Standards are helping to plan, implement and assess the
quality of services and to show that nursing is accountable to
society, to consumers of nursing services and to
governments, as well as to the profession of nursing itself. a
standard is an agreed way of doing something. It could be
about making a product, managing a process, delivering a
service or supplying materials – standards can cover a huge
range of activities undertaken by organizations and used by
They are powerful tools that can help drive innovation and
increase productivity. They can make organizations more
successful and people’s everyday lives easier, safer and
healthier. Standard setting includes establishing
fundamental definition in nursing and determining
qualifications for education and practice .Administration
encompasses interpreting these standards ,developing
mechanisms and tools for their enforcement,and
conducting the actual processes for regulation.
Standard is a broad statement of quality
MEANING OF STANDARD: a level of quality or
DEFINITION OF STANDARD:according to ANA :A
standard is described as a criterion used by general
agreement as acceptable level of practice or an established
Norms: - Norm is the current level of performance of a
particular criterion, as determined by description study of
the target population. The Norm is an authoritative
standard, a type, the ordinary the more frequent value of
statement. The term norm is frequently used
synonymously with standard in the literature.
DEFINITION OF NURSING STANDARD
Nursing practice standards are descriptive statements that
effect the nature of current nursing practice current
knowledge and current quality of nursing care.As such ,they
are a means of establishing accountability of nursing care
rendered by the professional nurse.
IMPORTANCE OF STANDARDS
Standards form the fundamental building blocks for product
development by establishing consistent protocols that can be universally
understood and adopted.
In summary standards fuel the development and implementation of
technologies that influence and transform the way we live, work and
In the case of nursing practice ,standards are the established criteria for
the practice of nursing. Standars are statements that are widely
recognized describing nursing practice and are seen as having
permanent value.A standard is a performance model that results from
integrating criteria with norms and is used to judge quality of nursing
objectives ,orders and methods.one method of nursing quality
improvement is nursing audit ,in which patient outcomes are measured
against nursing standards and performance criteria to determine the
efficiency of nursing actions.
As a professional body ,nursing must guarantee the
quality of its service to the public and these standards are
a concomitant and on assurance that the highest quality
of care will be provided to all patient in all health care
setting.(American hospital association-1995)
To evaluate the quality of care provided ,the nursing
profession has established standards of practice through
the American Nurse Association the professional body for
all professional nurses in the country,and these standards
serve as a guideline for peer evaluation ,employee
assessment and self evaluation of nursing practice
according to the latest theories and techniques advances
associated with the practice of professional nursing.
PURPOSES OF STANDARDS
COMMUNICATION:communication provides for sharing a
common language with nursing professional which can cross
RESEARCH:The standards provide a framework for further
investigation,so that current practices are no longer based on
intention “word of mouth”but are derived fronm theory
developed by authorities with the nursing profession
LEGAL IMPLICATION:The nursing profession must be self
regulating to maintain credibility as a profession .The courts
use the professional standards “as a yard stick”to determine
whether hospitals and health care professionals have provided
quality patient care according to rationally acceptable
QUALITY ASSURANCE:Standards can be used as the
criteria for quality assurance studies to assess the current
levels of practice rendered by the health care services
provided by the organization or both
PROFESSIONAL ACCOUNTABILITY:standards set
guidelines for nursing practice ,providing uniform basis for
collecting a conjvation with an established assurance
programme and or performances appraisal system.
DECISION MAKING:Standards also help in decision
making and choosing alternatives for delivering of health
care,Helps in supervision and improving performance.
BASIC PRINCIPLES OF STANDARDS
Standards should be designed to achieve a stated purpose
standards should be based upon clear definitions of professional
scope and accountability
Standards should promote the fullest development of the
profession in accordance with its potential social contribution
Standards should be sufficiently broad and flexible to achieve
their objective and at the same time permit freedom for
innovation ,growth and change
Standards should promote universal levels of performance and
encourage professional identity and mobility
Standards should recognize the equality and interdependence of
professions offering essential services
Standards should be formulated according to requirement which
facilities their applicability and use by the profession.
FRAMEWORK OF STANDARDS The focus of the standards and the framework,within which the multiple
activities of nursing are performed,need to be determined.Auseful and very
commonly used framework for organizing standards is the structure
process outcome model.
