The classic definition of a professional association is “an organization of practitioners who judge one another as professionally competent and who have banded together to perform social functions which they cannot perform in their separate capacity as individuals” (Merton, 1958). As the professional association representing all registered nurses, the American Nurses Association (ANA) has the responsibility to describe the scope and standards of practice for all registered nurses.

In writing about nursing as a profession, Richard Hall (1968) described a professional model with five indicators of an individual’s attitude toward professionalism. The attitudinal attributes are (1) use of a professional organization as the major source of ideas and judgments for the professional, (2) belief that the profession was created to serve the public, (3) belief that the profession must be self-regulating, (4) belief in a sense of calling to the work of the profession, and (5) belief in the importance of autonomy in decision-making about work. These attributes remain relevant to the present-day discussion about the important role that the professional organization plays in setting standards for the practice of that profession (standards of practice). His work also emphasizes the need for each profession to develop its own method of measuring professionalism (standards of professional performance).

Cyril Houle (1980) studied the functions that professions perform in relation to society and suggested that three groups of characteristics reflect the professionalization of an occupation: conceptual, performance, and collective identity. An important characteristic of a profession is the ability to develop a credentialing system and to certify competence. The conceptual characteristic of a profession is that a profession must be able to state and define its mission and foundations of practice. There are four characteristics of performance: mastery of theoretical knowledge, capacity to solve problems, use of practical knowledge, and self-enhancement. Finally, Houle defined nine characteristics within the collective identity: formal training, credentialing, subculture norms and values, legal reinforcement, public acceptance, ethical practice, penalties, relations to other vocations, and relations to users of the service.

The ANA defines and disseminates the responsibilities associated with the functions of a profession through three foundational publications—Nursing’s Social Policy Statement: The Essence of the Profession (ANA, 2010a); Code of Ethics for Nurses with Interpretive Statements (ANA, 2001); and Nursing: Scope and Standards of Practice, 2nd Edition (ANA, 2010b). These publications define the accountability and autonomy that nursing has by virtue of its status as a profession. Nurses are accountable for their knowledge; skills; and behavior to self, to institution, to regulatory and legal entities, to the profession, to the healthcare consumer, and to society. They have autonomy to act independently and to make appropriate decisions as they relate to control over their own practice. This accountability and autonomy for practice are governed by nursing’s scope and standards of practice.

Standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable. Standards reflect the values and priorities of the profession and provide both a direction for professional nursing practice and a framework for the evaluation of this practice. They also define the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible (ANA, 2010b). Standards are important because they outline what is expected of a professional. The set of nursing standards published by ANA are formally designated as the Standards of Professional Nursing Practice, which contain the Standards of Practice and the Standards of Professional Performance. The competencies that accompany each standard may be evidence of compliance
with the corresponding standard. This list of competency statements is not exhaustive for a given standard. Whether a particular standard or competency applies will depend on the circumstances.

The Standards of Practice “describe[s] a competent level of nursing care, as demonstrated by the critical thinking model known as the nursing process, which includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation,” and represents the problem-solving process that the registered nurse follows in daily interactions with patients, groups, communities, and systems. These standards “encompass significant actions taken by registered nurses and form the foundation of the nurse’s decision-making.” (ANA, 2010b, p. 9)

The Standards of Professional Performance “describe[s] a competent level of behavior in the professional role, including activities related to ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health” (ANA, 2010b, p. 10). The Standards of Professional Performance describes how the registered nurse follows the Standards of Practice, completes the nursing process, and deals with other nursing practice issues as they arise in his or her career. “Registered nurses are accountable for their professional actions to themselves, their patients, their peers, and ultimately to society” (ANA, 2010b, p. 11).

Competence in nursing practice is an essential aspect of understanding and advancing the profession. Since the publication of the 2004 edition of Nursing: Scope and Standards of Practice, this topic has become even more prominent. A key portion of the 2010 scope of practice statement (ANA, 2010b, pp. 12-13) addresses this topic. Also, each of the standards is accompanied by a list of competency statements, which are key indicators—but not the only indicators—of competent practice for that standard.

ANA’s 2008 position statement, Professional Role Competence (which is included as an appendix in the 2010 edition), articulates the importance of professional role competence in nursing:

An individual who demonstrates competence is performing successfully at an expected level. A competency is an expected and measurable level of nursing performance that integrates knowledge, skills, abilities, and judgment, all of which are based on scientific knowledge and expectations for nursing practice (ANA, 2010b, p. 64). Formal, informal, and reflective learning experiences foster development of the requisite knowledge, skills, abilities, and judgment necessary for safe, high-quality nursing practice. Competence in nursing practice must be evaluated by the individual nurse (self-assessment); nurse peers; and nurses in the roles of supervisor, coach, mentor, or preceptor. In addition, other aspects of nursing performance may be evaluated by professional colleagues and by patients or clients.

The list of competency statements that accompany each standard may be evidence of compliance with the corresponding standard, but each list is not exhaustive. However, the selection of competency statements for each standard considered as a whole constitutes a minimum set of competencies applicable across all practice settings for all registered nurses. In addition, each standard except for one (the professional communication standard) also lists competencies unique to advanced practice by graduate-level prepared nurses and advanced practice registered nurses.