The ANA Professional Nursing Development Scope and Standards, 2009: A Continuing Education Perspective

Dora Bradley PhD, RN-BC; M. Beth Benedict, DrPH, JD


January 21, 2010

Nursing Professional Development (NPD) practice has been experiencing major changes in the last 10 years since the last American Nurses Association NPD Scope and Standards were written. During this time, we have seen an escalation of online education, an expanded target audience, and increased expectations for metrics and measurable outcomes. We have also seen changing expectations for competency and patient safety; and the overall impact of globalization, generational, and cultural diversity; creating a dynamic practice and learning environment. Consequently, a new set of scope and standards needed to be developed that could provide not only current but also future direction for the NPD Specialist.

A presentation on the NPD Scope and Standards at the 2009 Accreditation Symposium highlighted the new approach and elements in the 2009 NPD Scope and Standards. It provided an overview of the new scope and how it builds on the strong foundation of past documents. The presentation described the conceptual model that shows the multi-dimensional features of the NPD systems. The proposed scope offers a trajectory for the next few years using trends and future expectations while still recognizing the current state of practice. The standards are updated along with new standards and metrics.

Scope: Capitalizing on the knowledge and expertise of educators and leaders from health care centers, public health, academia, and the military, the new American Nurses Association NPD Scope and Standards were drafted and submitted for public comment. Building on a strong foundation of the 2000 ANA NPD Scope and Standards, there was an intentional focus placed on the expanding practice of nurses in the specialty.

The NPD role is dynamic, evolving as the specialist's environment and functions have expanded. The overall impact of the nurse's context and its influence on the way practice is considered became critical elements to the development of the new scope and standards. A number of key concepts serve as the basis for the scope. These include responsibilities, core values, technology and innovations, globalization, and competency.

Responsibilities: NPD responsibilities have expanded and will vary based on the position and practice environment requirements. The key responsibilities include, but are not limited to, career development guidance, education, leadership, program management, and assurance of compliance to a variety of regulating entities.

Core Values: NPD core values in the new document are the same or closely reflect those of the ANCC CNE Accreditation Program. Of importance are the values that emphasize knowledge management, innovation and competence, mentoring/peer review, inter-professional networking and the inclusion of relevant stakeholders, and inclusiveness so that each program emphasizes integrity, accountability, responsiveness, and diversity.

Technology and Innovation: Advances in technology are driving the NDP Specialist to become innovative. Innovations in approaches to presenting information make CE learning easier and more interesting. Examples include the use of color, illustrations, and graphics in electronic media. Technology is also advancing how the NPD Specialist can manage one's practice, including program administration and financial management.

Globalization: Our educational programs may now be available across nations for different cultures and even different languages. Relevance now means adapting educational opportunities to meet a target audience's professional learning needs, abilities, and skills. Globalization challenges the need to assure quality in the development, implementation, and evaluation of CE learning. Advances in technology are a major driver by increasing electronic and internet access to information.

Competence: The theme that practice must reflect competence serves as a basic principle for NPDs whether in CE or other roles. Competence applies to any role and any responsibility. It sets the expectation for the public that our practice's ultimate goal is to assure safe, high quality health services for all. Competence is expected from the basic nursing degree through to advanced practice or certification.

Model: A new framework was created that attempted to operationalize the former domain model as a professional development system with inputs, throughputs, outputs, and influential aspects that would be inclusive of all domains. The model accommodates all practice and learning environments, and all settings and modes of learning.

Inputs were conceptualized as learning and practice environments. Throughputs were addressed as developmental processes that are included under the umbrella of nursing professional development, specifically orientation, competency, in-service, continuing education, career development and role transition, research and scholarship, and academic partnerships. The principles of evidence-based practice and practice-based evidenced were placed at the center of the NPD processes to demonstrate that these principles serve as scientific underpinnings. The outputs were viewed as learning, change, professional role and growth. The protection of the public and provision of quality care remain as the ultimate outcomes of the system. The feedback loop of the system was conceptualized as the influence the outputs/outcomes had on the throughputs and on the inputs of learning and the NPD practice environment.

