Professional Practice, Ethics, and Legal Issues
Core concepts
This domain covers the legal and ethical framework of nursing: scope of practice, licensure, delegation, informed consent, confidentiality (HIPAA), documentation, and advocacy. Know the ethical principles-autonomy (patient's right to decide), beneficence (do good), nonmaleficence (do no harm), justice (fairness), and fidelity (keeping promises). Understand informed consent: the provider obtains it, the nurse witnesses and verifies understanding, and the patient must be competent and free of coercion. Master delegation rules: the RN delegates tasks, not the nursing process (assessment, diagnosis, planning, evaluation remain RN responsibilities); delegate to the right person, task, circumstance, and communication with supervision. Know mandatory reporting (suspected abuse, communicable diseases), advance directives, and the nurse's role as patient advocate.
Traps in questions
A frequent trap is delegating something that requires nursing judgment-such as assessing a patient or teaching-to a UAP. Another trap: assuming the nurse obtains informed consent (the provider does; the nurse verifies and witnesses). Questions about a patient refusing treatment test autonomy: a competent adult may refuse even life-saving care; document and notify the provider. For confidentiality, remember HIPAA allows disclosure for treatment, payment, and operations, and in certain safety situations, but not casual discussion. Also know that a nurse who makes an error should report it through the incident-report system, not alter the record.
Rule of thumb
Delegate tasks, not judgment. If the activity requires assessment, teaching, or evaluation, it stays with the RN.
Worked example
A UAP reports that a patient "seems confused." The RN should assess the patient personally rather than instructing the UAP to complete a nursing assessment-assessment cannot be delegated.