Standards of Practice for Nurses and Midwives

  Introduction

Medical advances, social and demographic changes and an increasingly complex healthcare delivery system are challenging the ability of nurses/midwives to provide safe quality care. However, the ideals for nursing care have not changed over the years. This document defines the required level of practice expected of all nurses/midwives and replaces the previous Singapore Nursing Board Standards for Nursing Practice (1992).

The standards have been revised to reflect the accountability of nurses/midwives and the importance of practising within the defined scope of their profession. Commitment to professional development, efficiency in managing resources and collaborative partnerships with other health care professionals are emphasised.

These standards provide nurses/midwives with a framework to assess, implement and evaluate the delivery of nursing care in any clinical setting. They may be used to develop standards for nursing specialities.

Nurses/midwives have the professional responsibility and accountability to uphold these standards and to contribute to their dissemination, interpretation and development.

CHIEF NURSING OFFICER /
REGISTRAR , SINGAPORE NURSING BOARD
1 August 1999

 Standard One

Nurses/midwives work within their defined professional scope of practice.

RATIONALE

Nursing / Midwifery practice aims to prevent illness, restore health and rehabilitate the injured or infirm through health promotion activities and evidence-based practice in primary, secondary and tertiary care. The activities include:

• monitoring and assessment of the health status and needs of clients,
• nursing interventions such as the administration of medication and treatment, and
• counselling and health education of individuals or groups.

The scope of nursing/midwifery practice refers to the range of activities and clinical decisions in nursing / midwifery practice that each nurse/midwife is trained and authorised by licence to perform independently and the performance of which the nurse/midwife is accountable for. It is determined by the nurse/midwife's professional qualifications, competencies, and clinical role. It may be expanded to include new skills and responsibilities to keep abreast of advances in medical science and technology, innovations in treatment modalities and changes in the health needs of the population.

PRACTICE GUIDELINES

Accountability and competence

Nurses/midwives shall:

• be personally accountable for providing safe and competent care to their clients.
• perform, without supervision, only those procedures which they have the appropriate skills and training to carry out competently.
• seek the advice and supervision of a more competent practitioner when the care required is beyond their own level of competence.
• abide by the policies and protocols of the Nurses and Midwives Act, the employing institutions and all legislation relevant to nursing practice.

Delegation of assignments

Nurses/midwives shall:

• ensure that any delegation of duties is only done after assessing the other person's ability and competency.
• provide adequate guidance, supervision and assistance when required.

Expanding the scope of practice

Nurses/midwives shall:

• determine whether the new roles and responsibilities will enhance nursing/midwifery practice, benefit the clients and improve current standards of care.
• assist the hospital/institution in formulating a written policy/protocol/set of clinical guidelines for new procedures or clinical practices, and review this document regularly.
• be adequately prepared and certified before performing new skills and undergo regular re-certification as indicated.

OUTCOMES

• Nurses/midwives apply their knowledge, skills and judgement competently within their defined scope of practice.
• Nurses/midwives delegate and accept care assignments after appropriate assessment of their ability.
• Nurses/midwives undertake new skills and responsibilities after careful consideration of clients benefits, adequate training and certification, and the formulation of institutional guidelines.

 Standard Two

Nurses/midwives provide safe quality care that meets the needs and expectations of their clients.

RATIONALE

Nurses/midwives should constantly strive to improve the quality of the care they provide. It is the responsibility of nurses/midwives to provide care that promotes clients' well being and protects them from harmful and incompetent practice.

PRACTICE GUIDELINES

Safe and ethical care

Nurses/midwives shall:

• comply with the Code of Ethics and Professional Conduct issued by the Singapore Nursing Board.
• comply with policies/procedures related to the provision of safe and ethical care to clients. Such policies/procedures include but are not limited to infection control, administration of medication, fire safety and evacuation procedures, advance medical directive, drug abuse, human organ and tissue transplants and the termination of pregnancy.
• implement appropriate safety measures to prevent clients from injuries or hazards.

Quality improvement

Nurses/midwives shall:

• reflect critically on their nursing actions.
• apply up-to-date knowledge and clinical decision making skills in meeting the needs of clients.
• remain current in knowledge and maintain skills competency through participation in continuing education.
• continually seek and utilise clients' feedback, both formal and informal, to improve service quality.
• participate regularly in quality improvement activities to review and enhance current standards of care .
• incorporate appropriate research findings and outcomes from quality improvement reviews into their practice.

OUTCOMES

• Nursing care is safe, effective and responds to the changing health needs of clients.
• Nurses/midwives safeguard their clients from unsafe, unethical care.
• Nurses/midwives continually improve the quality of care through using appropriate research findings and clients' feedback, and participating in continuing education programmes.

