NSG/397 Week 3: Professional Standards in Practice, sample paper

One Night Shift, Six Standards: How the ANA Standards of Practice Govern a Psychiatric Nurse's Care of a Newly Admitted Patient

[Student Name]

University of Phoenix

NSG/397: Professional Nursing Role

Week 3 Assignment

[Instructor Name]

[Date]

The nurse, unit and patient are a composite written for a model paper. No real patient is described.

A composite registered nurse on an adult inpatient psychiatric unit began a night shift with seven patients, one of them a 42-year-old man admitted that evening after telling his primary care clinician that he had been thinking about ending his life. The unit is part of a general hospital, and the nurse is the only registered nurse on the unit overnight, working with two mental health technicians. No supervisor watched her work through the night; the standards of her profession were the structure that told her what good care required and how she would be held to it. This paper follows her shift through the ANA standards of practice.

The Standards

The American Nurses Association publishes the scope and standards of nursing practice. The standards of practice describe the nursing process in six standards, running from assessment and diagnosis through outcomes, planning and implementation to evaluation, and the standards of professional performance describe competencies such as ethics, advocacy, communication, collaboration, evidence-based practice, quality of practice and professional practice evaluation (American Nurses Association [ANA], 2021). The standards apply to every registered nurse in every setting, and courts, boards and employers use them to judge whether care was reasonable.

Standard 1: Assessment

At the start of the shift, the nurse reviewed the admission record and then assessed the patient herself. She used the Columbia-Suicide Severity Rating Scale, a structured interview that asks about the presence and intensity of suicidal ideation and about suicidal behavior; Posner et al. (2011) reported that it showed good validity and internal consistency in studies of adolescents and adults. He reported daily thoughts of suicide with a vague plan involving his medications and no preparatory behavior. She also assessed his mood, sleep, substance use, medical conditions and the protective factors he named, including his two children. Assessment extended to the environment: she checked his room for ligature risks and removed a belt that had been missed at admission.

Standard 2: Diagnosis

From the assessment, she identified nursing diagnoses consistent with her scope: risk for suicide, related to depressive symptoms, recent job loss and a specific plan; and disturbed sleep pattern. Stating the diagnoses in nursing terms focused her care on what nursing could address during the night, complementing the psychiatric diagnosis made by the admitting clinician.

Standard 3: Outcomes Identification

She identified outcomes for the shift that were measurable and realistic: the patient will remain free from self-harm, will agree to tell staff if urges intensify and will sleep at least four hours. She discussed these with him, asking what would help him feel safer tonight, which invited him into the plan.

Standard 4: Planning

Her plan combined the physician's orders for observation level with nursing interventions: observation every 15 minutes, documented by the technicians, with the nurse reviewing the log hourly; a room near the nurses' station; a check of all belongings; a brief conversation at bedtime about coping strategies; and a plan to notify the on-call psychiatrist if his ideation intensified or if he refused medications. The plan was written in the record so the next shift could continue it.

Standard 5: Implementation

Implementation included coordination of care, health teaching and safety measures. The nurse assigned a technician she trusted to his observations and explained what to watch for. At 1 a.m., the patient could not sleep and asked to talk. She spent twenty minutes with him, using therapeutic communication to explore his feelings without judgment, and reviewed a simple safety plan: warning signs, coping strategies, people to contact and the staff available to him. He agreed to try a breathing exercise and later slept.

Standard 6: Evaluation

Before the end of the shift, she repeated the brief screening questions. He reported that his thoughts were still present but less intense and that he felt safer on the unit. She documented his progress toward the outcomes, noted that he slept about five hours and recommended that the day team review whether his observation level remained appropriate. Evaluation closed the loop and handed the plan forward.

Professional Performance Standards and External Requirements

Several professional performance standards shaped her decisions. Communication and collaboration governed her report to the day team and her readiness to call the psychiatrist. Ethics shaped her respect for his dignity and privacy while keeping him safe; she explained why his belt was removed rather than taking it without comment. Evidence-based practice appeared in her use of a validated screening instrument. Quality of practice appeared in her hourly review of observation documentation.

External requirements reinforce the standards. The accreditation goal on suicide risk requires accredited hospitals to screen and assess patients for suicide risk using validated tools, to monitor high-risk patients and to address environmental hazards (The Joint Commission, 2024). The nurse's actions met these requirements because they followed from her professional standards.

When Standards Meet Workload

The standards do not change when the unit is busy, and this shift tested that. At 3 a.m., another patient became agitated and required her attention for forty minutes. The standards helped her set priorities: she confirmed that the observation plan for the man at risk of suicide continued without interruption, delegated to technicians only tasks within their role and documented her reassessment afterward. When workload threatens standards, the nurse's responsibility includes reporting the problem; she noted the staffing strain in her end-of-shift report to the nurse manager.

What the Standards Protect

The standards protect three parties at once. They protect the patient by defining a floor of care that does not depend on which nurse is on duty. They protect the nurse, because care that follows the standards and is documented clearly is care that can be defended if an outcome is poor. And they protect the profession, because nurses who hold themselves to shared standards earn the public trust that allows nursing to regulate itself. On this unit, where one registered nurse carries responsibility for seven patients overnight, all three protections depend on the nurse knowing the standards well enough to apply them without looking them up.

Conclusion

One night on a psychiatric unit showed how the ANA standards govern a single nurse's practice. Each standard of practice, from assessment through evaluation, appeared as a concrete action with a patient at risk of suicide, and the professional performance standards shaped how she communicated, collaborated and used evidence. Accreditation requirements reinforced the same actions. Standards documents can seem abstract in a classroom; on a night shift with no supervisor, they are the structure that defines safe, accountable nursing care.

References

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association.

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704

The Joint Commission. (2024). National patient safety goals effective January 2024 for the hospital program. https://www.jointcommission.org/standards/national-patient-safety-goals/