Download

Click here to download the PDF.

Standards of Clinical Nursing Practice and Role Delineations in the Gastroenterology Setting

Click each section below to expand the content you would like to view.

Acknowledgements

Copyright © 2018 Society of Gastroenterology Nurses and Associates, Inc. First published 1991; revised in 1996, 2001, 2005, 2009, & 2014.

This document was prepared and written by the SGNA Practice Committee and adopted by the SGNA Board of Directors. It is published as a service to SGNA members.

 

Contributors

SGNA Practice Committee 2018-2019
Susan Bocian, MSN BSN RN, Chair
Midolie Loyola, MSN RN CGRN, Co-Chair
Marcela Benitez-Romero BSN MBA RN CGRN
Cynthia M. Friis, MEd BSN RN-BC
Amy Granato, MSN RN CGRN
Jeanine Penberthy, MSN RN CGRN
Susan Selking, BSN RN CGRN
Christine Wahinehookae, BSN RN CGRN CFER

 

Disclaimer

The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) presents this guideline for use in developing institutional policies, procedures, and/or protocols. Information contained in this guideline is based on current published data and current practice at the time of publication. The Society of Gastroenterology Nurses and Associates, Inc. assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting. Nurses and associates function within the limits of state licensure, state nurse practice act, and/or institutional policy. The Society of Gastroenterology Nurses and Associates, Inc. does not endorse or recommend any commercial products, processes, or services. A commercial product, process, or service is recognized as being consumed by or used on patients.

 

Preface

A healthy work environment is one that is safe, empowering, and satisfying; supporting the optimal health and safety for all. In a culture of safety, all practitioners have a responsibility to perform with professionalism, accountability, transparency, engagement, effectiveness and efficiency (American Nurses Association [ANA], 2015).

A mutual partnership should exist between gastroenterology nurses and associates, each recognizing and accepting one another’s unique expertise and responsibilities. This collaboration is needed to meet patient health care goals in the gastroenterology setting (ANA, 2015). Nursing responsibilities will differ significantly depending upon the nurse practice act in each state, professional or vocational licensure, educational background, specialized knowledge, training and skills, and place of employment.

Standards are authoritative statements used by the nursing profession to describe the responsibilities for which practitioners are accountable. Standards of Clinical Nursing Practice presented in this document include:

  • Standards of Practice for the Registered Nurse in the Gastroenterology setting,
  • Standards of Professional Performance for the Registered Nurse in the Gastroenterology setting, and
  • Standards of Practice for the Licensed Practical/Vocational Nurse in the Gastroenterology setting.

The standards for Registered Nurses (RNs) are in accordance with the ANA Scope and Standards of Practice (2015), highlighting competencies for the registered nurse, graduate-level prepared RN and advanced practice nurse (APRN). The licensed practical/vocational nurse standards are in accordance with the National Association of Licensed Practical Nurses, Inc. (2015).

Competencies may be defined by scope and standards documents authored by specialty nursing associations. Professional nursing organizations, such as SGNA, recognize individual expertise through national certification in the specialty (ANA, 2015).

This document provides the Standards of Practice as they relate to the roles of: advanced practice nurses (APRN), registered nurses, licensed practical/vocational nurses (LPN/LVN), and unlicensed assistive personnel (UAP), in the gastroenterology role. Role delineations have been defined by the SGNA and examples for implementation are included in this document.

Definition of Terms

Advanced practice registered nurse (APRN) refers to a regulatory title given to a registered nurse who has completed an accredited graduate-level education program in preparation for the role of certified nurse practitioner or clinical specialist, passing a national certification examination that measures the APRN role and population –focused competencies (ANA, 2015). Competence is maintained by recertification and licensure to practice as an APRN.

Competency refers to an expected and measurable level of performance that integrates knowledge, skills, abilities, and judgment based on established scientific knowledge and expectations for nursing (ANA, 2015).

Gastroenterology refers to the study of the structure, functions, and diseases of the digestive system.

Gastroenterology Nurse refers to practitioners (APRN, RN, LPN/LVN) in gastroenterology, hepatology, or endoscopy setting.

Licensed Practical/Vocational Nurse refers to Licensed Practical Nurse (LPN) and Licensed Vocational nurse (LVN) that practice under the supervision of a registered nurse or physician (NALP, 2017).

Registered Nurse refers to Registered Nurse (RN) and Advanced Practice Registered Nurse (APRN) working in the gastroenterology, hepatology, or endoscopy setting.

Standards of Practice describe a competent level of clinical nursing care as demonstrated by the nursing process (ANA, 2015).

Standards of Professional Performance describes a competent level of behavior in the professional role (ANA, 2015).

Unlicensed Assistive Personnel (UAP) refers to individuals who are trained to function in an assistive role in the gastroenterology setting.

Standards of Practice for the Registered Nurse in the Gastroenterology Setting

Standard 1: Assessment

Standard: The Registered Nurse is accountable for collecting comprehensive data pertinent to the patient’s health or situation.

