibility of the care I provided.

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Ethics Provision Five


The nurse owes the same duties to self as to others, including the responsibility
to promote health and safety, preserve wholeness of character and integrity, maintain
competence, and continue personal and professional growth (ANA, 2015, p. 19).
Through utilization of universal precautions, proper body mechanic techniques when
lifting patients or repositioning patients, and using safety measures such as ambulating a
fall risk patient with a gait belt, I have also met this ethical provision. Safety cannot be
underestimated in patient care. I always think of my patients as my loved ones and treat
them as if I would my family. Through continuing education, certifications, attending
classes and conferences, and keeping up on evidence-based practice in the nursing
profession, I will be able to grow professionally in my career.
Ethics Provision Six
The nurse, through individual and collective effort, establishes, maintains, and
improves the ethical environment of the work setting and conditions of employment that
are conducive to safe, quality health care (ANA, 2015, p. 23). I meet this standard
through my clinical experience as a student nurse and my experience as a nursing
technician. I help ensure my patients safety throughout day. For example, I always stay
within an arms length of my patients when I assist them up to the bathroom or I secure
the environment from harm for a patient I am one-on-one with who has suicidal ideation.
Not only is it hospital policy to remove all sharp and dangerous items from the patients
room, but its the ethical thing to do in order to keep that patient safe. Collectively on the
units, the other nurses and I ensure patient satisfaction by answering call lights in a no

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pass zone, meaning we dont pass a room with the call light on without attending to
patient needs.
Ethics Provision Seven
The nurse, in all roles and settings, advances the profession through research and
scholarly inquiry, professional standards development, and the generation of both nursing
and health policy (ANA, 2015, p. 27). I do not feel I have met this standard completely
yet. Our curriculum at school allows us to research new evidence-based practices and use
those best practices in the clinical setting, but only time and experience working in the
profession will truly enable me to meet this ethical provision.
Ethics Provision Eight
The nurse collaborates with other health professionals and the public to protect
human rights, promote health diplomacy, and reduce health disparities (ANA, 2015, p.
31). I have not yet met this ethical provision in the community setting, but I have met it in
the hospital setting. I help reduce health disparities through educating patients on safety
at home, eating a well-balanced diet, and smoking cessation. Not every patient is going to
do these things, but by educating my patients, Im at least giving them the tools to make
informed decisions toward the betterment of their health. This is an ethical, responsible
role I play and will continue to participate in throughout my nursing career.
Ethics Provision Nine
The profession of nursing, collectively through its professional organizations,
must articulate nursing values, maintain the integrity of the profession, and integrate
principles of social justice into nursing and health policy (ANA, 2015, p. 35). I have met
this standard through my participation in Ferris Student Nurses Association (FSNA), but

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I have yet to meet this ethical provision as a professional. I plan to continue my


participation in a professional organization once I pass my state boards. Maintaining
integrity in my practice is very important to me.
Professional Development Plan
Continuous self-evaluation is a priority in my personal development in my
nursing profession. The American Nurses Association standards of practice and code of
ethics I have reflected upon in this paper will be the foundation of structure and
guidelines in my nursing career. Competency in each standard is what I wish to achieve
within my first year as a professional nurse. However, I also understand that competency
in each standard of practice and ethical code is a lifelong commitment. Standards and
ethical codes may remain the same, but evidence-based practice evolves daily.
With new practice comes new technique and skill. Continuous education will
enable me to keep up with the ever-changing healthcare environment. Although some
standards discussed above have been achieved, there is always room for improvement in
my professional career. Evaluations throughout the span of my nursing career will be
critical toward success as a competent, ethical and confident nurse. As I constantly
participate in self-evaluation, I will also receive peer and management evaluation.
Consistent evaluation will help hold me accountable for the care I provide and the
professionalism I exude.
My number one goal at this time upon completion of my BSN and pass the
NCLEX is to be hired on the Neuroscience unit at Butterworth as a RN. I have been
working on this unit for three years now and I have developed a passion for the neuro
patient population. Future goals include becoming a charge nurse on my unit, training

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newly hired RNs on my unit and attending numerous nursing conferences to enhance my
knowledge in the field. Evaluation of my plan and goals will be constant.
Conclusion
Nursing is one of the most respected professions. Continuous improvement,
education, and self-evaluation are crucial components in nursing. Striving to reach each
standard of practice and ethical code is a lifelong commitment in an ever-changing
healthcare environment. A career in nursing enables individuals to be influential,
essential advocates in the lives of many patients. I chose nursing because those
characteristics are what I want to be for my patients. Continuous education, experience,
empathy, compassion, cultural awareness, commitment and patient-centered care in my
nursing career will enable me to become competent in all areas of standards of ethics and
care.

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References
American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive
Statements. Silver Spring, MD: Nursesbooks.org. Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthic
sforNurses/Code-of-Ethics-For-Nurses.html
American Nurses Association. (2010). Nursing Scope and Standards of Practice. Silver
Spring, MD.