AACN Scope and Standards for Progressive and Critical Care Nursing Practice

**traumaRUs**, MSN, APRN

Critical care and progressive care is an ever-changing world. In order to provide the best care for our patients, we need access to the newest knowledge. The American Association of Critical-Care Nurses (AACN) is here to help expand our knowledge. They recently published the Scope and Standards for Progressive and Critical-Care Nursing Practice. This up to date resource contains information based on the AACN Synergy Model of Care:

The AACN Synergy Model for Patient Care is a conceptual framework that aligns patient needs with nurse competencies. Originally developed in 1996 as a new framework for AACN’s certification programs, the Synergy Model shifted the assessment of nursing skills from the then-prevalent body systems/medical model — which didn’t consistently match actual practice — to a “nurse competencies” framework.

The central idea behind this is that the patient's needs drive the nurses' competencies. This is the basic tenet of AACN's policies and practices - the needs of the patient.

What is the Healthy Work Environment Initiative?

The Scope and Standards for Progressive and Critical-Care Nursing Practice also incorporate healthy work environments guidelines:

Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership

What are some of the latest trends?

AACN built on these principles to author the new scope and standards. The latest trends also direct this document which includes:

Rising nursing turnover. It is estimated that 28% of the nurses in their first year of practice will change jobs.
Overall nursing shortage. It is estimated that "one million RNs will retire by 2030 and that “the departure of such a large cohort of experienced RNs means that patient care settings and other organizations that depend on RNs will face a significant loss of nursing knowledge and expertise that will be felt for years to come"."
More opportunities exist for nurses away from the bedside. As nurses develop their professional role through education and experience, they often progress to managerial positions, advanced practice or other leadership positions.
Nurses who remain at the bedside face increasing stress due to high patient acuity, low staffing situations and more technology.

Governmental regulations...

Regulatory changes impact nurses too. We all face the ever-present HCAPHS survey:

The HCAHPS survey asks discharged patients 27 questions about their recent hospital stay. The survey contains 18 core questions about critical aspects of patients' hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, the overall rating of the hospital, and would they recommend the hospital). The survey also includes four items to direct patients to relevant questions, three items to adjust for the mix of patients across hospitals, and two items that support Congressionally-mandated reports.

Value-based healthcare is another government initiative: "The Hospital Value-Based Purchasing (VBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality care provided to Medicare beneficiaries." This too impacts nursing care as nurses strive to provide the best patient care while being held accountable for a standardized quality measure.

The multigenerational workplace...

The multi-generational workplace also offers challenges. allnurses.com recently interviewed Karen Stutzer, PhD, RN, a recognized expert on the topic. She identified the five generations that are currently working:

Veterans - (born before 1945) who are mostly retired
Baby boomers - (1946 - 1964) want to work in collaboration with co-workers
Gen Xers - (1965 - 1980) many grew up in families of divorce and are quite independent
Millennials or Gen Y’ers - (1981 - 1995) grew up with technology so the world is much smaller. However, they also grew up with more violence in the world.
Gen Zs - (1996 - 2012) just starting to enter the workforce so these are nursing students, nursing assistants. They are less sure of their career path but can multitask and overall they read less.

Progressive and critical care nurses will always be needed. As our general population ages and technology advances the stress and strain on nurses will also increase. AACN strives to be proactive in providing guidance to nurses.