Competencies:

  1. Prioritizes data collection based on the patient's immediate condition or anticipated needs and the relationship to the proposed intervention.
  2. Collects comprehensive, pertinent data using appropriate evidence–based assessment techniques, instruments, and tools.
    1. Obtains data by interview, examination, observation, and review of health records.
    2. Obtains data related to age-appropriate assessment and culturally sensitive needs. Data includes, but is not limited to:
      1. Preferences, values, expressed needs and knowledge of healthcare situation.
      2. Function and significance to the gastroenterology/endoscopy patient, such as: airway patency, body image/need for privacy, current level of comfort or pain, physical limitations, communication barriers, elimination patterns, nutrition and hydration status, safety measures, self-care deficits, skin integrity/color/turgor, venous access, and the ability to swallow.
      3. Knowledge of health maintenance and practice of health promotion and disease prevention activities.
      4. Educational needs/developmental level.
      5. Previous access to and utilization of the health care systems.
      6. Current diagnosis(es), medications, and treatment(s).
      7. Environmental, occupational, recreational, psychosocial, cultural and spiritual information.
      8. Past medical history.
      9. Review of body system.
  3. Synthesizes available data, information, and knowledge relevant to the situation to identify patterns and variations.
  4. Assesses the impact of family dynamics on the patient’s health and wellness.
  5. Considers the interaction between the patient, family, and health care providers, as well as the environment for holistic data collection.
  6. Documents relevant data accurately and in a manner accessible to the interprofessional team (ANA, 2015).
  7. Applies ethical, legal and privacy guidelines and policies to the collection, maintenance, use and dissemination of data and information.

Standard 2: Diagnosis

Standard: The Registered Nurse analyzes the assessment data to determine the actual or potential nursing diagnoses or issues.

Competencies:

  1. Develops the nursing diagnosis from the assessment data. Examples may include:
    1. Potential risk for bleeding related to alterations in blood clotting mechanism.
    2. Knowledge deficit related to newly-diagnosed gastrointestinal disorder (e.g., Crohn’s disease, cancerous polyps).
  2. Validates nursing diagnoses and identifies actual or potential risks with the patient, family and health care providers, when possible and appropriate.
  3. Prioritizes diagnoses, problems and issues based on mutually established goals to meet the needs of the patient across the health continuum.
  4. Documents diagnoses, problems and issues in a manner that facilitates the determination of the expected outcomes and plan.

Standard 3: Outcome Dedication 

Standard: The Registered Nurse identifies expected outcomes for a plan individualized for the patient or situation. 

Competencies:

  1. Engages the patient, family, and interprofessional team in formulating expected outcomes. 
  2. Formulates culturally sensitive expected outcomes through collaboration with the patient by integrating their culture, values, ethical considerations with assessment findings and nursing diagnoses.
  3. Applies clinical expertise and current evidence-based practice to identify health risks that can impact expected outcomes.
  4. Documents expected outcomes as measurable goals with a time frame for attainment. Examples may include:
    1. The patient will meet discharge criteria within a specified time frame.
    2. The patient will identify the name, dose and frequency, purpose and potential sideeffects of the medications prescribed.
  5. Develops and modifies expected outcomes according to the status of the patient and evaluation of the situation for the actual outcomes that will facilitate the continuity of care.

Standard 4: Planning

Standard: The Registered Nurse develops a plan that prescribes strategies to attain expected outcomes.

Competencies:

  1. Develops an individualized, evidence-based plan of care by partnering with the patient and interprofessional team by considering examples such as:
    1. The ability of the patient to tolerate preparation for diagnostic or therapeutic interventions.
    2. The patient/family’s readiness to learn.
  2. Establishes the plan priorities with the patient, family and interprofessional team.
  3. Ensures that the plan reflects current evidence-based nursing strategies to address identified diagnoses, problems and expected outcomes. Examples may include but not limited to:
    1. Consideration of the patient's rights and expectations,
    2. Priorities for nursing actions and interventions.
  4. Modifies the plan according to the ongoing assessment of the patient’s response and other outcome indicators.
  5. Documents the plan using standardized language or recognized terminology.

Standard 5: Implementation

Standard: The Registered Nurse implements the identified plan by coordinating care and providing health teaching and health promotion.

Competencies:

  1. Partners with the patient to implement the plan in a safe, effective, efficient, timely, patient-centered and equitable manner.
  2. Demonstrates and employs caring behaviors to foster therapeutic relationships among patient and interprofessional team.
  3. Utilizes evidence-based interventions and strategies to achieve the mutually identified goals and outcomes specific to the needs of the patient and the diagnosis or problem. Examples may include:
    1. Ensuring patient safety.
    2. Acting as a patient advocate.
    3. Ensuring the patient’s privacy and confidentiality are maintained at all times.
    4. Providing dignified, culturally sensitive care that focuses on the patient.
  4. Implements interventions which comply with existing professional practice standards, regulatory agencies, accrediting bodies, and institutional policies and procedures. Examples may include:
    1. . Infection prevention measures,
    2. Sedation and analgesia safety,
    3. Radiation safety,
    4. Handling of hazardous materials,
    5. Health promotion, teaching, and safety
  5. . Implements the plan in a timely manner in accordance with patient’s safety goals.
  6. Documents implementation and any modifications, including changes or omissions, of the identified plan.
  7. Collaborates with a diverse, interprofessional team to implement a coordinated plan focused on the mutually identified expected outcomes.