STRUCTURE STANDARDS focus on the setting and environment in which
nursing is practiced
PROCESS STANDARDS focus on the practitioner and the activities carried
out in delivering care
OUTCOME STANDARDS focus on the end result of the nursing services
and activities carried out and changes which occurred
The second approach is based on the belief that structure,process and
outcome are interdependent.This approach may be most suitable for
standards developed at the local operational level and written within the
framework of the broader standards developed at the national level
The development of standards and related criterion measures are
then,guided by the basic principles,includes the general essential elements
and addreses the specific elements according to the specified functional
area of nursing,as illustrated in figure below.
ESSENTIAL ELEMENTS FOR STANDARDS FOR NURSING PRACTICE:
THE NURSE:standards should address,”who is the nurse”,specifying
qualifications for practice and requirements for licensure,such as
the determination of required competencies at,”entry to
practice”level.The accountability and responsibility of the
individual practitioner to consumers and employers is
demonstrated by the behaviours of the nurse in carrying out the
professional role.Accountabilty is also shown in the activities of the
nurse in relation to the nursing profession and in participating in
the advancement of the profession as well as to the nurse
him/herself as shown by practicing and maintaining through
continuing education of high quality in practice.Adherence to
ethical principles or a code of ethics should be stressed as well as
compliance with legal customs.
NURSING PRACTICE:as nursing practices are different in different
countries ,the various levels of nurses and levels of practice need to
be addressed.The regulation of nursing,who carries out this
function as well as how thee function is carried out,will determine
the scope of practice
PEOPLE REQUIRING NURSING CARE:nursing and nurse
only exist because people require nursing services .These
may be individuals ,families,groups or communities with
needs requiring nursing services
THE SETTING FOR NURSING PRACTICE:for nursing care to
be delivered to people,there needs to be adequate facilities
with sufficient resources to carry out safe practice of high
quality.When this is not so ,standards will not be maintained
EVALUATION OF NURSING PRACTICE:focus on the
practitioner requires standards regarding performances
appraisal.The methods and underlying philosophy of
appraisal should be stated whether disciplinary system and/
or merit or reward systems are used.
CHARACTERISTICS OF STANDARD:
statement must be broad enough to apply to a vide variety of
must be realistic,acceptable,attainable
the nurse care must be developed by members of the nursing
profession,preferable nurses practising that the direct care level
with consultation of experts in the domain.
should be resembled in positive terms and indicate acceptable
performance i.e. good,excellence etc.
the nursing care must express what is desirable optional level
must be understandable and stated in unambiguous terms.
must be based on current knowledge and scientific practice
must be reviewed and revised periodically
may be directed towards an ideal,i.e. optional standards or may only
specify the minimal care that must be attained ,i.e. minimum
standards that work are objective,acceptable,achievable and flexible
SOURCES OF NURSING CARE STANDARDS:
professional organization ,e.g,association,TNAI,GNAK
licensing bodies ,e.g,statutory bodies,INC,MCI,ETC.
Institutions/health care agencies
department of institutions,e.g Department of nursing
patient care units,
government units at national,state and local government
individual e.g.personal standards
DEVELOPMENT OF STANDARDS:
Every profession is required to develop its own values of providing service to
justify its existence.For nursing profession must establish ,maintain and
improve wherever possible the standards of care and these standards must
serve as the minimum level of acceptable performance by the professional
and/or the organization.As a professional body ,nursing must guarantee the
quality of its service to the public and these standards are a concomitant and
on assurance that the highest quality of care will be provided to all patient in all
health care setting.(American hospital association-1995)
To evaluate the quality of care provided ,the nursing profession has established
standards of practice through the American Nurse Association the professional
body for all professional nurses in the country,and these standards serve as a
guideline for peer evaluation ,employee assessment and self evaluation of
nursing practice according to the latest theories and techniques advances
associated with the practice of professional nursing
CLASSIFICATION OF STANDARDS:
NORMATIVE STANDARDS describe practices considered
good or ideal by some authoritative group.ideal sides set by
EMPIRICAL STANDARDS describe practices actually
observed in a large number of patient care setting.Here ,the
norm active standards describe a higher quality of
performance than empirical standards .generally,professional
organizations (ANA/TNAI) promulgate normative standards
where as law enforcement and regulatory bodies
(INC/MCI)promulgate empirical standards.