 Standard Three

Nurses/midwives use a systematic approach in the delivery of care.

RATIONALE

The systematic delivery of nursing care involves the identification of clients' needs, the development of an appropriate plan of care and the implementation and subsequent evaluation of that plan.

PRACTICE GUIDELINES

Systematic delivery of care

Nurses/midwives shall

• assess the health needs of clients with the information from family members and/or significant others to identify actual and potential problems for attention
• collaborate with clients, families and/or significant others to develop a plan of care and priorities based on clients'  needs.
• implement appropriate clinical interventions in accordance with institutional policies and procedures.
• conduct health education sessions with clients and home caregivers to promote, maintain and restore optimal health and well being.
• initiate discharge planning activities for clients at an early stage of admission.
• evaluate clients' responses to care and revise the plan of care as necessary. 
• maintain complete, legible, dated and signed nursing records, which accurately document the initial assessment, proposed plan of care, clinical interventions, health education sessions, discharge plans and outcomes of nursing/midwifery care.

OUTCOMES

• Clients' care is organised and provided in a systematic manner that addresses the clients'  specific needs and allows for appropriate review and evaluation.
• Documentation provides a clear and accurate record of the care provided to the clients.
• Clients as well as their family members and/or significant others are actively involved in the identification of clients' needs, health education sessions and discharge planning for continuing and after-care.

 Standard Four

Nurses/midwives establish collaborative partnerships with clients, community, and colleagues to achieve optimal outcomes for clients.

RATIONALE

Collaboration between members of the healthcare team and other health professionals is essential to achieve an effective integration of disciplines for optimal client outcomes. Working relationships should be built upon mutual respect and a common interest in the clients' welfare.

PRACTICE GUIDELINES

Collaborative partnerships

Nurses/midwives shall:

• acknowledge the expertise and contributions of nursing colleagues and members of the healthcare team.
• develop and maintain collaborative relationships with other health professionals to ensure continuity of care across disciplines.
• provide feedback on clients' needs and progress to colleagues and professionals involved in the care of clients.
• co-ordinate with external agencies to ensure holistic continuing and after-care.
• maintain open communication links with all members of the healthcare team to achieve quality care for the clients.

OUTCOMES

• Nurses/midwives share knowledge and expertise with other members of the healthcare team. Consensus of decision is achieved through discussion and negotiation.
• Clients' care is integrated across disciplines and agencies. Positive clients' outcomes are achieved through co-ordination and teamwork between members of the health care team and other health professionals.

 Standard Five

Nurses/midwives manage manpower and other resources effectively and efficiently.

RATIONALE

RATIONALE Nurses/midwives have to aim for an appropriate match between the clients' needs and the resources available. Where necessary, they should work within the constraints of the staff, equipment and facilities in their institution to achieve the best possible outcome for their clients.

PRACTICE GUIDELINES

Effective and efficient resource management

Nurses/midwives shall:

• highlight inadequacies in the nursing staff/skill mix to institutional management and seek their assistance to provide sufficient numbers of appropriately trained staff to meet clients' needs.
• prioritise the use of equipment, facilities and other resources based on a clinical assessment of the clients' needs.
• perform pre-operational safety checks, regular servicing and corrective actions to replace faulty or unsafe equipment.
• evaluate new equipment and facilities to ensure that operational requirements and clients' needs are met.

OUTCOMES

• Institutional manpower and resources are utilised in a manner that achieves the best clients' outcomes.
• Nurses/midwives contribute positively to decisions regarding effective and efficient management and utilisation of resources.

 Standard Six

Nurses/midwives contribute to the advancement of the profession and the enhancement of professional image.

RATIONALE

Nurses/midwives participate in continuing education activities and research to ensure that nursing practice remains current and relevant to the changing needs of clients. They have a professional responsibility to assist in the education and development of other nurses/midwives. Nurses/midwives should contribute their professional expertise to their institution or community by serving as nursing representatives on committees or nursing advisors to special projects.

PRACTICE GUIDELINES

Advancing and enhancing the profession and its image.

Nurses/midwives shall:

• share knowledge and skills with their colleagues and mentor nursing students for the benefit of clients through formal and informal training programmes.
• participate in conferences, workshops and continuing education programmes organised by professional bodies.
• participate in nursing research and encourage the practice of evidence-based nursing.
• contribute to decisions related to nursing, health policies and practices. 
• provide professional inputs as nursing representatives to committees and community projects.
• participate in the growth of the profession through involvement in activities of professional bodies.

OUTCOMES

• Nurses/midwives play an active part in training and mentoring students and colleagues.
• Nurses/midwives actively participate in professional education and nursing research activities.
• Nurses/midwives represent the profession responsibly as members of committees or workgroups.

 Glossary