Professional Practice, Ethics, and Leadership
Core concepts
Professional nursing practice is grounded in ethics: autonomy, beneficence, nonmaleficence, justice, and veracity. Pediatric ethics adds assent (child's agreement when developmentally able) alongside parental consent, best-interest standards, and confidentiality for adolescents. Know mandatory reporting, informed consent, and end-of-life care principles.
Leadership includes delegation (task, competence, supervision), prioritization, and communication (SBAR). Understand scope of practice, chain of command, and quality improvement. Advocate for the child and family, and recognize implicit bias and health equity issues.
Professional boundaries, documentation, and error reporting (just culture) are tested. Recognize that nurses must report errors and near misses, not conceal them.
Traps
- Obtaining consent from a child without parental consent when required.
- Delegating assessment or teaching to unlicensed personnel.
- Choosing "document and monitor" when advocacy or escalation is needed.
- Confusing confidentiality limits-safety overrides secrecy.
- Failing to report errors or suspected abuse.
Rule of thumb
When priorities conflict, use ABCs first, then safety, then comfort and family needs. For ethical dilemmas, identify the principles in conflict and use the chain of command or ethics committee.
Worked example
A parent refuses a life-saving treatment for a child. The nurse should explore the family's concerns, provide information, involve the care team and ethics resources, and follow legal and institutional processes-advocating for the child's best interests while respecting the family.