THE ENDS STANDARD are patient oriented
.They describe the change as desired in a patients
physical status or behavior.
THE MEANS STANDARD are nursing oriented
,they describe the activities and behavior
designed to achieve the ends standard .ends or
patient outcomes standards require information
about the patient .A means standard call for
information about the nurses performance.
CLASSIFICATION OF NURSING STANDARDS
ACCORDING TO FRAME OF REFERENCES
STANDARDS FOR NURSING EDUCATION PROGRAMS:
Section1. 1)Statement of Purpose: -.The purpose of
Serve as a guide for the development of new nursing
Provide criteria for the evaluation and approval of new
and established nursing education programs
Foster the continued improvement of established nursing
Ensure that graduates of nursing education programs are
prepared for safe nursing practice;
Section 2. Approval of Nursing
(a) Provisional Approval
(i) Before a nursing education program is permitted to admit
students, the program should submit evidence of the ability to
meet the standards for nursing education.
(A) Proposal which includes at least the following
(1.) Documentation of the present and future need for the nursing
education program in the state;
(2.) Rationale for the establishment of the nursing education
(3) Availability of qualified administrator and faculty;
(4.) Evidence of financial resources adequate for the planning,
implementation and continuation of the nursing education
(B) Application for provisional approval shall be made: Once the
proposal has been approved by the board and the following conditions
have been met:
(I) A qualified nurse administrator has been appointed and there are
sufficient qualified faculty to initiate the nursing education program;
(II) A written proposed nursing education program plan, developed in
accordance with the standards for nursing, has been submitted; and
(III) A site visit has been conducted by the board if necessary by the
(C) Following board review of the proposed nursing education
program, the board may grant or deny provisional approval
.(D) The parent institution and administrative head of the proposed
nursing education program may be present at the meeting to clarify
information contained in any of the reports.
(E) If provisional approval is denied, the institution may request a
hearing before the board.
(F) Following board provisional approval, progress reports shall be made
to the board as requested.
(G) Following graduation of the first class, a self-evaluation report of
compliance with the standards for nursing education shall be submitted
by the nursing education program. A site visit by the board shall occur
for consideration of full approval of the nursing education program.
. (b) Full Approval/Conditional Approval
( I ) The board may grant varying levels of approval after
Full Approval: full approval is granted to a nursing education
program after the first graduating class has taken the board
approved licensing examination and the program has
demonstrated compliance with the standards for nursing
Conditional Approval: conditional approval may be granted
for a limited time to a nursing education program that has
had provisional or full approval and has now failed to meet
the standard for nursing education. The board will
determine the length of time and identify the deficiencies
that must be corrected.
Continued Full Approval.
All nursing education programs shall be reevaluated at least
every 8 years, upon request of the nursing education
program, to ensure continuing compliance with the
standards for nursing education
Continuing compliance with the standards for nursing
education involves the submission of a self-evaluation report
by the nursing education program and a site visit by a board
representative. Announcement of a site visit shall be sent to
schools at least three months in advance of the visit. Ten
copies of the nursing education program’s self-evaluation
report of compliance with the standards for nursing
education shall be submitted to the board 30 days prior to
the scheduled site visit;
Section 3. Board Review of
Nursing Education Programs
(a) Annual ReviewAll nursing education programs excluding those
with provisional approval shall submit an annual report
(b) Site Visit Site visits may be conducted when the board receives
evidence that indicates that the nursing education program is not in
compliance with the standards for nursing education.
(1)The administrator of the parent institution and the administrator of
the nursing education program receive a written notice of deficiencies
from the board including a reasonable period of time, based upon the
number and severity of deficiencies, to correct the deficiencies. No
period for correction shall exceed 18 months.
(ii) Following a determination that a nursing education program is not
in compliancewith the standards for nursing education programs the
board may withdraw full approval and may place the program on
.((A) The administrator of the nursing education program
shall, within 10 days from the date of receipt of the notice of
deficiencies, file a plan of correction with the board.
(B) The administrator of the nursing education program may,
within 10 days from receipt of the notice of deficiencies,
submit a written request for a hearing before the board to
appeal the board’s determination of deficiencies.
