certification acknowledges nursing competence at an advanced level of practice.
The nursing practice act establishes the standard of care and scope of practice, which are monitored by the state’s governing board, usually the board of nursing examiners. The nursing practice act also regulates advanced practice; for example, the clini-cal nurse specialist. The scope of nursing practice
has been expanded by telenursing, requiring the development of the Nurse Licensure Compact (NLC). The NLC creates standardization within nurse practice acts that vary and lack uniformity from state to state, providing more standard meth-ods of compliance, discipline, and rehabilitation.
Nursing has been developed upon the core com-petence of caring, a concept difficult to measure, document, or legislate. Other essential competen-cies, which appear to be measurable behaviors, include health promotion, supervision, interper-sonal communication, direct care, computer, and case load competencies. Competencies may be doc-umented with videotaping, orientation records, portfolios, self-assessment tools, records of manda-tory intranet training courses, and continuing education records. Advanced areas of nursing prac-tice have more specialized sets of competencies.
Specific competencies are required in nursing informatics at four levels, consisting of the begin-ning, experienced, informatics specialist, and informatics innovator nurse. Informatics may be integrated into the nursing standards.
Evidence-based nursing practice is the expected standard of care. Nursing research is the mecha-nism to provide evidence-based practice. The nurse may integrate evidence-based practice into the nurs-ing process, for example, by follownurs-ing a four-step clinical decision-making process. Policies and pro-cedures also establish the standard of care and thus regulate nursing practice.
Independent organizations, such as JCAHO, monitor a health-care provider’s compliance with state and federal laws and regulations. Accredita-tion is the process utilized by an organizaAccredita-tion, such as a school of nursing or health-care facility, to ver-ify competency of its educational or health-care pro-gram, respectively. Staffing and productivity must also be regulated under these accreditation guide-lines to meet the standard of care.
Legislative and administrative regulation of nursing occurs on the federal level; for example, through CMS. CMS oversees the administration of HIPAA, a federal law that regulates confidentiality issues related to patient care. OSHA is a federal agency that promotes standards for patient safety in the health-care environment. The CDC is the fed-eral agency that develops and promotes disease pre-vention and control.
Regulating Nursing 89
Let’s Talk
1.What is the nursing standard for advanced practice, management, and informatics?
2.Do you believe that nurses should seek certification? If so, why?
3.In what areas can a nurse specialize that are considered advanced practice?
4.How has telenursing expanded nurse practice acts?
5.Does an interstate compact have to exist for a nurse to practice telenursing in those states?
6.How does lack of uniformity in state nurse practice acts affect interstate compacts and telenursing?
7.What can influence student nurse learning of competencies in the clinical area?
NCLEX Questions
1. A nursing competency:
A. Is a skill that the nurse has to perform.
B. Is a specific behavior that a nurse must demonstrate.
C. A and B.
D. Is the proficiency level that the nurse must obtain.
2. A standard of care:
A. Requires use of the nursing process.
B. Is the degree of care, expertise, and judgment exercised by nurses under similar circum-stances.
C. A and B.
D. Is the number of patients that a competent nurse can care for on any given shift.
3. What affects nursing regulation?
A. A state nurse practice act.
B. Accreditation by an official body.
C. Policies and procedures.
D. All of the above.
4. The goal of state and federal legislation is to:
A. Protect the public.
B. Regulate nursing education.
C. Oversee nurse competency via licensure and discipline.
D. All of the above.
5. A nurse practice act:
A. Governs the role of the nurse.
B. Governs nursing education.
C. A and B.
D. Prescribes the competencies for the nursing role.
6. Certification is:
A. An examination.
B. Developed by a professional organization.
C. Aids a nurse in demonstrating compe-tency.
D. All of the above.
7. What types of disciplinary action can a board of nursing take?
A. License suspension.
B. Licensure denial.
C. Mandate that the offender take courses in legal ethical decision making or pharmacol-ogy.
D. All of the above.
8. An advanced practice nurse:
A. Is a registered nurse.
B. Has studied in a post-basic or advanced edu-cational program of study.
C. Acts independently of other health-care pro-fessionals in the delivery of health-care serv-ices.
D. All of the above.
9. Portfolios:
A. Can be used to demonstrate to state boards of nursing that one is qualified to be a regis-tered nurse.
B. Can be designed to demonstrate one’s com-petence.
C. Consist of documentation that captures learning from experience.
D. B and C.
10. Modeling:
A. Is the facilitation and nurturance of an indi-vidual.
B. Assists one in attaining, maintaining, and promoting health.
C. Is a purposeful nursing intervention.
D. Is a process used by nurses to develop an understanding of the client’s world.
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06Jones Leadership(F)-ch 06 1/15/07 6:42 PM Page 90
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