The Blueprint’s nine domains of acute and critical care nursing practice: Results of the What Nurses Do Survey

BACKGROUND: Current patient outcomes, derived from the work of nursing in hospitals, are narrow in scope and focused on harm. To appreciate the value of the unique contributions made by nurses, nursing's work must be fully articulated. PURPOSE: The nine domains of acute and critical care practice in the Call to Action: Blueprint for Change in Acute and Critical Care Nursing were articulated for this purpose but require validation from nurses practicing in hospitals. The nine domains include creating safe healing environments, building caring relationships, managing symptoms, administering care, surveillance, teaching patients and families, interprofessional collaboration, advocacy, and navigating patient transitions in care. METHODS: In the national, cross-sectional What Nurses Do Survey, 987 nurses actively practicing in the hospital setting rated the relevance, frequency, and importance of each Blueprint for Change domain and identified any core practice activities absent from the nine domains. DISCUSSION: Nurse respondents overwhelmingly endorsed all nine practice domains and indicated that they fully captured the scope and breadth of nursing practice in the inpatient environment. Symptom management was the highest-rated domain, followed by interprofessional collaboration and advocacy. Additional practice activities identified by respondents align with current scope and standards of professional practice that serve as a foundation for the nine practice domains. CONCLUSION: Results confirm the face validity of the domains. Once fully validated with nurses, patients, and families, the Blueprint for Change nine domains can be used to guide the selection or development of new nurse-sensitive patient outcome measures that fully represent the work of acute and critical care nurses.