ANA guides recognition, approval of scope and standards of practice

The path to becoming a nurse begins with educational preparation to enter the profession by completing curriculum at a recognized school of nursing. Then, we pass our nursing licensure examination and secure state, commonwealth or territorial regulatory board licensure and registration to permit us to legally practice nursing. This type of general knowledge and practice regulation applies across all care settings, as reflected in the definition of nursing from Nursing: Scope and Standards of Practice, Fourth Edition:

“Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.”

The Nursing Scope and Standards of Practice, Fourth Edition describes the who, what, where, when, why, and how of all nursing practice, in any setting. This publication and the Code of Ethics for Nurses with Interpretive Statements are considered foundational resources for all nurses in every environment. Personal interest, work experience, continuing professional development activities as well as our growing professional knowledge and competencies further define and refine our preferred practice environment and interest in a particular specialty.

Many nurses decide to become certified, demonstrating that they have specialized knowledge and continued competence in a specialty practice. The American Nurses Credentialing Center offers 18 such nursing specialty certifications and has certified more than 300,000 RNs.

Promoting quality and safety

To support nurses in their professional journey and to address the evolving practice and profession of nursing, the American Nurses Association (ANA) provides guidelines for recognizing a nursing specialty. ANA identifies that a nursing specialty encompasses a specific area of distinct study, research, and practice as defined and recognized by the profession. Specialists include those who elect to focus their professional practice on their identified specialty. Over time, ANA has recognized a range of specialties, including Emergency, Informatics, Faith Community, Public Health, Neonatal, Psychiatric Mental Health, Radiology, Cannabis, Neurovascular, and Vascular Nursing.

The ANA Board of Directors serves as the final reviewing body for recognizing a nursing specialty and approves specialty nursing scope of practice statements, acknowledges specialty nursing standards of practice, and affirms focused practice competencies. ANA’s involvement in this process dates back decades, when leaders appreciated the need for more specialization as healthcare continued to transform and nursing care became ever more complex. The board aimed to continue promoting quality, safety, and best practices. In the 1990s, with this goal in mind, ANA convened representatives from various specialty nursing groups to address and develop a means to ensure consistency in standards of practice, and to identify a formal mechanism to confirm professional regulation of specialty practice.

Today, the ANA board relies on the ANA Committee on Nursing Practice Standards, a designated expert panel of appointed members, to assist in this work. Last April, the committee revised the established specialty review program, and the ANA board approved these revisions.

Emerging, evolving, established specialties

The ANA specialty review program designates the evolution of nursing specialties in three categories: emerging specialties or focused practice; evolving specialties; and established specialties. Emerging specialties have begun defining characteristics of practice, but have no defined or few formalized competencies, and have few members. Evolving specialties have established formalized competencies, show increasing member numbers, demonstrate growing recognition in the practice environment, and may seek ANA specialty recognition when they develop scope and standards of practice. Established specialties have historical roots and recognized presence, maintain a clearly defined scope and standards of practice, and include a substantial number of members who devote most of their professional time to the specialty.

Recognizing specialties

ANA specifies 14 criteria for an area of practice to be recognized as a nursing specialty. The first criterion calls for the specialty to define itself as nursing by describing RNs, graduate-level prepared nurses, and advanced practice RNs, and their use of the nursing process as a critical component of the specialty nursing practice. Other recognition criteria include that a specialty be able to identify a need and demand for itself and have a well-derived knowledge base particular to its practice. (See Nurse specialty criteria.)

Through the years, ANA has recognized over 40 nursing specialties. Among the most recently recognized include Burn Nursing in 2020 and Cannabis Nursing in 2023. Specialty nursing organizations representing many of these specialties hold ANA organizational affiliate status. ANA and its organizational affiliates collaborate on solutions to issues that face the nursing profession as a whole, regardless of specialty.

ANA stipulates 11 criteria for approval of a specialty nursing scope statement, which range from a description of the practice environment in sufficient detail and the establishment of an understanding of the specialty practice settings to guidance for professional development and lifelong learning. ANA has published scope and standards of practice for at least 24 nursing specialties, frequently co-publishing them with the relevant specialty nursing organization.

(See Nursing scope statement criteria.)

As healthcare continues to evolve, so does the nursing profession. As these changes rapidly unfold, nurses remain committed to patient safety, and to quality and efficacy of care. As we advance in our professional journeys and consider an emerging, evolving, or established specialty nursing practice, we can rest assured that it meets rigorous standards that support those aims.

— Carol J. Bickford is a senior policy advisor at ANA.