Previous columns have recounted the process for updating the third edition of the Nursing Professional Development: Scope and Standards of Practice, discussed the trends influencing the revisions, and delineated the changes in the scope of practice reflecting the evolution of the Nursing Professional Development (NPD) specialty over the past 6 years. This column focuses on the revision process and changes to the standards of professional practice.
STANDARDS DEFINED
The American Nurses Association (ANA) develops the general nursing scope and standards that apply to all nurses. Specialty organizations align with those broad parameters by developing and revising their own specific scope and standards of practice. Standards of professional practice include a description of the standard followed by multiple competency statements that serve as evidence for compliance with the standard (Strong, 2016). The standards of professional practice are divided into two categories, standards of practice and standards of professional performance. The standards of practice align with the nursing process and define what NPD practitioners do (Wilson, 2012). The standards of professional performance describe how NPD practitioners comply with the standards of practice, apply the nursing process, and attend to other practice concerns and issues (ANA, 2010). These specialty standards drive NPD practice, and it is important that they not only reflect current practice but also define future practice.
REVISION PROCESS
In 2014, the Association for Nursing Professional Development Board of Directors appointed a work group to revise the 2010 Nursing Professional Development: Scope and Standards of Practice. This work group divided into four task forces, two of which were responsible for revising the Standards of Professional Practice. One task force revised the Standards of Practice, and the other revised the Standards of Professional Performance. These task forces based their work on several foundational documents. Only one of these documents, the 2010 Nursing Professional Development: Scope and Standards of Practice (National Nursing Staff Development Organization [NNSDO] & ANA, 2010), was complete at the start of the revision. The other documents have been works in progress. They include the Nursing Professional Development Role Delineation Study (Warren & Harper, 2015), ANA's Nursing: Scope and Standards of Practice (ANA, 2015a), and the ANA Code of Ethics (ANA, 2015b).
To maintain alignment with the ANA's format for nursing standards, the task forces were charged with transitioning from measurement criteria to competency statements for each standard. In addition, ANA alignment called for differentiation of two practice levels: the generalist and the graduate-prepared and -certified specialist. As a result, each task force reviewed the corresponding sections of ANA's (2015) draft of Nursing: Scope and Standards, 2nd edition, and the 2010 NPD standards of practice during the revision process.
In addition to aligning with ANA's format, the task forces incorporated each of the seven NPD practitioner roles described in the standards, primarily in the Standards of Professional Performance. These roles are as follows: learning facilitator, change agent, mentor, leader, champion for scientific inquiry, partner for practice transitions, and advocate for the NPD specialty.
The roles of learning facilitator (educator), leader, change agent, mentor, and champion for scientific inquiry (researcher) had been incorporated in the 2010 standards as intertwined elements of practice (NNSDO & ANA, 2010). However, the roles of advocate for the specialty and partner for practice transitions were not articulated in the previous edition. The task forces need to consider not only how to incorporate these new roles into the standards but also how to update the previously identified ones to accurately reflect current and future NPD practice.
THE REVISED STANDARDS
The Standards of Practice (Standards 1-6) align with the steps of the nursing process and, as mentioned earlier, define what NPD practitioners do in their practice. The Standards of Professional Performance (Standards 7-16) relate to how the NPD practitioner complies with the Standards of Practice, performs the nursing process, and manages other nursing practice issues and concerns (ANA, 2010).
Standards of Practice
The primary changes in the standards of practice were the addition of practice gap identification and analysis and the integration of cultural competency statements into Standards 4-6 (Harper & Maloney, 2016), which are identified in Table 1.
Standard 5: Implementation has three parts:
* Standard 5A: Coordination
* Standard 5B: Facilitation of Positive Learning and Practice Environments
* Standard 5C: Consultation
A new competency for Standard 5A describes the need for the NPD specialist to lead "the coordination of interprofessional healthcare and community resources (e.g., human, clinical, financial, technical, educational, cultural) for integrated educational services" (Harper & Maloney, 2016, p. 37).
As shown in Table 1, the title of Standard 5B changed from "Learning and Practice Environment" to "Facilitation of Positive Learning and Practice Environments." In addition to the name change, additional competencies for the NPD specialist were added:
* "Evaluates diverse learning environments (such as virtual) and their suitability to the organization and target audience.
* Establishes the value of positive learning and practice environments.
* Role models practices for creating and sustaining positive learning and practice environments.
* Creates processes that support seamless transitions to practice and between practice settings" (Harper & Maloney, 2016, p. 39).
The theme of value that was initiated in Standard 5B was continued in Standard 6 with the addition of the competency statement: "Demonstrates program value based on achieved outcomes" (p. 41).
Standards of Professional Performance
To align with the Nursing Professional Development Role Delineation Study findings (Warren & Harper, 2015) and subsequent inclusion of the seven NPD roles in the NPD practice model, the Standards of Professional Performance task force added two new standards: Change Management and Mentorship/Advancing the Profession. Two standards from the 2010 edition, Collegiality and Advocacy, were integrated throughout the Standards of Professional Performance. The task force also sequenced the Standards of Professional Performance by importance and frequency of use. These changes are reflected in Table 2.