Standard 6: Evaluation

Standard: The Registered Nurse evaluates progress toward attainment of goals and outcomes.

Competencies:

  1. Conducts a systematic, ongoing, criterion-based evaluation of the outcomes, including elements such as:
    1. Response to diagnostic or therapeutic interventions.
    2. Level of understanding of health promotion and maintenance.
  2. Collaborates with the patient and others involved in the care or situation in the evaluation process.
  3. Uses ongoing assessment data to revise diagnoses, outcomes, plan, and implementation strategies as new needs may be identified for the patient.
  4. Sharing evaluation data and conclusions with the patient and interprofessional team.
  5. Documents the results of the evaluation.

Standard 7: Ethics

Standard: The Registered Nurse practices ethically.

Competencies:

  1. Utilizes the Guide to the Code of Ethics for Nurses: with Interpretive Statements: Development, Interpretation, and Application (ANA, 2015) to guide practice.
  2. Maintains patient confidentiality.
  3. Serves as a patient advocate by assisting patient with self-advocacy skills and informed decision-making.
  4. Delivers care in a manner which preserves and protects patient autonomy, dignity, rights, values, & beliefs.
  5. Takes appropriate action in instances of unethical or inappropriate behavior.
  6. Advocates for equitable patient care.
  7. Maintains responsibility for nursing practice through continued professional development.
  8. Contributes to the advancement of gastroenterology nursing through scholarly inquiry, professional standards development, generation of policy, and

Standard 8: Culturally Congruent Pratice

Standard: The Registered Nurse practices in a manner that is congruent with cultural diversity and inclusion principles.

Competencies:

  1. Demonstrates respect, equity, and empathy in actions and interactions with all patients.
  2. Participates in lifelong learning to understand cultural preferences, worldview, choices, and decision-making processes of diverse patient populations.
  3. Applies knowledge of variations in health beliefs, practices, and communication patterns in all nursing practice activities.
  4. Uses the skills and tools that are appropriately vetted for the culture, literacy, and language of the population served.
  5. Communicates with appropriate language and behaviors, including the use of medical interpreters and translators in accordance with patient preferences.
  6. Respects patient decisions based on age, traditions, beliefs, family influence, and stage of acculturation.

Standard 9: Communication

Standard: The Registered Nurse communicates effectively in all areas of practice.

Competencies:

  1. Assess one’s own communication skills and effectiveness.
  2. Seeks continuous improvement of communication.
  3. Assesses patient’s communication ability, health literacy, resources, and preferences.
  4. Conveys accurate information.
  5. Contributes the nursing perspective in discussions with the interprofessional team.

Standard 10: Collaboration

Standard: The Registered Nurse collaborates with patient, family, and others in the conduct of nursing practice.

Competencies:

  1. Identifies the areas of expertise and contributions of other professionals to optimize the attainment of desired outcomes.
  2. Communicates and coordinates with the patient, family, and interprofessional team regarding patient care and the nurse's role in the provision of care.
  3. Participates in building consensus or resolving conflicts in the context of patient care.
  4. Adheres to the standards and applicable codes of conduct to create a work environment that promotes cooperation, respect, and trust.
  5. Partners with patients, families, and others in creating a comprehensive plan of care.

Standard 11: Leadership

Standard: The Registered Nurse demonstrates leadership in the gastroenterology setting and in the profession. Competencies:

  1. Contributes to the establishment of an environment that supports and maintains respect, trust, and dignity.
  2. Manages change and addresses conflict.
  3. Mentors others for the advancement of gastroenterology nursing practice and the profession.
  4. Promotes advancement of the profession and gastroenterology nursing practice through participation within SGNA and certification through the American Board of Certification for Gastroenterology Nurses (ABCGN).
  5. Seeks ways to advance gastroenterology nursing autonomy and accountability.
  6. Demonstrates a commitment to continuous, lifelong learning for self and others.

Standard 12: Education

Standard: The Registered Nurse attains knowledge and competence that reflects current nursing practice and promotes futuristic thinking.

Competencies:

  1. Acquires knowledge and skills relative to gastroenterology nursing.
  2. Demonstrates a commitment to lifelong learning through self-reflection and inquiry.
  3. Demonstrates accountability for maintaining competency and participates in educational activities relevant to professional issues and changing needs in gastroenterology nursing practice.
  4. Shares educational findings, experiences, and ideas with peers.
  5. Facilitates a work environment of role modeling, encouraging, and mentoring.

Standard 13: Evidence-Based Practice and Research

Standard: The Registered Nurse integrates the findings of peer-reviewed, published scientific evidence and research into practice.

