Professional Practice, Ethics, Leadership, Teamwork and Evidence-Informed Practice
Professional practice
Know your scope of practice, delegation rules, and chain of command. RNs cannot delegate assessment, teaching, evaluation, or clinical judgment to unlicensed assistive personnel. Use SBAR for handoffs and escalation. Informed consent requires capacity, disclosure, understanding, and voluntariness; the physician obtains consent, while the nurse verifies and advocates.
Ethics and leadership
Apply beneficence, nonmaleficence, autonomy, justice, and fidelity. Ethical dilemmas include end-of-life care, device deactivation, resource allocation, and disclosure of errors. Just culture encourages reporting without blame while maintaining accountability. Teamwork requires closed-loop communication and psychological safety.
Evidence-informed practice
Appraise guidelines, systematic reviews, and primary studies for validity and applicability. Implement evidence with attention to local context and patient preferences. Quality improvement uses measurement, PDSA cycles, and outcome review.
Traps
Do not confuse legal requirements with ethical obligations. Do not delegate a stable patient’s admission assessment. Avoid hierarchical silence when a patient is deteriorating.
Worked example
SBAR: “Situation: Mr. K is hypotensive and confused. Background: post-PCI, femoral access. Assessment: BP 82/50, cool extremities, site swelling. Recommendation: urgent bedside evaluation and activate rapid response.”