Standards for Acute and Critical Care Nursing Practice
In 1998, the AACN Board of Directors formed a Practice Standards Task
Force to evaluate and revise the current standards. In support of the
American Nurses Association's (ANA) position that specialty standards
should be framed from the general clinical nursing practice standards,
the AACN Practice Standards Task Force used the latest edition of the
ANA Standards of Clinical Nursing Practice as a template for its work.
The Task Force evaluated each Standard of Care and Standard of
Professional Performance for its relevance to and inclusion of acute
and critical care nursing competencies. The original standards statements
were either unchanged or revised to better articulate the professional
expectations of competent acute and critical care nursing practice. The
measurement criteria, which detail how nurses meet each standard, were
evaluated and revised as necessary to reflect the unique aspects of
acute and critical care nursing. These Standards for Acute and Critical
Care Nursing Practice also reflect the key concepts of the AACN Mission,
Vision, Values, and Ethic of Care, scope of practice, and the Synergy Model.
What Are Standards?
Clinical nursing practice can vary considerably depending on the setting
in which the nurse is employed and the patients cared for in that setting.
The Standards for Acute and Critical Care Nursing Practice describe the
practice of the nurse who cares for an acutely or critically ill patient
no matter where that patient is cared for within the healthcare environment.
The Standards for Acute and Critical Care Nursing Practice
- are defined as authoritative statements that describe a level of care or
performance common to the profession of nursing by which the quality of
nursing practice can be judged.
- are written to establish an example of the roles and responsibilities
expected of the practitioner by the profession at large.
- include both standards of care, which prescribe a competent level of
nursing practice, and standards of professional performance, which
articulate the roles and behaviors expected of nursing professionals.
Standards of Care for Acute and Critical Care Nursing
Standard of Care I: Assessment
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS COLLECTS
RELEVANT PATIENT HEALTH DATA.
1. Data collection involves the patient, family, and other healthcare providers
as appropriate to develop a holistic picture of the patient's needs.
2. The priority of data collection activities is driven by the patient's
immediate condition and/or anticipated needs.
3. Pertinent data are collected using appropriate assessment techniques and
4. Data are documented in a retrievable form.
5. Data collection process is systematic and ongoing.
Standard of Care II: Diagnosis
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS ANALYZES THE
ASSESSMENT DATA IN DETERMINING DIAGNOSES.
1. Diagnoses are derived from the assessment data.
2. Diagnoses are validated throughout the nursing interactions with the
team consisting of the patient, family, and other healthcare providers,
when possible and appropriate.
3. Diagnoses are prioritized and documented in a manner that facilitates
determining expected outcomes and developing a plan of care.
4. Diagnoses are documented in a retrievable form.
Standard of Care III: Outcome Identification
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS IDENTIFIES
INDIVIDUALIZED, EXPECTED OUTCOMES FOR THE PATIENT.
1. Outcomes are derived from actual or potential diagnoses.
2. Outcomes are mutually formulated with the patient, family, and
other health care providers, when possible and appropriate.
3. Outcomes are individualized in that they are culturally appropriate
and realistic in relation to the patient's age and present and potential
4. Outcomes are attainable in relation to resources available to the patient.
5. Outcomes are measurable and should include a time estimate for attainment, if possible.
6. Outcomes provide direction for continuity of care so that the nurse's
competencies are matched with the patient's needs.
7. Outcomes are documented in a retrievable form.
Standard of Care IV: Planning
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS DEVELOPS A
PLAN OF CARE THAT PRESCRIBES INTERVENTIONS TO ATTAIN EXPECTED OUTCOMES.
1. The plan is individualized to reflect the patient's characteristics and needs.
2. The plan is developed collaboratively with the team, consisting of
the patient, family, and healthcare providers, in a way that promotes
each member's contribution toward achieving expected outcomes.
3. The plan reflects current acute and critical care nursing practice.
4. The plan provides for continuity of care.
5. Priorities for care are established.
6. The plan is documented to promote continuity of care.
Standard of Care V: Implementation
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS IMPLEMENTS
INTERVENTIONS IDENTIFIED IN THE PLAN OF CARE.
1. Interventions are delivered in a manner that minimizes complications
and life-threatening situations.
2. The patient and family participate in implementing the plan of care
based upon their ability to participate in and make decisions regarding care.
3. Interventions are documented in a retrievable manner.
Standard of Care VI: Evaluation
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS EVALUATES THE
PATIENT'S PROGRESS TOWARD ATTAINING EXPECTED OUTCOMES.
1. Evaluation is systematic, ongoing, and criterion-based.
2. The team consisting of patient, family, and healthcare providers
is involved in the evaluation process as appropriate.
3. Evaluation occurs within an appropriate time frame after
interventions are initiated.
4. Ongoing assessment data are used to revise the diagnoses,
outcomes, and plan of care as needed.
5. Revisions in diagnoses, outcomes, and plan of care are documented.
6. The effectiveness of interventions is evaluated in relation to outcomes.
7. The patient's responses to interventions are documented.
Standards of Professional Practice for Acute and Critical Care Nursing
Standard of Professional Practice I: Quality of Care
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS SYSTEMATICALLY
EVALUATES THE QUALITY AND EFFECTIVENESS OF NURSING PRACTICE.