Standard 7: Ethics. This standard became the first standard listed in the Standards of Performance to emphasize its importance to the NPD practitioner. As in the past, the ethics standard aligned with the updated Code of Ethics for Nurses With Interpretive Statements (ANA, 2015b). Competencies were unchanged related to identification of conflict of interest in programming and protection of individuals' privacy, security, and confidentiality. A competency statement was added for the NPD specialist: "Develops processes for monitoring the educational activities including screening for potential or actual unethical behavior, commercial bias, compromise of intellectual property rights or conflict of interest and to address ethical issues within the learning environment" (Harper & Maloney, 2016, p. 43).
Standard 8: Education. Minimal changes were made to this standard. One new competency statement was added for the NPD specialist: "Determines current and future educational needs of NPD practitioners within professional sphere of influence" (Harper & Maloney, 2016, p. 44).
Standard 9: Evidence-Based Practice and Research. This was based on the Nursing Professional Development Role Delineation Study (Warren & Harper, 2015) that identified one of the seven NPD roles as champion of scientific inquiry. This standard's statement changed from integrating research into practice to "acts as a champion of scientific inquiry, generating new knowledge and integrating best available evidence into practice" (Harper & Maloney, 2016, p. 45). This standard was expanded to include participation in quality initiatives for the NPD generalist and leading quality initiatives for the NPD specialist along with:
* "Synthesizes and appraises the best available evidence to recommend practice changes.
* Applies principles of implementation science to maintain and sustain practice changes.
* Recommends and implements research activities to align with the organizational strategic plan.
* Contributes to interprofessional practice by supporting, conducting, and synthesizing research and evidence-based practice.
* Disseminates research, EBP, and quality improvement findings through activities such as presentations, publications, and consultation.
* Advances the science of NPD practice" (Harper & Maloney, 2016, p. 46).
Standard 10: Quality of NPD Practice. The changes for this standard relate primarily to the NPD specialist with an emphasis on the following:
* demonstrating quality outcomes and the value of NPD practice on the delivery of care and patient outcomes,
* using data for NPD decision-making,
* leading NPD department quality improvement plans (Harper & Maloney, 2016).
Standard 11: Change Management (New). This is a new standard that was based on the change agent role delineated in the Nursing Professional Development Role Delineation Study (Warren & Harper, 2015). This standard uses the concepts of micro-, meso-, and macrosystems to describe NPD practitioners' area of focus related to change initiatives. The NPD specialist focuses on the mesosystem (part of the larger system that exists to support the microsystem) and macrosystem (the larger organization with the infrastructure and governance to support the microsystem). The NPD generalist focuses on the microsystem, "the unit level where the daily NPD practice is operationalized; frontline of NPD" (Harper & Maloney, 2016, p. 62).
Standard 12: Leadership. Leadership remains a very important standard with a continued emphasis on leading beyond the NPD unit/department to broader environments within and outside the organization. A new emphasis has been placed on creating both a just and innovative culture. The NPD specialist "demonstrates the value of NPD to the organization and healthcare through return on investment, enhanced quality of care, and improved patient outcomes" (Harper & Maloney, 2016, p. 51).
Standard 13: Collaboration. The importance of collaborative partnerships continues. As a result, a new competency for the NPD specialist requires the evaluation of collaborative endeavors.
Standard 14: Professional Practice Evaluation. This standard has expanded to include the seeking of interprofessional feedback, not just that of nursing colleagues. It also directs the NPD specialist to seek feedback from colleagues beyond the immediate practice setting. In addition, the NPD specialist is required to maintain certification in NPD.
Standard 15: Resource Utilization. This standard is almost unchanged, except for the addition of the word "quality" to the standard description. The previous standard stated that the NPD specialist "considers factors related to safety[horizontal ellipsis]" (NNSDO & ANA, 2010, p. 41). It has been updated to state that the NPD practitioner "considers factors related to quality, safety, effectiveness and cost regarding professional development activities and expected outcomes" (Harper & Maloney, 2016, p. 54).
Standard 16: Mentorship/Advancing the Profession (New). This new standard was also created in response to the Nursing Professional Development Role Delineation Study (Warren & Harper, 2015). Both the roles of mentor and advocate for the NPD specialty were identified in the study. The role of mentor was one of the intertwined elements in the previous edition (NNSDO & ANA, 2010). Advocate for the specialty is totally new. Although the title "Mentorship/Advancing the Profession" does not seem to reflect advocate for the specialty, the standard description clarifies its purpose: "The nursing professional development practitioner advances the profession and the specialty through mentoring and contributions to the professional development of others" (Harper & Maloney, 2016, p. 55). Competency statements related to this standard include describing and promoting NPD as a specialty, advancing the profession through scholarly works, mentoring and role modeling NPD excellence, and promoting the value of NPD to health care.
IMPLICATIONS/APPLICATION
The revised NPD Standards of Practice and Standards of Professional Performance should validate many of your practices and challenge others. Three of the biggest challenges are to extend leadership beyond the practice setting, to demonstrate the value of NPD to health care and patient outcomes, and to advocate for the specialty of NPD, recognizing that it is in fact a specialty as important as any clinical specialty. NPD is our specialty. Claim it!
A future column will describe how these standards are being implemented in a variety of settings. If you would like to contribute, please email mailto:[email protected].
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