The nursing process is the profession's formal account of how a nurse reasons at the bedside. Gather data, name the problem, decide what a good result looks like, act, then check whether it worked. It is taught in every accredited program in the United States, tested on the licensing examination, and written into the American Nurses Association's standards of practice.
Because the standards are organized around it, the nursing process is also the yardstick a board of nursing, a peer reviewer or an attorney will use when care is examined after the fact. A nurse who assessed a patient but never re-evaluated has a documented gap in the record, whether or not the patient came to harm.
The steps
Most textbooks teach five steps. The American Nurses Association's standards of practice use six, splitting outcomes identification away from planning.
Assessment. Collecting subjective and objective data: history, symptoms, vital signs, physical findings, laboratory values, the family's account, the chart. Assessment is continuous rather than an event at the start of a shift, and the standards treat every later reassessment as part of the same standard.
Diagnosis. A clinical judgment about the patient's response to a health problem, distinct from the medical diagnosis of the problem itself. A patient carries the medical diagnosis of heart failure. The nursing diagnosis might concern activity intolerance or fluid volume excess. See nursing diagnosis for the classification systems built around this step.
Outcomes identification. Stating what the patient should be able to do, and by when. Outcomes have to be measurable and time-bound, or the final step has nothing to compare against.
Planning. Choosing interventions expected to move the patient toward those outcomes, in priority order, and documenting them.
Implementation. Carrying out the interventions and recording what was done and how the patient responded. This covers direct care, medication administration, teaching, monitoring, referral and coordination.
Evaluation. Comparing the patient's actual status against the stated outcomes, then revising the plan. Evaluation feeds a new assessment, so the sequence runs as a loop rather than a straight line.
Where it came from
No single author owns the model. It was assembled over roughly two decades.
Ida Jean Orlando's work in the late 1950s and early 1960s described nursing as a deliberative sequence of patient behavior, nurse reaction and nurse action. That was an explicit rejection of nursing as the automatic execution of physician orders, and it is generally treated as the origin of the idea that nursing has a method of its own.
In 1967 Helen Yura and Mary Walsh published the first book-length treatment of the nursing process. Their model had four steps: assessment, planning, intervention and evaluation. Diagnosis was not separate. They treated it as the conclusion of assessment.
Diagnosis was broken out as its own step during the 1970s, alongside the first national conference on the classification of nursing diagnoses. The American Nurses Association's 1973 standards of practice then fixed the resulting model as the profession's official framework. Later editions separated outcomes identification from planning, producing the six-standard structure in the current fourth edition.
The case against it
The strongest objection comes from Patricia Benner's work on skill acquisition. Benner's study of clinical expertise found that experienced nurses do not work through explicit analytic steps. They recognize whole situations, grasp what matters without deliberating over which data to weigh, and act on pattern recognition they often cannot put into words. On that account the nursing process describes how a novice must proceed rather than how an expert actually thinks, which makes it a poor model of the profession's own best practitioners. See nursing theory.
A more familiar complaint concerns the artifact the process produces. The formal care plan is widely experienced as paperwork written for surveyors rather than a document anyone reads before touching a patient. Electronic records that generate plans from checkboxes have made this worse rather than better.
The defense of the model is institutional. It asserts that nursing has a method of its own, and that a nurse assesses, judges, decides and evaluates on her own license instead of executing someone else's decisions. Without it, the disciplinary structure, the standards of practice and much of the legal argument for nursing autonomy have nothing to rest on. See scope of practice.
Related
- Nursing diagnosis and standardized language
- Scope of practice
- Nursing theory
- Nurse practice acts and boards of nursing
Sources
- Nursing Process. Toney-Butler TJ, Thayer JM, StatPearls, National Center for Biotechnology Information. Accessed September 8, 2026.
- Nursing: Scope and Standards of Practice, 4th edition. American Nurses Association, 2021. Accessed September 8, 2026.
- Updated nursing scope and standards. American Nurse Journal, July 2021. Accessed September 8, 2026.
- The Nursing Process: Assessing, Planning, Implementing, Evaluating. Yura H, Walsh MB, 1967. Accessed September 8, 2026.
- From Novice to Expert. Benner P, 1984, summarized at Nursology. Accessed September 8, 2026.