1. The nurse participates in quality of care activities.
2. The nurse uses the results of quality of care activities to initiate
changes in nursing practices and the healthcare delivery system as appropriate.
3. The nurse assures that quality of care activities incorporate the patient
and family's perspective as appropriate.
Standard of Professional Practice II: Individual Practice Evaluation
THE PRACTICE OF THE NURSE CARING FOR ACUTELY AND CRITICALLY ILL PATIENTS
REFLECTS KNOWLEDGE OF CURRENT PROFESSIONAL PRACTICE STANDARDS, LAWS,
1. The nurse evaluates his or her own nursing practice in relation to the
professional practice standards and relevant statutes and regulations.
2. The nurse engages in a self-assessment and/or a formal performance appraisal
on a regular basis, identifying areas of strength as well as areas where
professional development would be beneficial.
3. The nurse seeks and reflects on constructive feedback from the team
consisting of patient, family, and other healthcare providers regarding his
or her own practice.
4. The nurse takes action to achieve performance goals.
Standard of Professional Practice III: Education
THE NURSE ACQUIRES AND MAINTAINS CURRENT KNOWLEDGE AND COMPETENCY IN THE
CARE OF ACUTE OR CRITICALLY ILL PATIENTS.
1. The nurse participates in ongoing educational activities to acquire
knowledge and skills needed to care for acute and critically ill patients.
2. The nurse seeks experiences that reflect current clinical practice in
order to maintain current clinical skills and competencies needed to care
for acutely and critically ill patients.
3. The nurse participates in ongoing educational activities related to
Standard of Professional Practice IV: Collegiality
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS INTERACTS WITH
AND CONTRIBUTES TO THE PROFESSIONAL DEVELOPMENT OF PEERS AND OTHER
HEALTHCARE PROVIDERS AS COLLEAGUES.
1. The nurse shares knowledge, skills, and experiences with colleagues.
2. The nurse provides peers and other healthcare providers with constructive
feedback regarding their practice, as appropriate to their level of expertise.
3. The nurse interacts with colleagues to enhance his or her own
professional nursing practice.
4. The nurse contributes to a learning environment that is conducive to
5. The nurse contributes to an effective team environment by working with others in a
way that promotes and encourages each person's contribution.
Standard of Professional Practice V: Ethics
THE NURSE'S DECISION AND ACTIONS ON BEHALF OF ACUTELY AND CRITICALLY ILL
PATIENTS ARE DETERMINED IN AN ETHICAL MANNER.
1. The nurse's practice is guided by the ANA's Code for Nurses, AACN's
Ethic of Care, and ethical principles.
2. The nurse maintains patient confidentiality within legal and regulatory parameters.
3. The nurse acts as a patient advocate and assists others in developing skills
so they can advocate for themselves.
4. The nurse delivers care in a nonjudgmental and nondiscriminatory manner
that is sensitive to patient diversity.
5. The nurse delivers care in a manner that meets the diverse needs and strengths
of the patient and preserves patient autonomy, dignity, and rights.
6. The nurse uses available resources in formulating ethical decisions.
Standard of Professional Practice VI: Collaboration
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS COLLABORATES WITH
THE TEAM, CONSISTING OF PATIENT, FAMILY, AND HEALTHCARE PROVIDERS, IN
PROVIDING PATIENT CARE IN A HEALING, HUMANE, AND CARING ENVIRONMENT.
1. The nurse communicates with the team regarding patient care and the nurse's
role in providing care.
2. The nurse works with the team to formulate the plan of care and to make
decisions related to the care and delivery of services.
3. The nurse consults with other healthcare providers and initiates referrals
as appropriate to promote continuity of care.
Standard of Professional Practice VII: Research
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS USES CLINICAL
INQUIRY IN PRACTICE.
The nurse continually questions and evaluates practice and uses best
available evidence or research findings to develop appropriate plans of care.
The nurse participates in activities to support clinical inquiry appropriate
to the nurse's level of expertise.
Standard VIII: Resource Utilization
THE NURSE CARING FOR ACUTE AND CRITICALLY ILL PATIENTS CONSIDERS FACTORS
RELATED TO SAFETY, EFFECTIVENESS, AND COST IN PLANNING AND DELIVERING PATIENT CARE.
1. The nurse evaluates factors related to safety, effectiveness, availability, and
cost when choosing between two or more practice options that would result in
the same expected outcome.
2. The nurse assists the patient and family in identifying and securing appropriate
and available services to address health-related needs.
3. The nurse assigns or delegates aspects of care as defined by the state nurse
4. If the nurse assigns or delegates aspects of care, the decision is based
upon an assessment of the needs and condition of the patient, the potential
for harm, the stability of the patient's condition, the predictability of
the outcome, and the competencies of the healthcare provider.
5. The nurse assists the patient and family in becoming informed consumers about
costs, risks, and benefits of treatment and care.