FEATURE

Standards of Care and Standards

of Practice
Kathleen C. Ashton, PhD, RN, ACNS-BC

Keywords: Standards of practice, standards of care, legal nurse consulting

Legal nurse consultants (LNCs) are valued for their nursing knowledge and experience. Beyond that,
understanding some pertinent legal principles can be an important complement to nursing expertise
used in a legal matter. Two common terms with notable differences are standards of practice and
standards of care. This article explains the differences to help LNCs use correct terminology

STANDARDS OF PRACTICE to determine and promulgate them. nurses published their standards of
Nursing has standards generally and professional performance for periop-
All professions develop their own
for all specialties, established practices erative nursing, and then revised them
standards of practice. Commonly, and procedures that are accepted as in 2015 (Association of periOperative
leaders of a specific profession work correct within a particular specialty. Registered Nurses, 2019). Simi-
through a professional association For example, in 2008 perioperative larly, ambulatory care nurses have

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 of opinions regarding professional
Table 1. Standards of Practice standards.
1. The RN will be responsible for implementation of the nursing process in See Table 2 for examples of standards
caring for each patient.
of care.
2. Assessment must be completed on each patient ASAP, but not to
exceed 8 hours of arrival to the inpatient nursing unit. NEGLIGENCE
A nurse who does not meet the accepted
3. The RN will develop an individualized plan of care within 24 hours of
the patient’s admission. standards of care may be charged with
negligence and be the target of a mal-
4. The RN will assess patient readiness to learn and learning needs within practice lawsuit, liable if failure to meet
24 hours of admission and ongoing. the standard of care results in harm to
the patient. A violation of the standard
5. The RN or Case Manager will initiate a discharge plan within 24 hours of of care occurs when the nurse, or one to
admission and reevaluate the plan.
whom a nurse has delegated care, fails
to comply with the standard of care. A
published their standards as well useful to ensure consistency in practice nurse is held liable for failure to moni-
(American Academy of Ambulatory so that patients and other recipients tor a patient’s condition or equipment,
Care Nurses, 2017). of nursing care receive quality care administer medication appropriately,
and protection. warn a patient about known harms or
See Table 1 for examples of standards dangers, or completely and accurately
of practice. Legal nurse consultants need to consid- report patient assessment and observa-
er standards of practice and standards tions in a timely manner.
STANDARDS OF CARE of care when developing opinions and
must be able to point to the source Nurses have a duty to communicate
Standards of care recognize the trusted for their opinions. Certain accrediting changes in patient condition to a
role that a nurse plays within the profes- bodies such as The Joint Commis- medical professional to avoid harm
sion and in society at large. They form sion do not promulgate standards of and ensure that patient can receive
the baseline for measuring quality care practice or standards of care. The Joint medical intervention. Inappropriate
and govern the nurse’s practice at every Commission uses performance stan- management of patient identification
level of practice and in every specialty of dards to evaluate hospitals and other and private data can result in HIPAA
nursing (SGNA, 2014). Standards of entities and is seldom an appropriate (Health Insurance Portability and
care are developed in consideration of resource for standards. The authorita- Accountability Act) violations as well as
state and federal rules, laws, and regula- tive professional organizations are the incur legal liability. Nurses must comply
tions that govern the practice of nursing. appropriate resources to use in support with state rules regulating the practice
Therefore, they have legal implications
that standards of practice may not
reflect. Standards of care are estab- Table 2. Standards of Care
lished at the national level and apply
to nursing in various settings; thus, 1. The patient can expect the RN to provide appropriate quality nursing
care through the use of the nursing process.
they are uniform regardless of venue.
Moreover, states and local regions may 2. The patient can expect to be assessed by an RN on admission and
establish their own set of standards of re-assessed throughout their stay.
care. Individual state nurse practice acts
are sources for standards of care within 3. The patient can expect to have an initial plan of care developed that
each state. identifies their individual needs, outlines nursing interventions, and the
patient outcomes.
Standards of care are used to delineate
professional expectations of nurses, to 4. The patient can expect to have learning needs assessed and evaluated.
guide them on proper protocol, and to
5. The patient can expect to have a discharge plan that identifies their
give them an objective standard with individual needs
which to evaluate other nurses. They are

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 FEATURE

of nursing including delegation of cer- LEGAL DEFINITION Similarly, at one time it was acceptable
tain tasks to unlicensed personnel. for a physician to opine on the standard
The legal definition of the standard of
of care for nursing. No longer can a
care for nurses differs from other guide-
SPECIAL KNOWLEDGE lines or policies set by individuals or
physician without a nursing degree offer
OR SKILL testimony about the standard of care
institutions and is broad in its scope. It
for a nurse. Nurses are now recognized
In cases where a nurse possesses special is the embodiment of collective knowl-
as the appropriate experts to testify
knowledge or skill, that nurse will be edge of the requirement for an average
and opine on the standard of nursing
judged against that special knowledge nurse delivering nursing care and sets
and skill. Depending on how this is care. The accepted standard of care is
the minimum criteria for proficiency
interpreted, a nurse may be compared that of an average nurse practicing in
(WOCNS, 2019).
with how a reasonably prudent nurse a similar area and delivering nursing
with the same special knowledge or It has only been since 1975 that care to a same or similar patient under
skill would have acted in the same or nurses were finally recognized as the same or similar circumstances
similar circumstances. This is why some professionals worthy of protection of (WOCNS, 2019)
institutions refuse to hire nurses into law afforded to other medical profes-
In cases of alleged malpractice or a
nursing assistant and other positions for sionals. Before that time, nurses were
breach of the standards of nursing care,
which the professional nurse is consid- judged by the standard of an ordinary
nurses are protected by the statutes in
ered overqualified; an RN is held to RN man or woman, indicating a lack of each individual state. The Nurse Prac-
standards for nursing practice regardless understanding or acceptance of nurs- tice Act is the legislation that provides
of job description. ing as a profession. authority for nursing practice in each
state and the individual state determines
and interprets the law.