(C) At any time during the correction period, the nursing
education program may request restoration to full approval if
the nursing education program demonstrates correction of
Section4. Denial or Withdrawal of
Approval for Nursing Education
The board may deny provisional approval when it determines that
standards for nursing education have not been met
(b) The board may deny full approval when it determines that a nursing
education program fails to meet the standards for nursing education.
(c) The board may withdraw full or conditional approval when it
determines that a nursing education program has not provided
sufficient evidence that the standards for nursing education are being
(d) If the board determines that an approved nursing education
program is not meeting the criteria set forth in these regulations, the
parent institution shall be given a reasonable period of time to correct
the identified nursing education program deficiencies. If the nursing
education program fails to correct the identified deficiencies within the
time specified, the board may withdraw the approval
(e) After the board has conducted the hearing, the board
may take any of the followingactions:
(i) Grant provisional approval if the board finds that the
proposed nursing education program meets the criteria as
stated in the board’s standards for nursing education
(ii) Deny provisional approval if the board finds that the
proposed nursing education program fails to meet the
criteria as stated in the board’s standards for nursing
Grant conditional approval if the board identifies
deficiencies in nursing education program that has been
failed to meet the criteria as stated in the board’s standards
for nursing education;
Grant full approval if the board finds that the nursing
education program meets the criteria as stated in the board’s
standards for nursing education;
Section 5. Appeal and
A parent institution may appeal the board’s
decision to withdraw approval of a nursing
education program and may request a
hearing to review the board’s decision. The
hearing and all actions related to the appeal
shall be affected in accordance with due
process rights, administrative rules of the
Section 6. Closure of Nursing
Education Program and Storage of
(a) Voluntary Closing.
(i) When the parent institution decides to close a nursing education
program, it shall notify the board in writing, stating the reason for
closure, the plan for discontinuation and the intended date of closing.
(ii) The parent institution may choose one of the following options
when closing a nursing education program:
(A) Continue the nursing education program until the last class
enrolled is graduated, or
(B) Assist in the transfer of students to other approved nursing
(iii) The nursing education program shall continue to meet the board’s
standards for nursing education until all of the enrolled students are
graduated or until the last student is transferred.
(iv)The date of closure is the date on the degree, diploma or certificate
of the last graduate or the date on which the last student was
(b) Closing as a result of withdrawal of approval.
(i) When the board withdraws approval of a nursing
education program, the parent institution shall comply with
the following procedures:
(A) The parent institution shall prepare a written plan for
termination of the nursing education program and shall
submit the plan to the board within thirty (30) days of receipt
of the notice of withdrawal of approval.
(B) The parent institution shall present a plan for the transfer
of students to other approved nursing education programs
within a time frame established by the board.
(C) The date on which the last student was transferred will be
the date of closure
(c) Storage of Records.The board shall be advised of the
arrangements for storage of permanent records.
Section 7. Standards of Nursing
a) The organization and administration of the nursing education
program shall be consistent with the law governing the practice of
(i) The parent institution shall be accredited by the appropriate
(ii) There shall be an organizational chart which demonstrates the
relationship of the nursing education program to the administration and
to comparable programs within the parent institution,
(iii) There shall be statements of purpose, philosophy and objectives
which are consistent with those of the parent institution and nursing
(iv)There shall be an organizational design with clearly defined
authority, responsibility, and channels of communication which assure
both faculty and student involvement.
(v) There shall be written policies, congruent with the policies of the
parent institution, which are periodically reviewed.
(vi)There shall be evidence of financial support and resources to
meet the goals of the nursing education program. Financial
resources include adequate educational facilities, equipment, and
qualified administrative, instructional, and support personnel.
(b) Administrator Qualifications.
(i) The administrator of the nursing education program shall be a
registered professional nurse, with the additional education and
experience necessary to direct the nursing education program
preparing graduates for the safe practice of nursing. The
administrator is accountable for the administration, planning,
implementation and evaluation of the nursing education program
(A)The administrator of the nursing education program
(I) hold a current license to practice as a registered professional
(II) Have a minimum of a master’s degree experience.