Competencies:

  1. Utilizes current evidenced-based nursing knowledge, including valid research findings to guide practice and coordination of patient care.
  2. Incorporates evidence when initiating changes in nursing practice.
  3. Promotes ethical principles of research in practice and the health-care setting.
  4. Participates in the formulation of evidenced-based practice through research by:
    1. Identifying clinical problems suitable for nursing research;
    2. Participating in data collection;
    3. Participating in a unit, organization, or community research committee or program;
    4. Sharing research activities with peers and colleagues;
    5. Conducting research;
    6. Reading and critiquing research for application to practice;
    7. Using knowledge gained from

Standard 14: Evidence-Based Practice and Research

Standard: The Registered Nurse contributes to quality nursing practice.

Competencies:

  1. Participates in quality improvement initiatives which may include:
    1. Identifying barriers and opportunities to improve healthcare safety, effectiveness, efficiency, equitability, timeliness, and patient-centeredness.
    2. Identifying indicators used to monitor quality, safety, and effectiveness of nursing care (e.g., use of reversal agents, return to baseline status).
    3. Collecting data to monitor quality and effectiveness of nursing practice.
    4. Analyzing quality data to identify opportunities to improve nursing practice.
    5. Formulating recommendations to improve nursing practice.
    6. Implementing activities to enhance the quality of nursing practice.
    7. Collaborating with interprofessional teams to implement quality improvement plans and interventions.
    8. Developing, implementing, and evaluating policies and procedures to improve quality of practice.
  2. Utilizes the results of quality improvement initiatives to change nursing practice.
  3. Achieves professional certification.

Standard 15: Professional Practice Evaluation

Standard: The Registered Nurse evaluates one’s own nursing practice in relation to professional practice standards, guidelines, and relevant statutes and regulations.

Competencies:

  1.  Engages in self-evaluation of practice on a regular basis, identifying areas of strength as well as areas for professional growth.
  2. Accepts feedback regarding own practice.
  3. Takes action to achieve goals identified during the evaluation process.
  4. Participates in peer review.
  5. Provides the evidence for practice decisions and actions as part of the evaluation process.
  6. Collaborates with peers and colleagues to enhance own professional nursing practice.

Standard 16: Resource Utilization 

Standard: The Registered Nurse utilizes appropriate resources to plan and provide safe, effective and fiscally responsible nursing services.

Competencies:

  1. Identifies patient care needs, potential for harm, complexity of the task, and desired outcome when considering resource allocation.
  2. Delegates elements of care to appropriate team members in accordance with any applicable legal or policy parameters or principles.
  3. Advocates for resources, including technology that enhance nursing practice.
  4. Assists the patient and family in identifying and securing appropriate services to address needs across the healthcare continuum.

Standard 17: Environmental Health

Standard: The Registered Nurse practices in an environmentally safe and healthy manner.

Competencies:

  1. Promotes a safe and healthy workplace and professional practice environment.
  2. Attains knowledge of environmental health concepts.
  3. Assesses the environment to identify risk factors.
  4. Maintains a practice environment that reduces environmental health risks. 5.
  5. Communicates environmental health risks and exposure reduction strategies to patients, families, colleagues, and communities. 6. Participates in developing strategies to promote healthy communities and practice environments.

Standards of Practice for the Licensed Practical /Vocational Nurse in the Gastroenterology Setting

These Standards were developed and adopted by National Association of Licensed Practical Nurses (NALPN) to provide a basic model whereby the quality of nursing service and nursing care given by the LP/VN may be measured and evaluated.

Standard 1: Education

  1. Completes a formal and approved education program in practical nursing.
  2. Successfully passes the National Council Licensure Examination for practical nurses.
  3. Acquires specialized knowledge and skills applicable to gastroenterology nursing.
  4. Maintains the highest level of professional competency at all times.
  5. Participates in continuing education and opportunities to enhance personal growth and professional development.

Standard 2: Legal/Ethical Status

  1. Possesses knowledge of the scope of nursing practice authorized by their state’s nurse practice act.
  2. Responds appropriately in situations in which unprofessional conduct by a peer or other health care provider occurs.
  3. Recognizes and has a commitment to meet the ethical and moral obligations of the nursing practice.
  4. Accepts or performs professional responsibilities within the legal scope of their practice, for which they are competent to perform

Standard 3: Practice

  1. Accepts assigned responsibilities as an accountable member of the interprofessional team.
    1. Planning
      1. Data collection of health status of the individual patient.
      2. Report information gained from data collection.
      3. Identify patient outcomes.
    2. Implementation
      1. Observe, record, and report significant changes which require intervention or different goals.
      2. Apply nursing knowledge and skills to promote and maintain health and prevent disease.
      3. Carry out therapeutic regimens and protocols under supervision according to institutional policy, state nurse practice act, and professional standards.
    3. Evaluation
      1. Evaluate the plan of care.
      2. Encourage patient and family to be involved in the evaluation process.
      3. Collaborate with interprofessional team to modify the plan of care.
  2. Functions within the limits of educational preparation and experience as related to the assigned duties.
  3. Collaborates with the interprofessional team in promoting and maintaining health and prevention of disease.
  4. Applies the nursing process in planning, implementing, and evaluating health services and nursing care. 
  5. Participates in the development of policies pertinent to the roles and functions of the LPN/VN.

