Part 1: Nursing standards, their history and significance

© The Medical-Legal News, 2007

At the completion of this CE module the individual will be able to:

1) Define the term “standard,”

2) Discuss the history of standards, specifically nursing standards, 

3) Articulate the responsibilities and accountability that are inherent in the nursing standards, and

4) Discuss the relationship between the Standards of Nursing Practice and the individual state Nurse Practice Acts.

Webster defines standard as, “something established as a measure or reference of weight, extent, quantity, quality or value” or “recognized excellence, popularity or reliability.”

The American Society of Testing and Materials states, “Standards are a vehicle of communication for producers and users. They serve as a common language, defining quality and establishing safety criteria. Costs are lower if procedures are standardized. Training is simplified. And consumers accept products more readily when they can be judged on intrinsic merit.”

Standardization is the process that encompasses the initiation, development and application experience to determine the precise optimum technical requirements for, and aspects of, technology. The result of this merger is an authoritative document called a “standard.”

The question could be asked, “How does this affect nursing?” In order to answer that question, one has to go back in history and look at where standardization began. Based on relics found, standardization can be traced back to the ancient civilizations of Babylon and early Egypt. The earliest standards were physical standards for weights and measures. As trade and commerce developed, written documents evolved that set mutually agreed upon standards for products and services. As time and technology has progressed, so has standardization. Today, standard setters seek to achieve uniformity in all global issues such as healthcare, environment and safety. Standards are fundamental to ensuring success for organizations that use them and create a better way of living for all of us.

Standards for nursing began with Florence Nightingale whose work represents the beginning of professional nursing. Her unique perspective for nursing practice focused on the relationship of patients to their surroundings. She set forth principles that were foundational to nursing and remain relevant to nursing practice today. For example, her belief of the importance of observing the patient and accurately recording information regarding the patient are clearly seen in today’s ANA’s (American Nurses Association) Standards for Nursing Practice.

After the Civil War, the need for a training school for nurses was realized and as training schools began to open, the need for standardized curricula was quickly identified. As nurse educators met to develop curriculum standards, the need to organize the practitioners of nursing was recognized. As time went on two major nursing organizations grew out of this first meeting of nursing leaders: The National League for Nursing became responsible for setting standards for training schools and their curricula, while the American Nurses Association became the recognized authority for scope of practice and standard development for the practicing nurse.

In the past, nurses were not considered responsible for their actions. The hospital, physician or clinic assumed responsibility for their actions. In the 19th century, life was fairly simple and questions were uncomplicated. Few medical advances were made. The role of the physician and the nurse was to support patients through times of illness, assisting them toward recovery or keeping them comfortable until death. The nurse functioned as a caregiver and a physician-helper. As technology and healthcare have advanced and become more complex, there have been increasing societal expectations for nurses. As society’s needs and expectations have changed, so have the regulations and standards that help to define nursing practice.

Knowledge of legal rights and responsibilities related to nursing practice is essential for the nurse of today. As our nursing practice becomes more autonomous, we will be held responsible for not only our own actions, but the actions of those we supervise. Understanding one’s own rights and responsibilities as a registered nurse, as well as those of others, is essential for safe and competent nursing care. The ANA has the responsibility for establishing and implementing standards of nursing practice, as it is the recognized professional organization for nurses. •

Part 2 of this CEU article will appear in the next issue.

Frances W. (Billie) Sills, RN, MSN, ARNP, is an assistant professor at ETSU College of Nursing in Tennessee and a member of this paper’s editorial board; dewars3@aol.com.