(III) Have a total of 5 years in nursing which must include a
minimum of two years of clinical experience and three years of
teaching experience (and/or a combination of teaching and
(B) In baccalaureate nursing programs the
administrator of the nursing education program shall:
(I) Hold a current license to practice as a registered
(II) Have a doctoral degree in nursing or related field; and
(III) Have a total of 5 years in nursing which must include a
minimum of two years of clinical experience and three years
of teaching experience (and/or a combination of teaching
and management experience).
(ii) The administrator of the nursing education program shall
not be assigned curriculum instructional duties that would
impair nursing education program administration.
(iii) The administrator of the nursing education program
shall have the authority to
administer the nursing education program in accordance
with the policies of the parent institution.
(i) There shall be sufficient faculty with graduate preparation and nursing expertise to
meet the objectives and purposes of the nursing education program.
(ii) Nursing faculty shall:
(A) Be currently licensed as a registered professional nurse.
(B) Have a minimum of a master’s degree.
(C) Have 2 years of clinical experience or national certification in clinical
(iii) Factors that shall be considered in determining the faculty/student ratio in clinical
settings are clinical site, level of student, number of beds, type of clinical experience,
Faculty/student ratio shall be a maximum of 1:8 for clinical experiences.
When clinical preceptors (partners in education) are used in a clinical setting the ratio
shall be 1:1 for the clinical preceptor/student ratio and no more than 1:15 for faculty/
(iv) Registered professional nurse faculty shall be responsible for:
(A) Developing, implementing, evaluating, and updating the purpose, philosophy,
objectives, and organizational framework of the nursing education program;
(B) Developing, implementing and evaluating the curriculum;
(C) Developing, evaluating, and revising student admission, progression, retention, and
graduation policies within the policies of the institution;
(D) Participating in academic advising and guidance of students;
(G) Evaluating student achievement related to nursing knowledge and practice;
(v) Faculty teaching non-clinical nursing courses, e.g., issues and trends,
pharmacology, nutrition, research, management, and statistics, shall have preparation
appropriate to these areas of content.
(i) The nursing education program shall admit students to the program based
upon the number of faculty, available educational facilities and resources, and
the availability of clinical learning experiences for the student.
(ii) Students shall be admitted without discrimination as to age, race,
religion, sex, national origin, or marital status, using an objective process
(iii) The nursing education program shall establish written policies for
admission, readmission, transfer, advanced placement, promotion, graduation,
withdrawal, or dismissal.
(iv) A nursing education program shall establish written policies for
student rights, responsibilities, grievances, health, safety, and welfare.
(v) Students shall be provided the opportunity to acquire and
demonstrate the knowledge, skills and abilities for safe nursing practice.
(vi) The nursing education program or parent institution shall
permanently maintain accurate records of scholastic achievement on each
(vii) The criteria for evaluating a student’s performance of each nursing
ability (these criteria must be measurable, appropriate to the nursing ability,
address the safety of the patient, and ascertain the accuracy of student
(f) Clinical Facilities:
A written contract or agreement shall be executed by the parent institution
conducting the nursing education program and the cooperating clinical facility
or agency; the contract shall be signed by the responsible individual(s) of each
party, and shall set forth the responsibilities of each party.
(g) Program Evaluation.
(i) The nursing education program shall have a written plan for the systematic
evaluation of the total nursing education program and its outcomes. The plan
shall include the methodology, frequency of evaluation, assignment of
responsibility, and evaluative criteria.
The following areas shall be evaluated:
(A) Organization and administration of the nursing education program;
(B) Philosophy and objectives;
(D) Educational facilities, resources, and services;
(E) Clinical resources;
(F) Students’ achievement;
(G) Graduates’ performance on the licensing examination;
(H) Graduates’ nursing competence;
(I) Performance of the faculty;
(J) Protection of patient safety; and
(K) The methods and instruments used for evaluation purposes.
Neerja KP,Textbook of Nursing Education, 1st edition, Jaypee
Brothers Medical Publishers Put Ltd, New Delhi
Basavanthapa BT, Textbook of Nursing Education, 1st edition,
Jaypee Brothers Medical Publishers Put Ltd, New Delhi
Nursing Administration and Management TNAI,
Publication, 1st ed,2000- Section IV, Administration and
Management of Nursing Schools
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