Standard 4: Continuing Education

  1. Maintains the highest level of professional competence.
  2. Assesses career goals and participates in continuing education and certification opportunities for personal growth and professional development.

Standard 5: Specialized Nursing Practice

  1. In addition to at least one year of nursing experience, presents qualifications that demonstrate the ability to practice in the gastroenterology setting.
  2. Provides evidence of completion of an approved program or course demonstrating the knowledge and skills necessary in the gastroenterology setting.
  3. Meets all of the standards of practice as outlined by NALPN (2015).

Summary

These standards are applicable in any gastroenterology practice setting. The degree to which they will be applied depends on the health services provided and the needs of the individual patient. Maintaining and improving the knowledge of gastroenterology nursing requires an interest in achieving the highest standards of performance. SGNA promotes certification to recognize competence and professional excellence.

References

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

Fowler, M. D. M. (Ed.). (2015). Guide to the Code of Ethics for Nurses with interpretive statements: Devlopment, Interpretation, and Application (2nd ed.) Silver Spring, MD: American Nurses Association.

National Association of Licensed Practical Nurses, Inc. (2015). Nursing practice standards for the licensed practical/vocational nurse. www.nalpn.org

Recommended Reading

Association of periOperative Registered Nurses. (2013). Perioperative standards and recommended practices. Denver, CO: Author.

Milton, C. L. (2008). Accountability in nursing. Nursing Science Quarterly, 21(4), 300-303.

Society of Gastroenterology Nurses and Associates, Inc. (2013). Gastroenterology nursing: A core curriculum (5th ed.). Chicago, IL: Author.

Role Delineation of the Registered Nurse in a Staff Position in the Gastroenterology Setting

Definitions
Competency refers to an expected and measurable level of performance that integrates knowledge, skills, abilities, and judgment based on established scientific knowledge and expectations for nursing (ANA, 2015).

Delegation is the transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome (ANA, 2015).

Registered Nurse (RN) is an individual who is educationally prepared and licensed by a state, commonwealth, territory, government, or regulatory body to practice as a registered nurse.

Role delineation is a description of the responsibilities and functions of a health care worker in a specific role, including the current activities common to this role.

Background
The role of the Registered Nurse in the gastroenterology setting has expanded with advancing technology and defined patient needs. The following is a statement intended to broadly describe the responsibilities and functions of the RN. The roles the RN assumes depend on basic nursing preparation, specialized formal or informal education, and clinical experiences. Certification in gastroenterology through the ABCGN validates the acquisition of specialized skills and knowledge. RNs practice in a variety of settings, such as hospitals, private offices, ambulatory care centers, and clinics (SGNA, 2013). The RN functions within the scope of practice as defined by state nurse practice acts, job description of the employing facility, specialized knowledge, training and skills, institutional policy, SGNA Standards of Clinical Nursing Practice and Role Delineation in the Gastroenterology Setting and the Guide to the Code of Ethics for Nurses with interpretive statements: Development, Interpretation and Application (Fowler, 2015).

Position
The RN is accountable for the quality of nursing care rendered to patients. The RN assumes responsibility for assessing, diagnosing, identifying outcomes, planning, implementing, and evaluating nursing care of patients. Additionally, the RN role includes directing and supervising nursing care for patients in the gastroenterology setting. The RN delegates tasks appropriate to the education and competency level of the team member (National Council of State Boards of Nursing [NCSBN], 2016). The following are general statements describing the RN role congruent with the ANA standards (2015).

The role of the RN in gastroenterology includes, but is not limited to:

  1. Systematically assessing the health status of individuals and record related health data,
  2. Establishing nursing diagnoses,
  3. Planning and implementing nursing interventions,
  4. Providing pre, intra, and post procedure education to the patients, families, significant others, and caregivers,
  5. Providing health promotion strategies and education to patients and their support system,
  6. Administering and evaluating pharmacological and other therapeutic treatment regimens based on the situation, evidence-based practice, and recent advancements in gastroenterology,
  7. Evaluating outcomes of nursing intervention and initiating change when appropriate,
  8. Documenting relevant data in accordance with institutional policy,
  9. Employing strategies to promote a healthy and safe environment,
  10. Making ethical and moral decisions surrounding patient care,
  11. Practicing in a manner that is congruent with cultural diversity and inclusion principles,
  12. Assisting the physician or advanced provider during diagnostic and therapeutic procedures to promote optimal patient outcomes,
  13. Promoting optimal patient outcomes by recognizing changes in the patient's health status and responding appropriately,
  14. Performing diagnostic studies as ordered,
  15. Managing follow up care,
  16. Collaborating with the patient and interprofessional team to ensure quality and continuity of care,
  17. Communicating effectively with the patient and interprofessional team to ensure quality and continuity of care,
  18. Serving as a patient advocate,
  19. Acting as a resource for others,
  20. Serving as a mentor for others,
  21. Participating in lifelong learning (e.g., continuing education, certification),
  22. Contributing to evidence- based practice by participating in research activities (e.g., data collection),
  23. Integrating evidence and research findings into nursing practice,
  24. Participating in self-evaluation reflective of professional practice standards,
  25. Utilizing appropriate resources to provide safe and effective nursing services,
  26. Participating in performance improvement activities, and;
  27. Participating as an active member in professional organizations, contributing to professional publications, and presenting at professional meetings.

