Standards, recommended practices, and guidelines

Nancy J. Girand, RN Understanding terminology is vital to communication, but sometimes, language use confuses rather than clarifies. Different uses for words can confuse people who are unfamiliar with a language—and often those who speak only that language. Three terms that nurses commonly find confusing are standards, recommended practices, and guidelines. Often the definition of these terms is blurred. I started writing this editorial to clarify the differences in these terms for readers, but the more information I found concerning them, the more it became clear that individual institutions, organizations, and businesses in which these terms are used often define them in their own ways. are guides for practice, provide evidence for best practices, can be used for quality improvement, can provide legal definition or explanation, can be used to identify risks, and often are used to identify competencies. Standard can be a noun or an adjective. As a noun, the word has at least 11 definitions. The one that fits nursing best is “An acknowledged measure of comparison for quantitative or qualitative value; a criterion.”1 Other definitions that seem to fit are, “Something, such as a practice or a product that is widely recognized or employed, especially because of its excellence;”1 and “a degree or level of requirement, excellence, or attainment.”1 It can also be a “requirement of moral conduct.”1 AORN uses the term standards to mean authoritarian statements that define values and priorities.2 Standards usually are considered to be the ultimate declaration, and they are more inflexible than recommended practices or guidelines. AORN's standards generally concern practice roles, such as clinician, manager, or provider of patient care. The best definition for recommend—none were found for recommended practice—is as a verb that suggests giving advice or counsel for something that needs to be done.3 Recommended practices are developed and published by almost every business one can think of from A (eg, air traffic control) to Z (eg, zoos). Recommended practices usually are a series of documents developed for a specific population that contain valuable reference information and have been through a rigorous review process. The ability to apply recommended practices varies according to the type of institution and by geographical location. AORN defines a recommended practice as an action that can be achieved, is evidenced-based to lead to the highest level of nursing practice, and can be used to develop policies and procedures.4 Recommended practices are specific to one activity or action (eg, counts, laser safety, skin preparation of patients). As with the other terms, the word guideline can mean different things to different people. One definition is “A document used to communicate the recommended procedures, processes, or usage of a particular business practice.”5 This definition appears similar to those for standards and recommended practices. Another definition is “any document that aims to streamline particular processes according to a set routine and … is never mandatory”6 AORN guidelines are a mix of specific practices and general statements that reflect policy.7 These briefly summarize and evaluate best practices using the most current data. The purpose is to provide standardization of nursing care, to raise the quality of care, and to minimize risks. They provide a course of action for clinical judgment. Examples include the guidelines for fire prevention, safe on-call practices, and safe medication administration. As you can see, the three terms overlap in definition, meaning, and purpose. Ultimately, the definition used by the profession or the organization is what matters to the practitioners. Conscientious and careful use of standards, recommended practices, and guidelines will improve practice and provide a safer environment for surgical patients.