Professional, Ethical and Legal Nursing Practice
Domain 1 - Professional, Ethical and Legal Nursing Practice
This domain tests whether you can act as an accountable professional: apply the Fiji Nursing Council's ethical and conduct expectations, obtain valid consent, protect confidentiality, document defensibly, stay inside your scope of practice, and recognise when a legal duty overrides what a patient or relative wants. Questions are usually short scenarios asking what the nurse should do first or next.
Core rules
- Four principles: autonomy, beneficence, non-maleficence and justice, plus veracity (truthfulness) and fidelity (keeping promises). Autonomy outranks staff convenience: a competent adult may refuse any treatment, even life-saving treatment.
- Informed consent requires capacity, adequate information (nature, risks, benefits, alternatives), voluntariness and documentation. Consent should be taken by the person performing the procedure or someone competent to explain it - a signature alone is not consent.
- Accountability is personal and cannot be delegated. You remain answerable for your own actions even when following a doctor's order. An order that is wrong, illegible, or unsafe must be clarified, not carried out.
- Documentation must be contemporaneous, factual, objective, signed, dated and timed. If it is not written, it is legally treated as not done. Never alter an existing entry; add a late entry explaining the delay.
- Confidentiality has statutory exceptions: notifiable disease reporting, court order, serious risk to others, child protection, and legitimate audit. Share only the minimum necessary.
- Negligence needs four elements: a duty of care, a breach of the standard of a reasonably competent nurse, causation, and actual harm.
Worked example
A competent 70-year-old man with a chronic leg ulcer says, 'No dressing today.' He is alert, orientated and understands the consequence. The doctor has ordered daily dressings. Reasoning: capacity is present, and refusal of a specific intervention is a valid exercise of autonomy. Dressing him anyway would be battery and a misconduct risk. Correct action: accept the refusal, explain the risks of a missed dressing, document the refusal and the discussion in the patient's own words, inform the treating team, and re-offer later. Escalate to the doctor to discuss alternatives - not to override the refusal.
Traps
- Choosing 'ask the family to sign' - relatives cannot consent for a competent adult.
- Proceeding because 'the doctor ordered it' when the patient has refused.
- Believing a signed form proves consent.
- Disclosing information to a caller who says they are family.
- Delegating assessment, teaching or evaluation to an unregulated worker.