References
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.) Silver Spring, MD: Author.

Fowler, M. D. M. (Ed.). (2015). Guide to the Code of Ethics for Nurses with interpretive statements: Development, Interpretation, and Application. (2nd ed.) Silver Spring, MD: American Nurses Association.

National Council of State Board of Nursing. (2016). National guidelines for nursing delegation.
Journal of Nursing Regulation. 7(1): 5–14.

Society of Gastroenterology Nurses and Associates, Inc. (2013). Gastroenterology nursing: A core curriculum (5th ed.) Chicago, IL: Author.
 

Recommended reading
American Nurses Association. (2005). Principles for practice. Silver Spring, MD: Author.

Fowler, M. D., M. (2015). Guide to Nursing’s social policy statement: Understanding the profession
from social contract to social covenant. Silver Spring, MD.

Role Delineation of the Licensed Practical/Vocational Nurse in the Gastroenterology Setting

Definitions
Licensed Practical/Vocational nurse refers to Licensed Practical Nurse (LPN) and Licensed Vocational nurse (LVN) that practice under the supervision of a registered nurse or physician (NALP, 2017).

Role delineation is a description of the responsibilities and functions of a healthcare worker in a specific role, including the current activities common to this role.

Background
Licensed Practical Nurses (LPN)/Licensed Vocational Nurses (LVN) practice in a variety of settings, such as hospitals, nursing homes, private offices, ambulatory surgery centers, and clinics (SGNA, 2013). The following is a statement intended to broadly describe the responsibilities and functions of the LPN/LVN in this specialty. The roles which the LPN/LVN assumes depend on basic nursing preparation, specialized formal or informal education, and clinical experiences. The LPN/LVN functions within the scope of practice as defined by state nurse practice acts, job description of the employing facility, SGNA Standards of Clinical Nursing Practice and Role Delineation in the Gastroenterology Setting, and the Nursing Practice Standards for the Licensed Practical/Vocational Nurse (National Federation of Licensed Practical Nurses, Inc., 2015).
 

Position
Under the supervision of an RN or physician, the LPN/LVN is accountable for the quality of nursing care provided to patients. Utilizing the nursing process, the LPN/LVN contributes to the planning, implementation, and evaluation of nursing care for patients in the gastroenterology setting (SGNA, 2013).
The role of the LPN/LVN includes, but is not limited to:

  1. Observing, recording, and reporting significant changes in the patient’s healthcare status,
  2. Documenting patient data to ensure continuity in the provision and coordination of patient care,
  3. Communicating effectively with patients, support system, and members of the interprofessional team,
  4. Administering and evaluating pharmacological and other therapeutic treatment regimens within the limitations of licensure and institutional policy,
  5.  Assisting the physician and/or RN during diagnostic and therapeutic procedures,
  6. Performing diagnostic studies as ordered by a physician within the limitations of licensure and institutional policy,
  7. Assisting with follow-up care, 
  8. Collaborating with the interprofessional team,
  9.  Acting as a resource for others,
  10. Serving as a mentor for other LPN/LVNs and Unlicensed Assistive Personnel,
  11. Participating in lifelong learning to advance current knowledge and skills and maintain competency,
  12. Participating in data collection for research and evidence-based practice to improve patient outcomes,
  13. Participating in quality improvement activities, and
  14. Participating as an active member in professional and consumer organizations.

References
National Association for Practical Nurse Education and Service, Inc. [NAPNES] (2007). Standards of practice and educational competencies of graduates of practical/vocational nursing programs. Alexandria, VA: Author.

National Federation of Licensed Practical Nurses, Inc. (2015). Nursing practice standards for the licensed practical/vocational nurse. Raleigh, NC: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2013). Gastroenterology nursing: A core curriculum (5th ed.) Chicago, IL: Author.

Recommended reading
Hudson, M., & Burke, K. (2009). Demystifying the LVN role. Sentinel, 28(2), 8-10.

Livornese, K. (2012). Advantages of utilizing LVNs. Nursing Management, 43(8), 19-21.

Reeves, D. (1996). A licensed practical nurse/licensed vocational nurse’s guide to the changing healthcare system, Gastroenterology Nursing, 20(2), 54-56.

Role Delineation of Unlicensed Assistive Personnel in the Gastroenterology Setting

Definitions
Accountability refers to being answerable to oneself and others for one’s actions as measured against a standard (ANA, 2015).

Delegation is the transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome (ANA, 2015).

