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.

Measurement Criteria
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 instruments.
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.

Measurement Criteria
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.

Measurement Criteria
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 capabilities.
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.

Measurement Criteria
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.

Measurement Criteria
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.

Measurement Criteria
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.

Measurement Criteria
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, AND REGULATIONS.

Measurement Criteria
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.

Measurement Criteria
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 professional issues.

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.

Measurement Criteria
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 healthcare education.
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.

Measurement Criteria
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.

Measurement Criteria
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.

Measurement Criteria
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.

Measurement Criteria
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 practice acts.
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.