The new model reflects the flexibility, diversity, and dynamic aspects in the specialty. The specialist may function in one or more of the major throughput processes of the practice, and may move in and out of the roles over time. However the input, output, and the feedback loop will vary with change. For CE, the needs assessment gathers information on the environmental factors and those of the learners. The educational content, objectives, and teaching/learning approach the main processes in the throughput of the system. The output/outcomes depend on the processes and reflect met or unmet identified needs. Thus output/outcomes vary widely, yet they all yield important information and more importantly, all influence future learning and practice.

The principles of evidence-based practice, while highly desirable, are still in the early stages of developmental for the NPD specialty. There is little research that identifies and validates best practices. However, since its inception, the specialty has drawn on the well-known principles in education and adult learning. In some practice areas such as medical-surgical, pregnancy and newborn care, and rehabilitation, there is a growing body of research that provides content guidelines for best nursing practice.

Practice-based evidence depends on the NPD's practice environments systemically collecting data for analyses that document best practices and that hopefully can be generalized to other settings. Some NPD practice environments are well suited to this type of contribution, and others are limited. The specialty as a whole will continue to develop as each NPD environment contributes its strengths to the specialty.

Standards: Using the ANA's general Standards of practice, the NPD Standards are focused on the nursing process and professional practice. For assessment, technology and innovations are added, as well as the inclusion of stakeholders in the process. Identification of issues and trends replaces nursing diagnosis because this is a clearer expression of the NPD process. Outcomes identification includes learner values and goals; current evidence that may support outputs or outcomes, and the more recent influences of regulation on outcomes. Planning now expressly includes the target audience, consideration of economic impacts of activities on organizations, as well as organizational changes on units that develop and offer educational activities. Implementation has the new sub-standards of coordination of activities; learning environment that promote a positive learning and practice environment; and consultation to influence the identified plans, enhance the abilities of others, and effect change. The standard of evaluation expressly involves stakeholders as well as learners.

Standards for professional practice are now focused solely on the NPD practice as distinct from a job performance appraisal which may include activities not related to NPD. The standard on performance appraisal is replaced by the professional practice evaluation measures. The standard on quality continues to be a 'bread and butter' type criterion that looks for quality in the performance of the nursing process standards. Education continues the requirement for the NPD Specialist to remain current with practice expectations. Collegiality now recognizes the need for a healthy and safe practice environment for the NPD Specialist and for the target audiences including peers, students, and others. Collaboration now includes both inter-disciplinary teams, which usually means across health related disciplines and inter-professional teams, that may include participants from any profession, most commonly the educational disciplines.

Over the past few years, requirements in ethics have significantly changed. In the CE context, the recent changes related to disclosing and resolving conflict of interest. Commercial interest entities and their contributions of support for educational activities challenge the need for unbiased, objective, and evidence-based learning opportunities. These expectations are threaded throughout Scope and the Standards.

A new standard was developed to describe and provide measurement criterion for the NPD function of advocacy. The role is broad, encompassing such work as advocating for protections and rights of individuals, families, communities, populations, healthcare providers, nursing and other professions, and institution and organizations. Both advocacy and ethics fit with the CE requirements for adhering to principles of practice, respecting codes of ethics across professions, observing confidentiality, cultural diversity and multigenerational differences.

Research is the standard that promotes evidence-based practice and practice-based evidence to further the scientific basis of the specialty. Resource utilization adds emphasis to safety, costs, efficiencies and effect. “Leadership” replaces the former standard entitled “management”, and it now includes flexibility, creativity, and culture as well as safe risk taking. NPD professionals often need to chart new approaches given the rapid changes in technologies, expanded professional and audience expectations, economic issues, and access to learning issues.

The ANA NPD Scope and Standards have been subjected to public comment. The task force was charged with addressing issues from the input by nurses throughout the profession. It is the goal that the revised ANA NPD Scope and Standards will move Nursing Professional Development practice to a new level.

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