Unlicensed Assistive Personnel (UAP) refers to individuals trained to function in an assistive role in the gastroenterology setting.

Role delineation is a description of the responsibilities and functions of a healthcare worker in a specific role, including the current activities common to this role.

Supervision refers to the provision of guidance or direction, oversight, evaluation, and follow-up by the licensed nurse for the accomplishment of a nursing task delegated to unlicensed assistive personnel (NCSBN, 2005).

Background
The UAP is an integral part of the health care team in the gastroenterology practice setting. UAP with specialized training or education in gastroenterology may have direct patient care responsibility and are supervised by a RN (ANA, 2007). UAP contribute to optimal patient outcomes by performing delegated patient care tasks.

Position
UAP will only perform responsibilities in which the individual has demonstrated competency.

The role of the UAP in gastroenterology includes but is not limited to:

  1. Completes tasks as delegated by RN within defined role functions and validated competency,
  2. Assists in data collection to identify the patient's needs, problems, concerns or human responses (e.g., vital signs),
  3. Assists, under the direction of the RN, in the implementation of the established plan of care,
  4. Assists the physician and/or RN before, during, and after diagnostic and therapeutic procedures,
  5. Reprocesses and maintains equipment according to manufacturers’ instructions, standards of infection prevention, and institutional policies/procedures,
  6. Provides and maintains a healthy and safe environment for the patient and staff by complying with regulatory agency requirements, accrediting bodies, standards set forth by professional organizations, and institutional policies,
  7. Respects cultural diversity,
  8. Participates in lifelong learning,
  9. Maintains knowledge of current practice issues related to the field of gastroenterology,
  10. Complies with legal and practice standards inherent in patient care (e.g., patient's bill of rights),
  11. Conducts oneself in an ethical manner,
  12.  Participates in quality improvement initiatives as directed,
  13. Collaborates with the interprofessional team to ensure quality and continuity of care,
  14.  Communicates effectively with patient, support system, and interprofessional team.

The UAP is encouraged to complete the SGNA GI Associate’s Programs and certification.

References
American Nurses Association and National Council of State Boards of Nursing (NCSBN). (2005). Joint ANA and National Council of State Boards of Nursing Position Statement. Retrieved from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions- and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Joint-Statement-on-Delegation-American-Nurses-Association-
ANA-and-National-Council-of-State-Boards.html

American Nurses Association. (2007) Registered nurses utilization of nursing assistive personnel in all settings [position statement]. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/RN-utilization-of-nursing-assistive-personnel-in-all-settings/

National Council of State Boards of Nursing (NCSBN) (2005). Working with Others: A position paper Retrieved from https://www.ncsbn.org/Working_with_Others.pdf

Recommended Reading List
Anthony, M.K. & Vidal, K. (2010). Mindful Communication: A Novel Approach to Improving Delegation and Increasing Patient Safety, OJIN: The Online Journal of Issues in Nursing, 15(2), Manuscript 2.

Association of periOperative Registered Nurses (AORN). (2011). Position Statement on Allied Health Care Providers and Support Personnel in the Perioperative Practice Setting. Retrieved from https://www.aorn.org/guidelines/clinical-resources/position-statements

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Position Statement. (2009). The Role of Unlicensed Assistive Personnel(Nursing Assistive Personnel) in the Care of Women and Newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38, 745-747.

Bystedt, M., Eriksson, M. & Wilde-Larsson, B. (2011). Delegation within Municipal Health Care. The Authors. Journal Compilation. Blackwell Publishing Ltd. 534-541.

Heard, L., (2004). A new opportunity for SGNA associate members. Gastroenterology Nursing, 27(4), 147-148.

Habgood, C. (2000) Ensuring Proper Delegation to Unlicensed Assistive Personnel, AORN Journal, 71(5), 1058-1060.

Joint position statement of the American Nephrology Nurses' Association (ANNA) and the National Association of Nephrology Technicians/Technologists (NANT) on unlicensed personnel in dialysis (May-June 2008) [Position Statements]. Nephrology Nursing Journal, 35(3), 313.

Potter, P., Deshields, T. & Kuhrik,M. (2010). Delgation practices between registered nurses and nursing assistive personnel, Journal of Nursing Management, 18, 157-165.

Saccomano, S. & Pinto-Zipp, G. (2011). Registered nurse leadership style and confidence in delegation. The Authors . Journal compilation. Blackwell
Publishing Ltd, 19, 522-533.

Oncology Nursing Society (ONS). (2006). the role of unlicensed assistive personnel on cancer care. [position statement]. Oncology Nursing Forum, 33(3), 521.

Role Delineation of the Advanced Practice Registered Nurse in the Gastroenterology Setting

Definitions

Role delineation is a description of the responsibilities and functions of a health care worker in a specific role, including the current activities common to this role.

Advanced practice registered nurse (APRN) refers to a registered nurse who has completed an accredited graduate-level education program in preparation for the role of certified nurse practitioner or clinical nurse specialist, passing a national certification examination that measures the APRN role and population –focused competencies (ANA, 2015). Competence is maintained by recertification and licensure to practice as an APRN.