Standards of care are developed in consideration THE ROLE OF THE LNC

of state and federal rules, laws, and regulations An LNC is the appropriate choice to
educate the attorney, the jury, and oth-
that govern the practice of nursing. Therefore, er individuals concerning the practice
they have legal implications that standards of of nursing. The nurse opines whether
the nurse in question has met the stan-
practice may not reflect. dards of care, so the opinion must be

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in accordance with accepted standards
of care. Understanding the difference
No longer can a physician without a nursing
between standards of practice and degree offer testimony about the standard of
standards of care is important and the
foundation for the LNC’s opinion. care for a nurse. Nurses are now recognized
Being in active nursing practice is the
most acceptable way for the LNC to
as the appropriate experts to testify and
demonstrate current expertise. The opine on the standard of nursing care.
legal profession needs credible LNCs
in active clinical practice who can opine
on nursing actions by applying accept-
ed and applicable standards of care and practice https://www.sgna.org/Portals/0/ S. Perry, editor. https://shop.lww.com/
Education/PDF/Standards-Guidelines/SGNA_ Wound-Ostomy-and-Continence-
standards of practice.
StandardsofClinicalNursingPractice_2014_ Nursing-Society-Professional-Practice-
Final.pdf Retrieved 7/29/19 Manual/p/9781975123628 and posted in
REFERENCES Lippincott Nursing Center at https://www.
Southern Regional Education Board. (2004).
American Academy f Ambulatory care Nursing nursingcenter.com/upload/static/403753/
Americans with Disabilities Act: implications
(2017) Scope & standards of practice for ch03.html Retrieved 7/28/19
for nursing education. https://www.harcum.
professional ambulatory care nursing (2017). edu/s/1044/images/editor_documents/
9th ed. https://tinyurl.com/y43b64be new_site/academics/core_performance_
Retrieved 7/29/19 standards_for_nursing__updated_. Kathleen C. Ashton, PhD,
Drake M and Miller R (1980) Standards of pdf?sessionid=7b339972-4950-4cd8-9e35- RN, ACNS-BC is Clinical
nursing practice. QRB Qual Rev Bull. 1980 064986b5d47f&cc=1 Retrieved 7/29/19 Professor of Nursing
May;6(5):16-9. Abstract at https://www.ncbi. Standards of care in nursing (2019). https:// Emerita in the College of
nlm.nih.gov/pubmed/6775261 Retrieved www.hg.org/legal-articles/standards-of-care- Nursing and Health
7/29/19 in-nursing-6237 Retrieved 7/29/19 Professions at Drexel
Indiana Association of School Nurses University in Philadelphia, Pennsylvania.
Standards of professional performance for
(nd). Performance criteria based on Her research interest is in the area of
perioperative nursing (2015). Association of
standards of nursing practice. https:// women and heart disease and she
periOperative Registered Nurses https://www.
iasn.org/wp-content/uploads/ aorn.org/guidelines/clinical-resources/aorn-
practices on a cardiac telemetry unit. As a
PerformanceCriteriaBasedOnSNstandards.pdf standards Retrieved 7/29/19 legal nurse consultant, she has reviewed
Retrieved 7/29/19 cases for plaintiff and defense firms for
Wound Ostomy and Continence Nursing over twenty years. She can be contacted
Society of Gastroenterology Nurses and Society Professional Practice Manual, 4/e
Associates (SGNA) (2014) Standards of clinical at [email protected]
(2019). Legal aspects of nursing, Ch. 3.

EDITOR'S NOTE (Continued from page 5)

any help when they are sick … We over the previous few years (https:// inappropriate private health informa-
currently do have (a few) confiden- tinyurl.com/yxj36kyk). It looks like tion (PHI) release.
tial nurse cases under monitoring. the public wouldn’t have known any of What would you do? Is there whis-
Another tipster in Texas reported that this without a whistleblower tip, and tleblowing in your future? We’d like to
a University of TX hospital had two — perhaps the hospitals wouldn’t have hear your thoughts.
two— nurses die of fentanyl overdoses protected patients, either.
in hospital bathrooms; the feds came
We have an article on confidentiality
down on the hospital for not having
done a very good job monitoring incom- of substance abuse records referencing Wendie A. Howland MN RN-BC
plete lost/misappropriated medication Department of Health and Human Ser- CRRN CCM CNLCP LNCC
reports. Upon further review, as they vices regulations. You’ll be interested to Editor
say euphemistically, the hospital then see how these could affect employment
reported about thirty such incidents law cases as well as others involving

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