Practice Matters

Updated nursing scope and standards

By: By Carol J. Bickford, PhD, RN-BC, CPHIMS, FAMIA, FHIMSS, FAAN

Foundational document reflects changes in healthcare. 

As the professional nursing association that represents all RNs in the United States, the American Nurses Association (ANA) has the accountability and responsibility to maintain, regularly review, revise as necessary, and broadly disseminate key foundational resources that guide professional nursing practice. In keeping with these responsibilities, in May 2021, ANA published Nursing: Scope and Standards of Practice, Fourth Edition, which reflects key updates of the 2015 third edition. 

The updated document evolved from the thoughtful deliberation of a 17-member volunteer workgroup of diverse expert nurses convened by ANA in August 2019. The dedicated group spent many hours in professional dialogue during small and whole group video conference calls and in writing comments and clarifications.

The workgroup carefully examined the 2015 content to ensure the new edition would fully reflect today’s nursing practice and lead to continued innovations. One of the most prominent changes in the 2021 document is a revised definition of nursing. The new language, which builds on the 2015 definition, references the art and science of caring, human functioning, compassionate presence, and recognition of the connection of all humanity. Care of individuals, families, groups, communities, and populations remains the focus of nursing and incorporates the important concept of advocacy.

This revised definition opens the scope-of-practice description crafted to answer the who, what, when, where, how, and why questions about nursing practice. Nursing: Scope and Standards of Practice, Fourth Edition, also includes a newly created Professional Nursing Model and a revised Model Representing Regulation of Professional Nursing Practice. Both depict these concepts in new ways and are intended to promote discussion and prompt research. An enhanced ethics discussion provides valuable examples of several models for decision-making and for integrating ethics in practice.

Today’s everchanging—even volatile—health­care and nursing environments prompted the workgroup to add a discussion about respect, equity, inclusion, and social justice. “A Potpourri of Opportunities for the Future” closes the scope of practice section and provides a reflective experience and mechanism to offer recommendations for ANA action.

The Standards of Practice section includes standards and accompanying competencies for each of the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. The document categorizes the accompanying competencies for RNs, graduate-level prepared RNs, and advanced practice RNs. The companion Standards of Professional Performance are similar to the 2015 version but now include a new Standard 8: Advocacy. In addition, new labels for Standard 9: Respectful and Equitable Practice, Standard 14: Scholarly Inquiry, and Standard 17: Resource Stewardship, aim to better clarify the concepts and competencies being addressed.

A free webinar that introduces the new document is available for 3 years (; registration is required).

Nursing: Scope and Standards of Practice, Fourth Edition, is intended to provide opportunities for learning, discussion, action, and celebration as individual nurses and the profession embrace Abraham Lincoln’s quote: “The best way to predict your future is to create it.”

Carol J. Bickford is senior policy advisor in ANA’s Nursing Practice & Work Environment department.


American Nurses Association. Nursing: Scope and Standards of Practice, Fourth Edition. Silver Spring, MD: American Nurses Association; 2021.

1 Comment. Leave new

  • Marilyn A. Ray, RN, PhD, FNAP, FTCNSS, FAAN
    September 29, 2022 10:21 am

    As a caring scientist and theorist, I am overjoyed to see the new definition of Nursing incorporating nursing as the science and art of caring.


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