Background
Increasing complexity of patient care, rising healthcare costs, a shortage of physicians, and concerns about the quality of healthcare have directed national attention toward the APRN. State law and regulation further define criteria for licensure for the APRN roles. The need to ensure patient safety and access to APRNs by aligning education, accreditation, licensure, and certification is shown in the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (APRN Joint Dialogue Group, 2008).

The APRN practices in a variety of settings including ambulatory care and acute care. The APRN provides a wide range of services to individuals, families, groups and communities.

The APRN functions within the scope of practice defined by the graduate degree, the state nurse practice act, job description of the employing facility, the Nursing: Scope and Standards of Practice (ANA, 2015), the Guide to the Code of Ethics for Nurses with interpretive statements: Development, Interpretation and Application (Fowler, 2015), the Standards of Practice for Nurse Practitioners (American Association of Nurse Practitioners [AANP], 2013), the Scope of Practice for Nurse Practitioners {AANP, 2015} and the Statement on Clinical Nurse Specialist Practice and Education (National Association of Clinical Nurse Specialists [NACNS], 2004). The APRN’s education and certification are population focused (e.g., family, pediatric, adult-gerontology).

Specialization within the advance practice role is determined by the individual professional nursing specialties. The responsibility and function of the APRN specializing in gastroenterology is continually evolving. The APRN scope of practice is more advanced than the gastroenterology RN and APRN has greater responsibility, autonomy and coordination with other health care professionals.

Position
The APRN provides service through core competencies of direct patient care, consultation, research, expert guidance, leadership, ethical decision making, and collaboration (ANA, 2015). The care provided to gastroenterology patients may include, but is not limited to, advanced assessment, diagnosis, outcomes identification, treatment/care planning, implementation, evaluation, patient education. With specialized training and credentialing, the APRN may perform endoscopic procedures.

APRNs build upon the roles of the RN by acquiring advanced and specialized knowledge and skills through graduate-level education in a population-focused specialty (ANA, 2015). The following are general statements describing the APRN role congruent with ANA and AANP (2015) standards.

The role of the APRN in gastroenterology includes, but is not limited to:

  1. Provides advanced assessment of the patient, by obtaining relevant medical history and performing a physical examination,
  2. Develops a treatment plan of care by initiating, performing, and interpreting diagnostic tests and endoscopic procedures,
  3. Systematically compares and contrasts clinical and diagnostic findings with normal and abnormal variations in making differential diagnoses,
  4. Identifies expected outcomes that incorporate scientific evidence and are achievable through implementation of evidence-based practices,
  5. Identifies expected outcomes that incorporate cost effectiveness, clinical benefits, and patient satisfaction,
  6. Designs strategies to meet the multifaceted needs of complex patients,
  7. Leads interprofessional teams to identify the cultural and language needs of the patient,
  8. Selects therapeutic interventions that reflect current evidence-based practice,
  9. Incorporates new knowledge and evidence-based research to develop innovative strategies to improve nursing care practices,
  10. Prescribes evidenced-based treatments, therapies, and procedures, considering the patient’s comprehensive healthcare needs,
  11. Evaluates the accuracy of the diagnosis and the effectiveness of the treatment plan to achieve expected outcomes,
  12. Modifies the treatment plan by reassessing needs of the patient/family to achieve their healthcare goals,
  13. Provides leadership in the coordination of interprofessional health services for integrated delivery of patient care,
  14. Provides expert consultation to influence the identified plan, enhance the abilities of others, and effect change,
  15. Prescribes pharmacological agents within prescriptive authority and state law,
  16. Evaluates and incorporates complementary and alternative therapy into education and practice,
  17. Provides leadership in the design and implementation of quality improvement initiatives,
  18. Practices ethically by incorporating the Code of Ethics for Nurses with Interpretative Statements (ANA, 2015) and advocates for patients’ rights to informed decision making and self-determination,
  19. Mentors others in the acquisition of clinical knowledge, skills, and judgment,
  20. Participates in lifelong learning, and
  21. Models advanced practice by being a leader in professional and practice issues through active membership in professional and consumer organizations, publication of scholarly works, and presentations at professional meetings.

References
American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.) Silver Spring, MD: Author.

American Nurses Association. (2010). Nursing’s Social Policy Statement: The essence of the Profession (3rd ed.). Silver Spring, MD: Author.

Fowler, M. D. M. (Ed.). (2015). Guide to the Code of Ethics for Nurses with interpretive statements: Development, Interpretation, and Application. (2nd ed.) Silver Spring, MD: American Nurses Association.

American Association of Nurse Practitioners. (2015). Scope of practice for nurse practitioners. Austin, Texas: Author.

American Association of Nurse Practitioners. (2013) Standards of practice for nurse practitioners. Austin, Texas: Author

Recommended Reading
Society of Gastroenterology Nurses and Associates, Inc. (2013). Gastroenterology nursing: A core curriculum (5th ed.). Chicago, IL: Author.

Login