The evolution of standards. From capability of performance to demonstrated performance

Standardization of performance expectations and accountability for nursing care have been an integral part of nursing departments for many years. The Joint Commission on Accreditation of Hospitals (JCAHO) has used the nursing standards manual to evaluate a nursing division's capability to provide quality care. In this article, the way in which a meaningful quality assurance system is developed is discussed. The aspects discussed in depth are (1) development of standards that define performance; and (2) quality assurance measures that audit performance. By following the steps outlined, a nursing department will have progressed from describing the nurse's capability to provide optimum care to demonstrating optimum performance.