Professional Practice and Ethical Conduct
Framing the domain
Questions in this domain test whether you can name the standard, apply it to a messy scenario, and recognise when an action is outside your scope. Anchor your answers in the NMBA Registered Nurse Standards for Practice: think critically and analyse nursing practice, engage in therapeutic and professional relationships, maintain the capability for practice, comprehensively conduct assessments, develop a plan for nursing practice, provide safe, appropriate and responsive quality nursing practice, and evaluate outcomes. Ethical reasoning draws on the ICN Code of Ethics: promote health, prevent illness, restore health, alleviate suffering, and uphold dignity regardless of background.
Concepts to know
Consent (informed, specific, voluntary, re-negotiable), capacity versus willingness, guardianship and advance care directives, privacy and confidentiality including minimum necessary disclosure, mandatory reporting of notifiable conduct, scope of practice and delegation, professional boundaries, conflict of interest, open disclosure after an adverse event, and the distinction between advocacy and paternalism. Know that a competent adult may refuse treatment even if the refusal seems unwise; document capacity assessment and the refusal.
Common traps
- Treating a family member's consent as sufficient for a competent adult.
- Assuming a signature equals informed consent when risks were never discussed.
- Confusing advocacy (supporting the person's own decision) with deciding for them.
- Believing mandatory reporting requires proof rather than reasonable belief.
- Forgetting that delegation still leaves the delegator accountable for appropriate supervision.
Rule of thumb and worked example
Rule of thumb: name the standard, name the person's right, then name your action and your escalation pathway.
Worked example: A competent 78-year-old declines a blood transfusion after the risks are explained. Her daughter demands it proceed. The correct response is to confirm and document capacity and the informed refusal, continue all other agreed care, offer the daughter a chance to discuss concerns, and escalate to the treating team and, if needed, the nursing unit manager - not to obtain the daughter's consent or proceed covertly.