1 Nursing Roles and Professional Foundations

Nursing as a profession

Nursing is a person-centered, evidence-informed profession that combines caring, knowledge, critical thinking, and clinical judgment. Nurses promote health, prevent illness and injury, reduce suffering, and support healing across the lifespan. Their work serves individuals as well as families, communities, and populations.

Nursing is both relational and practical. Nurses build therapeutic relationships while assessing needs, coordinating care, taking action, and evaluating results. Practice is shaped by professional standards, ethical responsibilities, scientific evidence, and the needs and preferences of the people receiving care.

Scope and accountability

Scope of practice describes the activities and responsibilities a nurse is authorized and prepared to perform. In the United States, the legal scope depends on the applicable state or jurisdiction’s nurse practice act and regulations, as well as the nurse’s education, licensure, competence, role, and practice setting. A task being customary in a workplace does not by itself make it legally or professionally appropriate for every nurse.

Standards of practice are related to scope but serve a different purpose: scope sets the boundaries of authorized practice, while standards describe competent performance within those boundaries. Employer policies and procedures may guide practice, but workplace expectations do not replace applicable law or professional standards.

Nurses should clarify uncertainty and seek guidance when an activity may exceed their authority or competence. They are accountable for their own actions and decisions. When assigning or delegating tasks, a nurse must follow applicable law and policy, consider the other person’s training and competence, communicate expectations, and provide appropriate oversight. A nurse should address concerns about safety, competence, or authorization through appropriate channels rather than accepting an assignment or performing a task without addressing them.

Roles nurses perform

Nursing roles vary by population, setting, education, and specialization, and several roles may be involved in one interaction.

• Care provider: Delivers or coordinates care in response to a person’s assessed needs and goals.

• Advocate: Supports rights, dignity, informed choices, and access to appropriate care; raises concerns when safety or preferences are not being addressed.

• Educator: Explains health information and care plans in understandable terms, checks understanding, and supports informed decisions.

• Communicator and collaborator: Shares relevant information clearly with patients and the interprofessional team, listens to different perspectives, and helps coordinate care.

• Leader and coordinator: Organizes care, helps establish priorities, and contributes to effective teamwork, whether or not the nurse has a formal management position.

• Quality and safety contributor: Identifies risks, follows evidence-informed procedures, reports errors and near misses through appropriate channels, and participates in efforts to improve systems of care.

• Scholar and lifelong learner: Uses evidence, reflection, and continuing learning to maintain competence and improve practice.

For example, when a nurse notices that a patient is confused about a new medicine, the nurse assesses what the patient understands, explains the plan in accessible language, checks for barriers, and communicates unresolved concerns to the care team. This interaction combines assessment, education, advocacy, and collaboration.

Professional identity and conduct

Professional identity is a developing understanding of what it means to think and act as a nurse. Education, practice, reflection, relationships with colleagues and patients, and continuing professional development all help shape it. Nursing identity includes accountability, integrity, compassion, respect, advocacy, humility, inclusivity, and commitment to the public good.

Professional identity does not require nurses to set aside their personal identity. It calls them to examine how personal experiences, values, and biases may influence professional decisions.

Professionalism is expressed through everyday conduct: being prepared, protecting confidentiality, communicating respectfully, documenting accurately, acknowledging limits, following through on responsibilities, and responding constructively to feedback. When uncertain, a professional nurse seeks appropriate help rather than guessing or concealing a concern.

Person-centered care

Person-centered care treats the patient as a whole person and an active partner in care. It considers health needs alongside preferences, values, lived experience, culture, family or other supports, resources, and circumstances. Nurses listen, communicate respectfully, and include the person in decisions to the extent the person wishes and is able.

The nursing process and clinical judgment

The nursing process provides an ongoing structure for organizing care, rather than a one-time checklist:

1. Assess: Gather and verify relevant information, including the person’s account, observations, and available clinical data.

2. Identify needs or problems: Interpret the information to recognize actual or potential health concerns.

3. Plan: Set priorities and goals with the person and care team, and select appropriate, evidence-informed actions.

4. Implement: Carry out authorized interventions, communicate as needed, and document care.

5. Evaluate: Check the person’s response and whether goals were met; revise the plan when necessary.

New information or a change in condition may require reassessment and a new priority. Clinical judgment is the reasoning used to interpret assessment findings, determine what matters most, decide what action is appropriate, and evaluate its effect. Decisions should reflect evidence, professional standards, the person’s goals, and the urgency of the situation.

Ethics and communication

Ethical nursing practice respects human dignity, autonomy, privacy, and confidentiality. Nurses support informed decision-making, provide fair and respectful care, and raise ethical concerns through appropriate channels. Professional ethical guidance describes nurses’ responsibilities and accountability across their different roles.

Clear communication supports safe, coordinated care. Nurses use attentive listening, plain language, accurate documentation, and timely information-sharing with the patient and team. They confirm important information rather than relying on assumptions, and escalate urgent concerns according to policy.

Safety and quality

Safety and quality are shared responsibilities. Nurses help prevent harm by following appropriate procedures, recognizing changing risks, reporting unsafe conditions and near misses, and contributing to improvement. Safety problems may arise from system conditions as well as individual actions; learning from events and reducing future risk are therefore important parts of professional practice.